7/24/2010 Esophageal Disorders • Dysphagia – Difficulty Swallowing and passing food from mouth via the esophagus Gastrointestinal Diseases • Diagnostic aids: Endoscopy, Barium x‐ray, Cineradiology, Scintigraphy, ambulatory esophageal pH monitoring, esophageal Fernando Vega, MD manometery HIHIM 409 Esophageal Disorders Peptic Ulcer Disease • Reflux esophagitis –(GERD) • Hypersecretion of HCL, impaired mucosal • Hiatal Hernia resistance factors • Barret’s esophagus – • Role of H.Pylori – • Esophageal Varices • Bldileeding Ulcer – Diseases of the Small Intestine Wireless capsule endoscopy • Duodenal ulcer • Malabsorption • Regional Enteritis (Crohn’s Disease) • Single use • Gastroenteritis • PlldPropelled by peritliistalsis • Excreted naturally • Inguinal Hernia • 2 frames/second • Last 7‐8 hrs (>50,000 images) 1 7/24/2010 Diarrhea Diarrhea • Single greatest cause of morbidity and • The GI tract absorbs 9 Liter of water a day = 2 mortality in the world liters of dietary fluids+ 7 liters of digestive fluids. Only 100 – 200 ml water comes out in form of stool. Diarrhea Diarrhea • Acute diarrheal illnesses are common and self‐limited. Most often caused by • Caused by impaired absorption or adenoviruses, rotaviruses, astroviruses and cdaliciviruses not detectable by ordinary laboratory tests. No antiviral therapy is available. hypersecretion or both • • Consider: • ↓ absorption • Medication • Antibiotics • Mucosal damage • Travelers’ diarrgia • • Tropical sprue Osmotic Diarrhea • Parasitic infections • • Food poisoning Motility abnormalities • • ↑ secretion • Fever • Blood in stool • Bacterial toxins • Abdominal tenderness • Significant volume depletion 2 7/24/2010 Inflamatory Bowel Disease: Crohn’s Diarrhea disease, Ulcerative colitis • Chronic Diarrhea –three weeks or longer • Common presentation: abdominal pain, diarrhea, blood in stool • • • Is it bloody, fatty or watery? • Ulcerative colitis • • ilinvolves the colon only • Bloody – Colitis: IBS or ischemic • involves the mucosa of the intestine • Fatty – Malabsorption: sprue or pancreatic • insufficiency • Crohns • Watery – Irritable bowel, meds, • May involve any part of the GI tract • Involves the full thickness of the intestine Pancreatic Diseases Gallstones and Biliary tract disease • Clinical presentation: colicky RUQ pain, radiation to scapula • Gallstones or alcoholism in majority of acute • Nausea, • Dark urine pancreatitis. • • May have fever • Alcohol ~ 80% and idiopathic ~ 20% of chronic • Scleral icterus • Tenderness, guarding, rebound pancreatitis cases • Labs • Leukocytosis • Amylase • Bilirubin, alk phosphaase • • Imaging • Ultrasound • CT • Cholescintigraphy Gallstones and Biliary tract disease Gallstones and Biliary tract disease • Treatment • 90% are cholesterol or mixed cholesterol • Meperidine for pain • ~20 % are pigment stones • Surgery, laporoscopic cholecystectomy • Dissolution • Lithotripsy 3 7/24/2010 Acute viral hepatitis Chronic Hepatitis • Hepatitis A –fecal‐oral, food transmission • definition lasting more than 6 months • Hepatitis B – needles and sexual transmission • clinical manifestations can be diverse • Hepatitis C – needles • • HtitiHepatitis D(de lta ) –co‐ifinfec tion with Hep B, • Hepatitis B rare in US • Hepatitis C • Hepatitis E –rare in US • Hepatitis D • CMV • • EBV • Autoimmune Hepatitis Cirrhosis of the Liver Gastrointestinal bleeding • Alcohol • Presentation: bloody stools: bright red blood (BRBP) • Chronic Hepatitis C • Currant jelly • • Black stools • Primary Billiary Cirrhosis • OlOccult blee d • Wilson’s Disease • Abdominal pain • Primary Billiary Cirrhosis • Hypotension signs and symptoms when loss > 1,500cc (25% of volume) • • • Complications: variceal bleeding, ascites, • Approach: upper or lower? Diseases causing malabsorpton and Diverticulosis, Diverticulitis, maldigestion • Small bowel disease • Diseases of the pancreas: • Glutten sensitive enteropathy • Chronic pancreatitis • Sprue • Cystic fibrosis • Giardia • Cancer • AIDS • Diseases of the liver and biliary tract • Crohn’s • Cirrhosis • Cholestasis 4 7/24/2010 Diseases causing malabsorpton and maldigestion • Combined defects • Hyperthryoridism • Diabetes • Carcinoid • Zellinger‐Ellison • Post‐gastrectomy 5.