Two Commonly Confused Conditions WHAT YOU SHOULD KNOW ➢ GERD Occurs When a Muscle Between the Here Is How You Can Distinguish Between a Stomach Ulcer and GERD
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IRRITABLE BOWEL SYNDROME by Michael Sperling MD
IRRITABLE BOWEL SYNDROME By Michael Sperling MD Irritable bowel syndrome (IBS) involves vague symptoms of abdominal pain, diarrhea, constipation, gas and bloating for which there is no understandable cause. Incredibly, IBS affects up to 20% of the population but only three- quarters of those people actually seek medical attention. It is the second most common reason for work absenteeism. Irritable bowel symptoms may also be related to other complaints such as belching, heartburn, swallowing problems, fullness after eating, nausea, frequent urination, painful menstruation and pain during intercourse. Extremely severe cases can sometimes be related to a history of traumatic abuse. Some common associations or factors: Michael Sperling, MD 1. ‘Spastic colon’ is frequently found along with irritable bowel syndrome. Spastic colon consists of painful muscle contractions which can be relieved by bulk agents or anti- spasm drugs. 2. Post-infectious IBS occurs when irritable bowel follows a gastrointestinal infection, such as the stomach flu. These recurrent symptoms can last up to two years. 3. Stress and anxiety can worsen IBS symptoms so occasionally anti-anxiety agents may be helpful. 4. Food intolerances classically worsen symptoms of irritable bowel in some people. Common “offending foods” include lactose, legumes (beans) and cruciferous vegetables like brussel sprouts, cauliflower, broccoli and cabbage. 5. Hypersensitivity of the bowel wall: Normal colon activity is not usually noticed however in “visceral hypersensitivity”, the bowel wall reacts painfully to normal activity. This condition may be helped by the use of low dose antidepressants, which can block these painful stimuli. Careful and selective testing of patients with these symptoms and the development of a long-term doctor/patient relationship is the key to diagnosing and managing these symptoms. -
Health History
Health History Patient Name ___________________________________________ Date of Birth _______________ Reason for visit ____________________________________________________________________________________________ Past Medical History Have you ever had the following? (Mark all that apply) ☐ Alcoholism ☐ Cancer ☐ Endocarditis ☐ MRSA/VRE ☐ Allergies ☐ Cardiac Arrest ☐ Gallbladder disease ☐ Myocardial infarction ☐ Anemia ☐ Cardiac dysrhythmias ☐ GERD ☐ Osteoarthritis ☐ Angina ☐ Cardiac valvular disease ☐ Hemoglobinopathy ☐ Osteoporosis ☐ Anxiety ☐ Cerebrovascular accident ☐ Hepatitis C ☐ Peptic ulcer disease ☐ Arthritis ☐ COPD ☐ HIV/AIDS ☐ Psychosis ☐ Asthma ☐ Coronary artery disease ☐ Hyperlipidemia ☐ Pulmonary fibrosis ☐ Atrial fibrillation ☐ Crohn’s disease ☐ Hypertension ☐ Radiation ☐ Benign prostatic hypertrophy ☐ Dementia ☐ Inflammatory bowel disease ☐ Renal disease ☐ Bleeding disorder ☐ Depression ☐ Liver disease ☐ Seizure disorder ☐ Blood clots ☐ Diabetes ☐ Malignant hyperthermia ☐ Sleep apnea ☐ Blood transfusion ☐ DVT ☐ Migraine headaches ☐ Thyroid disease Previous Hospitalizations/Surgeries/Serious Illnesses Have you ever had the following? (Mark all that apply and specify dates) Date Date Date Date ☐ AICD Insertion ☐ Cyst/lipoma removal ☐ Pacemaker ☐ Mastectomy ☐ Angioplasty ☐ ESWL ☐ Pilonidal cyst removal ☐ Myomectomy ☐ Angio w/ stent ☐ Gender reassignment ☐ Small bowel resection ☐ Penile implant ☐ Appendectomy ☐ Hemorrhoidectomy ☐ Thyroidectomy ☐ Prostate biopsy ☐ Arthroscopy knee ☐ Hernia surgery ☐ TIF ☐ TAH/BSO ☐ Bariatric surgery -
Acid Reflux and Oesophagitis Gastro-Oesophageal Reflux Disease (GORD)
Acid reflux and oesophagitis Gastro-oesophageal reflux disease (GORD) Acid reflux is when acid from the stomach leaks up into the gullet (oesophagus). This may cause heartburn and other symptoms. A medicine which prevents your stomach from making acid is a common treatment and usually works well. Some people take short courses of treatment when symptoms flare up. Some people need long term daily treatment to keep symptoms away. Understanding the oesophagus and stomach When we eat, food passes down the oesophagus (gullet) into the stomach. Cells in the lining of the stomach make acid and other chemicals that help to digest food. Stomach cells also make mucus that protects them from damage from the acid. The cells lining the oesophagus are different and have little protection from acid. There is a circular bank of muscle (a ‘sphincter’) at the junction between the oesophagus and stomach. This relaxes to allow food down but then normally tightens up and stops food and acid leaking back up (refluxing) into the oesophagus. In effect the sphincter acts like a valve. What are reflux and oesophagitis? Acid reflux is when some acid leaks up (refluxes) into the oesophagus. Oesophagitis means inflammation of the lining of the oesophagus. Most cases of oesophagatis are due to reflux of stomach acid which irritates the inside lining of the oesophagus. The lining of the oesophagus can cope with a certain amount of acid. However, it is more sensitive to acid in some people. Therefore, some people develop symptoms Source: Endoscopy Reference No: 6556-1 Issue date: 11/9/19 Review date: 11/9/22 Page 1 of 6 with only a small amount of reflux. -
Medicine Hx- Gastrointestinal System History of “Heartburn”
Medicine Hx- Gastrointestinal System History of “Heartburn” A. Overview: GORD is common, and is said to exist when reflux of stomach contents (acid ± bile) causes troublesome symptoms (≥2 heartburn episodes/wk) and/or complications. If reflux is prolonged, it may cause oesophagitis, benign oesophageal stricture or Barrett’s oesophagus. Causes: lower oesophageal sphincter hypotension, hiatus hernia, loss of oesophageal peristaltic function, abdominal obesity, gastric acid hypersecretion, slow gastric emptying, overeating, smoking, alcohol, pregnancy, surgery in achalasia, drugs (tricyclics, anticholinergics, nitrates), systemic sclerosis. Symptoms: 1. Heartburn (burning, retrosternal discomfort after meals, lying, stooping or straining, relieved by antacids) 2. Belching; acid brash (acid or bile regurgitation) 3. Waterbrash (Increased salivation: “My mouth fills with saliva”) 4. Odynophagia (painful swallowing, eg from oesophagitis or ulceration). 5. Extra-oesophageal: Nocturnal asthma, chronic cough, laryngitis (hoarseness, throat clearing), sinusitis. (From Oxford Handbook Of Clinical Medicine p244) Don’t confuse between acid regurgitation and waterbrash: -Acid regurgitation: the patient experiences a sour or bitter tasting fluid coming up into the mouth. This symptom strongly suggests that the reflux is occurring. -Waterbrash: excessive secretion of saliva into the mouth may occur, uncommonly, in patients with peptic ulcer disease or oesophagitis. The patient experience tasteless or salty fluid his mouth. B. Differential diagnosis: -
The Herbivore Digestive System Buffalo Zebra
The Herbivore Digestive System Name__________________________ Buffalo Ruminant: The purpose of the digestion system is to ______________________________ _____________________________. Bacteria help because they can digest __________________, a sugar found in the cell walls of________________. Zebra Non- Ruminant: What is the name for the largest section of Organ Color Key a ruminant’s Mouth stomach? Esophagus __________ Stomach Small Intestine Cecum Large Intestine Background Information for the Teacher Two Strategies of Digestion in Hoofed Mammals Ruminant Non‐ruminant Representative species Buffalo, cows, sheep, goats, antelope, camels, Zebra, pigs, horses, asses, hippopotamus, rhinoceros giraffes, deer Does the animal Yes, regurgitation No regurgitation regurgitate its cud to Grass is better prepared for digestion, as grinding Bacteria can not completely digest cell walls as chew material again? motion forms small particles fit for bacteria. material passes quickly through, so stool is fibrous. Where in the system do At the beginning, in the rumen Near the end, in the cecum you find the bacteria This first chamber of its four‐part stomach is In this sac between the two intestines, bacteria digest that digest cellulose? large, and serves to store food between plant material, the products of which pass to the rumination and as site of digestion by bacteria. bloodstream. How would you Higher Nutrition Lower Nutrition compare the nutrition Reaps benefits of immediately absorbing the The digestive products made by the bacteria are obtained via digestion? products of bacterial digestion, such as sugars produced nearer the end of the line, after the small and vitamins, via the small intestine. intestine, the classic organ of nutrient absorption. -
Mouth Esophagus Stomach Rectum and Anus Large Intestine Small
1 Liver The liver produces bile, which aids in digestion of fats through a dissolving process known as emulsification. In this process, bile secreted into the small intestine 4 combines with large drops of liquid fat to form Healthy tiny molecular-sized spheres. Within these spheres (micelles), pancreatic enzymes can break down fat (triglycerides) into free fatty acids. Pancreas Digestion The pancreas not only regulates blood glucose 2 levels through production of insulin, but it also manufactures enzymes necessary to break complex The digestive system consists of a long tube (alimen- 5 carbohydrates down into simple sugars (sucrases), tary canal) that varies in shape and purpose as it winds proteins into individual amino acids (proteases), and its way through the body from the mouth to the anus fats into free fatty acids (lipase). These enzymes are (see diagram). The size and shape of the digestive tract secreted into the small intestine. varies in each individual (e.g., age, size, gender, and disease state). The upper part of the GI tract includes the mouth, throat (pharynx), esophagus, and stomach. The lower Gallbladder part includes the small intestine, large intestine, The gallbladder stores bile produced in the liver appendix, and rectum. While not part of the alimentary 6 and releases it into the duodenum in varying canal, the liver, pancreas, and gallbladder are all organs concentrations. that are vital to healthy digestion. 3 Small Intestine Mouth Within the small intestine, millions of tiny finger-like When food enters the mouth, chewing breaks it 4 protrusions called villi, which are covered in hair-like down and mixes it with saliva, thus beginning the first 5 protrusions called microvilli, aid in absorption of of many steps in the digestive process. -
Stomach Flu (Viral Gastroenteritis)
Stomach Flu (Viral Gastroenteritis) The stomach flu (also called viral gastroenteritis) is caused by a virus (rotavirus, adenovirus, Norwalk virus to name a few) that affect the stomach and small intestines. It may come on suddenly or over the course of a few hours. The illness is usually brief, lasting 24-72 hours. Symptoms include: Nausea Vomiting Stomach cramps Diarrhea Mild fever Fatigue Body Chills/Sweats Loss of appetite Muscle aches To help take care of yourself: • The best thing to do is to let your stomach rest from solid foods. • Sip on clear liquids (Hi-C, apple, cranberry, and grape juices, Jell-O, Gatorade- type liquids and ginger-ale or ginger tea). There are special properties in ginger that help soothe the stomach. It is extremely important to keep up your hydration. Water is great for hydration but Gatorade-type products are better because they will restore your electrolytes (Sodium, Potassium and Chloride) which are essential for body functions. You may "stir" the bubbles out of the soda if the carbonation is harsh on your stomach. • Once you have not vomited for a few hours and your stomach is feeling better, you may start to eat solid foods. You may try crackers, plain noodles, eggs, broth, pretzels and yogurt. • The BRAT diet (Bananas, Rice, Applesauce & Toast) includes foods that are low in fiber and are easily digested. • Stay away from dairy products, citric (including orange and grapefruit juices), tomato-based & spicy foods. • SLOWLY increase your dietary intake to include fruits, vegetables and meat once symptoms are gone (usually over 2-3 days). -
Nutrition Intake History
NUTRITION INTAKE HISTORY Date Patient Information Patient Address Apt. Age Sex: M F City State Zip Home # Work # Ext. Birthdate Cell Phone # Patient SS# E-Mail Single Married Separated Divorced Widowed Best time and place to reach you IN CASE OF EMERGENCY, CONTACT Name Relationship Home Phone Work Phone Ext. Whom may we thank for referring you? Work Information Occupation Phone Ext. Company Address Spouse Information Name SS# Birthdate Occupation Employer I verify that all information within these pages is true and accurate. _____________________________________ _________________________________________ _____________________ Patient's Signature Patient's Name - Please print Date Health History Height Weight Number of Children Are you recovering from a cold or flu? Are you pregnant? Reason for office visit: Date started: Date of last physical exam Practitioner name & contact Laboratory procedures performed (e.g., stool analysis, blood and urine chemistries, hair analysis, saliva, bone density): Outcome What types of therapy have you tried for this problem(s)? Diet modification Medical Vitamins/minerals Herbs Homeopathy Chiropractic Acupunture Conventional drugs Physical therapy Other List current health problems for which you are being treated: Current medications (prescription and/or over-the-counter): Major hospitalizations, surgeries, injuries. Please list all procedures, complications (if any) and dates: Year Surgery, illness, injury Outcome Circle the level of stress you are experiencing on a scale of 1 to 10 (1 being the lowest): -
Abdominal Pain - Gastroesophageal Reflux Disease
ACS/ASE Medical Student Core Curriculum Abdominal Pain - Gastroesophageal Reflux Disease ABDOMINAL PAIN - GASTROESOPHAGEAL REFLUX DISEASE Epidemiology and Pathophysiology Gastroesophageal reflux disease (GERD) is one of the most commonly encountered benign foregut disorders. Approximately 20-40% of adults in the United States experience chronic GERD symptoms, and these rates are rising rapidly. GERD is the most common gastrointestinal-related disorder that is managed in outpatient primary care clinics. GERD is defined as a condition which develops when stomach contents reflux into the esophagus causing bothersome symptoms and/or complications. Mechanical failure of the antireflux mechanism is considered the cause of GERD. Mechanical failure can be secondary to functional defects of the lower esophageal sphincter or anatomic defects that result from a hiatal or paraesophageal hernia. These defects can include widening of the diaphragmatic hiatus, disturbance of the angle of His, loss of the gastroesophageal flap valve, displacement of lower esophageal sphincter into the chest, and/or failure of the phrenoesophageal membrane. Symptoms, however, can be accentuated by a variety of factors including dietary habits, eating behaviors, obesity, pregnancy, medications, delayed gastric emptying, altered esophageal mucosal resistance, and/or impaired esophageal clearance. Signs and Symptoms Typical GERD symptoms include heartburn, regurgitation, dysphagia, excessive eructation, and epigastric pain. Patients can also present with extra-esophageal symptoms including cough, hoarse voice, sore throat, and/or globus. GERD can present with a wide spectrum of disease severity ranging from mild, intermittent symptoms to severe, daily symptoms with associated esophageal and/or airway damage. For example, severe GERD can contribute to shortness of breath, worsening asthma, and/or recurrent aspiration pneumonia. -
The Ear, Nose, and Throat Exam Jeffrey Texiera, MD and Joshua Jabaut, MD CPT, MC, USA LT, MC, USN
The Ear, Nose, and Throat Exam Jeffrey Texiera, MD and Joshua Jabaut, MD CPT, MC, USA LT, MC, USN Midatlantic Regional Occupational and Environmental Medicine Conference Sept. 23, 2017 Disclosures ●We have no funding or financial interest in any product featured in this presentation. The items included are for demonstration purposes only. ●We have no conflicts of interest to disclose. Overview ● Overview of clinically oriented anatomy - presented in the format of the exam ● The approach ● The examination ● Variants of normal anatomy ● ENT emergencies ● Summary/highlights ● Questions Anatomy ● The head and neck exam consists of some of the most comprehensive and complicated anatomy in the human body. ● The ear, nose, and throat comprise a portion of that exam and a focused clinical encounter for an acute ENT complaint may require only this portion of the exam. Ears www.Medscape.com www.taqplayer.info Ear – Vestibular organ www.humanantomylibrary.com Nose/Sinus Anatomy Inferior Middle Turbinate Turbinate Septum Dorsum Sidewalls Ala Floor Tip www.ENT4Students.blogspot.com Columella Vestibule www.beautyepic.com Oral cavity and oropharynx (throat) www.apsubiology.org Neck www.rdhmag.com The Ear, Nose, and Throat exam Perform in a standardized systematic way that works for you Do it the same way every time, this mitigates risk of missing a portion of the exam Practice the exam to increase comfort with performance and familiarize self with variants of normal Describe what you are doing to the patient, describe what you see in your documentation Use your PPE as appropriate A question to keep in mind… ●T/F: The otoscope is the optimal tool for examining the tympanic membrane. -
Medical Terminology Abbreviations Medical Terminology Abbreviations
34 MEDICAL TERMINOLOGY ABBREVIATIONS MEDICAL TERMINOLOGY ABBREVIATIONS The following list contains some of the most common abbreviations found in medical records. Please note that in medical terminology, the capitalization of letters bears significance as to the meaning of certain terms, and is often used to distinguish terms with similar acronyms. @—at A & P—anatomy and physiology ab—abortion abd—abdominal ABG—arterial blood gas a.c.—before meals ac & cl—acetest and clinitest ACLS—advanced cardiac life support AD—right ear ADL—activities of daily living ad lib—as desired adm—admission afeb—afebrile, no fever AFB—acid-fast bacillus AKA—above the knee alb—albumin alt dieb—alternate days (every other day) am—morning AMA—against medical advice amal—amalgam amb—ambulate, walk AMI—acute myocardial infarction amt—amount ANS—automatic nervous system ant—anterior AOx3—alert and oriented to person, time, and place Ap—apical AP—apical pulse approx—approximately aq—aqueous ARDS—acute respiratory distress syndrome AS—left ear ASA—aspirin asap (ASAP)—as soon as possible as tol—as tolerated ATD—admission, transfer, discharge AU—both ears Ax—axillary BE—barium enema bid—twice a day bil, bilateral—both sides BK—below knee BKA—below the knee amputation bl—blood bl wk—blood work BLS—basic life support BM—bowel movement BOW—bag of waters B/P—blood pressure bpm—beats per minute BR—bed rest MEDICAL TERMINOLOGY ABBREVIATIONS 35 BRP—bathroom privileges BS—breath sounds BSI—body substance isolation BSO—bilateral salpingo-oophorectomy BUN—blood, urea, nitrogen -
Appendicitis
Appendicitis Your child has abdominal pain, it might be appendicitis. Appendicitis is swelling or infection in the appendix. The appendix is a small organ attached to the large intestine. Appendicitis usually develops over 12-24 hours. It has symptoms such as abdominal pain, nausea, vomiting, fever, and loss of appetite. Most importantly, pain that continues, worsens and moves to the right lower side of the abdomen is common in appendicitis. Appendicitis is the most common childhood “emergency” that must be treated in a timely manner. However, it’s important to know that many conditions have symptoms similar to appendicitis but don’t require surgery. At Hasbro Children’s Hospital (HCH), we evaluate your child’s abdominal pain to determine if appendicitis is the cause. That way, we avoid unnecessary operations. What happens now? Your child will be well cared for. First your child will be seen in the HCH emergency department (ED) by a nurse and doctor trained in pediatric emergency medicine. If necessary, your child will have tests that include blood work and a urinalysis. Your child’s pain will be managed with intravenous (IV) pain medication. Your child will not be allowed to eat or drink and may receive fluids through an intravenous line. Members of the pediatric surgical team will examine your child to help determine whether your child has appendicitis or another condition. We will perform a painless ultrasound on your child and the ultrasound images will be read by pediatric radiology doctors with advanced training in imaging children. Usually, ultrasound is the only imaging required but sometimes an MRI may be needed as well.