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Peptic Ulcer Heart Failure • Pancreatitis Ketoacidosis • Enteritis and Colitis Acute Leukemia • Cholecystitis Vasculitis • Hepatitis Plevritis+ Pneumonia

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Peptic Ulcer Heart Failure • Pancreatitis Ketoacidosis • Enteritis and Colitis Acute Leukemia • Cholecystitis Vasculitis • Hepatitis Plevritis+ Pneumonia Gastroenterology Lecture for third year dental faculty students Common symptoms • abdominal pain, dyspepsia, nausea and vomiting, diarrhea, dysphagia, hiccups, constipation and signs related to GI bleeding (e.g., hematemesis, hematochezia, and melena). • 2. Explain that symptoms • Right answers • Dyspepsia is an imprecise term to describe an upper abdominal discomfort, such as epigastric tenderness, fullness sensation, bloating, early satiety, heartburn, or regurgitation. • Nausea and vomiting are symptoms that may involve more than a GI system abnormality. Systemic illness (e.g., CNS disorders), side effects of medications, and some viral illnesses may cause nausea and vomiting. Also, nausea and vomiting are common symptoms of pregnancy. If intestinal obstruction is not suspected, common antiemetics and oral intake limited to clear fluids are helpful to control it. • Diarrhea , the frequent passage of loose, watery stools, usually the result of increased activity of the large intestine (colon). The stool may also contain mucus, pus, blood, or large amounts of fat. Diarrhea is usually a symptom of some other disorder. Common symptoms • Odynophagia is pain on swallowing. It is important to know if dysphagia is for solids or liquids. • Heartburn is described as substernal burning sensation that radiates toward the mouth and is increased by bending forward. • Hiccups are a sporadic and unremarkable symptom that generally does not mandate medical consultation. However, chronic, recurrent hiccups may indicate a severe condition that mandates further examination. • Constipation is a common complaint. Constipation can have several causes, such as lack of medications (e.g., aluminum hydroxide, anticholinergics, iron supplements, narcotics, antihypertensives), or systemic diseases (e.g., hypothyroidism, diabetes, hypercalcemia). It is important to question the patient about the presence of tenesmus (pain during the defecation), which may indirectly cause constipation. Ask about and document any change in the pattern of stools, including consistency, thickness, or presence of blood. Colon cancer always needs to be considered. • GI bleeding. Hemodynatnically unstable patients are treated initially by maintaining an adequate circulatory volume, and their initial assessment is oriented initially toward monitoring the heart rate, blood pressure, urinary output, postural changes, and so forth. Nonacute GI bleeding can be evaluated in the office and can he classified as upper or lower GI bleeding, depending on the signs and symptoms. • Upper GI bleeding may be suggested by the presence of hematemesis or melena. When hematemesis is referred, upper airway sources or hemoptysis must be ruled out. The approach to those patients depends on the patient's stability, the rate of blood loss, procedural availability, and local expertise. • Lower GI bleeding can be referred as hematochezia or brisk blood in feces, or can be suggested during positive Guaiac test (i.e., hemoccultpositive stool test). Remember, this test may have false-positive results due to certain foods (e.g., broccoli, radishes, turnips, roast beef) and medications (e.g., Pepto-Bismol). Abdominal pain • Gastritis Heart attack • Peptic ulcer Heart failure • Pancreatitis Ketoacidosis • Enteritis and colitis Acute leukemia • Cholecystitis Vasculitis • Hepatitis Plevritis+ pneumonia Topography of organs of GIT Gastritis • Gastritis is inflammation of the gastric mucosa. The word comes from the Greek gastro- meaning of the stomach and -itis meaning inflammation. gastritis • Depending on the cause, it may persist acutely or chronically and may coincide with more serious conditions such as atrophy of the stomach. Gastritis • Causes • The following are known causes of gastritis: • Bacterial infection (most often by Helicobacter pylori and other Helicobacter bacteria) • Fungal infection (most often in people with AIDS) • Parasitic infection (most often from poorly cooked seafood) • Viral infection • Bile reflux • NSAIDs • Cigarette smoke • Autoimmune disorders • Excessive alcohol consumption • Certain allergens • Certain types of radiation Gastritis • Symptoms • The following symptoms can be a result of gastritis or can be related to the underlying cause: • Upper abdominal pain or discomfort • Gastric hemorrhage • Appetite loss • Belching • Nausea • Vomiting • Fever • Fatigue Gastritis • Diagnosis • In suspected cases, a doctor usually orders a barium meal test and gastroscopy to determine gastritis and related conditions such as peptic ulcers and gastric cancer. Gastritis • It is always important that the doctor reviews a patient's history regarding medications, alcohol intake, smoking, and other factors that can be associated with gastritis. In some cases, the appearance of the stomach lining seen during gastroscopy and the results of the barium meal test are reliable in determining gastritis and the cause. However, the most reliable method for determining gastritis is doing a biopsy during gastroscopy and checking for histological characteristics of gastritis and infection. For Helicobacter infection (the most common cause), one can test non- invasively with a urea breath test, stool antigen test, or blood antibody test. • For Helicobacter infection (the most common cause), one can test non- invasively with a urea breath test, stool antigen test, or blood antibody test. Gastritis • Treatment • Treatment usually consists of removing the irritant or the infection. In the case of Helicobacter infection, a doctor may prescribe antibiotics Peptic ulcer • A peptic ulcer is an ulcer of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. Most ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach. Ulcers can also be caused or worsened by drugs such as Aspirin and other NSAIDs. Contrary to general belief, more peptic ulcers arise in the duodenum (first part of the small intestine, just after the stomach) than in the stomach. About 4% of stomach ulcers are caused by a malignant tumor, so multiple biopsies are needed to make sure. Duodenal ulcers are generally benign. Peptic ulcer Peptic ulcer Symptoms and signs • Symptoms of a peptic ulcer can be: • Abdominal pain, classically epigastric with severity relating to mealtimes (duodenal ulcers are classically relieved by food, while gastric ulcers are exacerbated by it); • Bloating and abdominal fullness • Waterbrash (rush of saliva after an episode of regurgitation to dilute the acid in esophagus) • Nausea, and sometimes vomiting • Loss of appetite and weight loss; • Hematemesis (vomiting of blood); • Melena (tarry, foul-smelling feces due to oxidised iron from hemoglobin); • Rarely, an ulcer can lead to a gastric or duodenal perforation. This is extremely painful and requires immediate surgery. Peptic ulcer • syndrome), rare gastrin-secreting tumors, cause multiple and difficult to heal ulcers. • Diagnosis • An esophagogastroduodenoscopy (EGD), a form of endoscopy, also known as a gastroscopy, is carried out on patients in whom a peptic ulcer is suspected. By direct visual identification, the location and severity of an ulcer can be described. Moreover, if no ulcer is present, EGD can often provide an alternative diagnosis. • Gastrosocopic ulcers in patients taking to many pain medications : • "I have suffered gastric ulceration due to prolonged use of aspirin." ~ anonymous • Other pain relievers such as tylenol may cause this problem but much more rarely. As stated clearly on the aspirin box, DO NOT EXCEED THE RECOMMENDED DOSE OF PAIN KILLERS! It may lead to gastric bleeding and of course possible death due to blood loss. Persons noticing blood in their vomit or stool where excessive medication may be the cause should seek hospital attention immediately. • The diagnosis of Helicobacter pylori can be by: • Biopsy during EGD; • Breath testing (does not require EGD); • Direct culture from an EGD biopsy specimen; • Direct detection of urease activity in a biopsy specimen; • Measurement of antibody levels in blood (does not require EGD). It is still somewhat controversial whether a positive antibody without EGD is enough to warrant eradication therapy. • The possibility of other causes of ulcers, notably malignancy (gastric cancer) needs to be kept in mind. This is especially true in ulcers of the greater (large) curvature of the stomach; most are also a consequence of chronic H. pylori infection. Peptic ulcer Treatment • Younger patients with ulcer-like symptoms are often treated with antacids or H2 antagonists before EGD is undertaken. Bismuth compounds may actually reduce or even clear organisms. • Patients who are taking nonsteroidal anti-inflammatories (NSAIDs) may also be prescribed a prostaglandin analogue (Misoprostol) in order to help prevent peptic ulcers, which may be a side-effect of the NSAIDs. • When H. pylori infection is present, the most effective treatments are combinations of 2 antibiotics (e.g. Erythromycin, Ampicillin, Amoxicillin, Tetracycline, Metronidazole) and 1 proton pump inhibitor (PPI). An effective combination would be Amoxicillin + Metronidazole + Pantoprazole (a PPI). In the absence of H. pylori, long-term higher dose PPIs are often used. • Treatment of H. pylori usually leads to clearing of infection, relief of symptoms and eventual healing of ulcers. Recurrence of infection can occur and retreatment may be required, if necessary with other antibiotics. Since the widespread use of PPI's in the 1990s, surgical
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