1. Alterations in Nutrition Gastroesophageal Reflux Disease Peptic Ulcer Disease Cholecystitis/Gastric Surgery

2. Upper GI

8. Gastroesophageal Reflux Disease(GERD) • Occurs when contents of the stomach including stomach juices (flow back) into the esophagus

9. Causes for GERD • Incompetent lower esophageal sphincter • Transient LES relaxation • Increased intragastric pressure

13. Contributing Factors to GERD • Smoking • Caffeine • ETOH • Fatty meals • Obesity • Increased gastric acid and pepsin production

14. Heartburn,indigestion Chest pain Regurgitation Pain after eating Dysphagia Belching Sore throat Hoarseness Pain is worsened when the patient bends over at the waist or reclines. Signs and Symptoms of GERD

15. Complications of GERD • Esophageal strictures • Ulcers • Erosions

16. Barrette's Esophagus • Pre- malignant condition from irritation of gastric content on the normal cell epithelium of the esophagus. It may progress to adenocarcinoma.

18. Diagnosing GERD • Barium swallow • Endoscopy (EGD) • Esophageal motility studies • Ambulatory pH monitoring • Esophageal manometry

19. Treatment for GERD • Practical changes in daily living • Pharmacology • Surgery

20. Practical changes in life style • Diet changes • loose weight and eat smaller meals • Refrain eating 3 hrs. after bed time and say upright 2 hours after a meal. • Limit the amount of citrus juices, coffee, chocolate, spicy foods alcohol and peppermint.

21. Practical changes in life style • Stop smoking • Avoid tight clothing • Avoid bending

22. Pharmacological treatments • H2 receptor antagonist (Cimetidine, Ranitidine, famotidine,nizatidine) • Proton Pump inhibitors (Prilosec, Prevacid) • Promotility agents (Cisapride=Propulsive)

23. Pharmacological treatments • Antacids-to neutralize acidity, increased LES pressure. • It is usually take 1-3hrs after a meal and at bed time.

24. Surgery • It is reserve for patients who can develop serious complication. • The must common surgery done is called • Nissen Fundoplication-This surgery involve wrapping the fundus of the stomach around the lower esophagus and suture the fundus to itself.

26. Hiatal (diaphragmatic) Hernia • What is it? • Partial Stomach protrusion through the diaphragm.

29. Congenital problems Trauma Intra-abdominal pressure Why does Hiatal Hernia happen?

30. Reflux Chest pain Occult bleeding Regurgitation Dysphasia Belching What are the symptoms of Hiatal Hernia ?

31. Complications of Hiatal hernia • Incarcerated necrotic hernia • Hemorrhage

32. How is hiatal hernia diagnosed • EGD • Barium swallow

33. Treatment for Hiatal hernia • Pharmacological (same as GERD) • Changes in life style • Surgery (Nissen fundoplication)

34. Hiatus hernia repair

35. Hiatus hernia repair

36. Esophageal spasm • Pt. Experiences spastic contractions of the esophagus . • Symptoms: angina-like chest pains and dysphasia. • Treatment: Calcium channels blockers, nitrates and anticholinergics

37. Achalasia • What is it ? Dilation and loss of tone in the esophagus with high gastroesophageal sphincter pressure. • Why does it happen? Cause unknown.

38. Achalasia symptoms • Nocturnal cough • Chest pains • Dysphagia • Regurgitation • Weight loss

39. Achalasia treatments • Small frequent feedings of soft warm food and fluids. • Avoids hot spice food and ETOH • LES dilatation with a balloon dilator • Calcium channel blockers and nitrates • Surgical myotomy(opening LES )

40. Cancer of the stomach • Is the second most common cancer in the world. • Every year 25,000 Americans develop gastric cancer. • 13,000 Americans died every year • Highest in Hispanic, African Americans, Asian Americans. • Men affected twice as much as women.

41. Stomach cancer • Common location for the stomach cancer: distal portion of the stomach. A mayor factor for the development of gastric cancer is H. Pylori

42. Risk Factors for Stomach cancer • Genetic predisposition • Carcinogenic dietary • Pernicious anemia • Gastric polyps • Chronic H. Pyloric gastritis • Achlorhydria -lack of hydrochloric acid in the stomach.

43. Cancer of the stomach • Adenocarcinoma which involves the mucous producing cells is the most common form of gastric cancer. • These carcinomas may arise anywhere on the mucosa surface of the stomach but are more frequently found in the distal portions.

44. Stomach cancer • When the disease is limited to submucosa and mucosa; it is early gastric carcinoma. • Metastasis occur early due to rich blood supply of the area. • Symptoms are vague and usually the discovery is done when the disease is advance.

46. A general feeling of being tired or weak. Bloating or indigestion soon after eating. Vague pain in the upper abdomen. Heartburn Nausea/vomiting Poor appetite Blood in vomits or blood in the stool Symptoms of gastric carcinoma

47. Stomach cancer diagnostic studies • Blood test will show presence iron deficient anemia or pernicious anemia. • Gastric analyses-may reveal deficiency of hydrochloric acid. • An upper GI X-ray study with barium swallow could identify lesions. • (the special x-rays of the esophagus and the stomach in which the pt. Drinks a solution containing barium. It shows up in x-rays and may outline a tumor or abnormality).

48. Stomach cancer diagnostic studies • The stool may be tested for occult (hidden) blood. • Computerized Topography (CT) Scan of the abdomen may show tumor particularly when combined with a barium swallow. • Gastroscopy examination in which along thin tube is inserted down esophagus into stomach a small video camera at the other end pick up the image and displayed on monitor screen.