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Complications of GERD
- Esophagitis
- Esophageal strictures
- Ulcers, hemorrhage
- Barrett's esophagus --> adenocarcinoma
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Classic presentation of PUD
- Chronic, intermittent epigastric pain, often relieved by antacids or milk
- Occult blood, n/v may also be seen
- Gastric ulcers are exacerbated by eating; duodenal ulcers are relieved by eating
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What type of peptic ulcer is more likely to be related to H. pylori?
Duodenal (gastric=NSAIDs)
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Major complication of PUD
Perforation
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Chronic, recurrent ulcers, refractory to tx
Measure serum gastrin to r/o ZE
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Triple therapy
- PPI
- Clariththromycin
- Amoxicillin
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Weakness, dizziness, sweating, n/v after eating in a patient after surgery for PUD
Think about dumping syndrome--a complication of the Billroth procedure
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Common causes of an upper GI bleed
- Gastritis
- Esophagitis
- Varices
- PUD
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Common causes of a lower GI bleed
- Diverticulosis
- Colitis
- IBD
- Vascular ectasia
- Hemorrhoids
- Cancer
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Management of a px with a GI bleed
- Stabilize
- NG tube--if there's blood, it's an upper bleed
- Endoscopy (upper or lower, depending on symptoms and NG aspirate) to identify the lesion
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Correction of a GI bleed
- Angiography, to ID source of bleeding and embolize vessel
- Surgery for severe, resistant bleeds
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Complications of diverticulitis
- Abscess
- Fistula formation
- LBO
- Sepsis
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LLQ pain + fever + diarrhea + neutrophila: what is the condition, and how is it managed?
- Think about diverticulitis
- Can use CT to dx and r/o complications (e.g. abscess, fistula)
- If there are no complications, tx with abx (fluoroquinolones) and bowel rest
- If there are complications, tx surgically
After the px recovers, do colonoscopy to r/o colon cancer (can look like diverticulitis clinically and on CT)
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