disturbance in ingestion MODULE 1

diverticulum

AN OUT-POUCHING MUCOSA AND SUBMUCOSA THAT PROTRUDES TO A WEAK PORTION OF MUSCULATURE OF ESOPHAGUS

1. sliding hiatal hernia (type 1)

2. paraesophageal hiatal hernia

2 types of hiatal hernia

sliding hiatal hernia

• JUNCTION BETWEEN THE STOMACH AND THE ESOPHAGUS SLIDES UP THROUGH THE HIATUS

• 90% of hiatal hernia are this type

paraesophageal hiatal hernia

• NO SLIDING UP AND DOWN A PORTION OF THE STOMACH REMAINS STUCK IN THE CHEST CAVITY

• less common

• HEAVY LIFTING 

• HARD COUGHING 

•  HARD SNEEZING 

•  PREGNANCY AND DELIVERY 

•  VOMITING 

•  CONSTIPATION 

• OBESITY

causes of hiatal hernia 

• HEART BURN 

•  REGURGITATION 

•  DYSPHAGIA 

•  SENSE OF FULLNES

S/S hiatal hernia

• CHEST X-RAY 

•  BARIUM X-RAY 

•  UPPER ENDOSCOPY

Dx hiatal hernia

• PPI

• ANTACID 

Tx hiatal hernia

NISSEN FUNDOPLICATION

Sx hiatal hernia

INCOMPETENT LOWER ESOPHAGEAL SPHINCTER (LES)
 • AGING
 • C-A-S-H (COFFEE, ALCOHOL, SPICY & HOT FOODS)
 • HIATAL HERNIA

causes of GERD

• remain upright

• during sleep; semi-fowler or two pillow

position GERD

• sense of fullness

• nausea & vomiting 

• dysphagia

• ptyalism (hypersalivation)

S/S GERD

• give ice chips (if vomited or NPO)

• antiemetic : metoclopramide, ondansetron, granisetron

intervention nausea & vomiting GERD

• chew sugarless gum / hard candy

• toothbrushing

intervention ptyalism GERD

• flex neck

• thicken liquid

• feed slowly

intervention dysphagia GERD

• POSTPRANDIAL (occurs after meal)

•  SHORT LIVED 

•  ASYMPTOMATIC 

•  NO NOCTURNAL SX

physiological GERD (how it should function)

• SYMPTOMS 

•  MUCOSAL INJURY 

•  NOCTURNAL SX

pathologic GERD (abnormal)

ulcer

high HCL =?

antacid

to neutralized the acid(HCL)

• BARIUM SWALLOW 

•  ENDOSCOPY

•  PH MONITORING 

•  ESOPHAGEAL MANOMETRY

Dx GERD

• ANTACID

• H2 RECEPTOR BLOCKER 

•  FUNDOPLICATION

Tx GERD

Reflux and regurgitation

Hallmark of Ingestion 

• Epithelial Layer

• Lamina Propria

• Muscularis Mucosa

3 Layers of Mucosa

Epithelial Layer

Absorbs & secretes mucus & digestive enzymes

Lamina propria

blood & lymph vessels

muscularis mucosa

smooth muscle -> breaks down food

gall bladder

stores & concentrates bile produced by the liver

pancreas

releases insulin

pancreatic lipase

breaks down fats into fatty acids and glycerol

pancreatic amylase

breaks down carbohydrates into sugar

proteases

break down proteins into smaller peptides

Achalasia

rare disorder, malfunction of nerves that control the movement of food through the esophagus

• jackhammer esophagus

• diffuse esophageal spasm 

• type III achalasia

3 types of esophageal spasm 

jackhammer esophagus

hypercontractile esophagus (most common)

diffuse esophageal spasm

spasm are normal in amplitude

type III achalasia

characterized by LES obstruction 

1. dysphagia 

2. regurgitation

3. chest discomfort

4. weight loss

5. pyrosis (heart burn)

achalasia symptoms

dysphagia

hallmark sign of achalasia

esophageal manometry

definite diagnosis of achalasia

endoscopy

basic diagnosis achalasia

• endoscopy

• esophageal manometry

• esophagram

Dx achalasia

• CANNOT BE REPAIRED
• EAT SLOWLY, DRINK PLENTY OF FLUID WHILE YOU EAT
• CHEW FOOD THOROUGHLY
• STAY UPRIGHT WHILE EATING AND AT LEAST 1 HOUR AFTER EATING
• DRINK A FULL GLASS OF WATER WITH PILL

Tx achalasia

• isosorbide dinitrate or CCB

• botox injection - easier to swallow after 6-12 mths

• pneumatic balloon dilation

pharmaco achalasia

hiatal hernia

THE UPPER PART OF THE STOMACH PUSHES THROUGH AND OPENING IN THE DIAPHRAGM, AND UP INTO THE CHEST. PROTRUSION OF THE UPPER PART OF A STOMACH.

liver

makes bile

Epiglottis

Seals airway off

• Ingestion 

• Digestion 

• Absorption

• Excretion

Main Function of GI System

• laparoscopic

• heller myotomy -> fundoplication

surgical achalasia

hiatal hernia

• DIAPHRAGM HAS A LARGER OPENING THAN NORMAL

• A PORTION OF THE UPPER STOMACH SLIPS UP OR PASSES THROUGH THAT HIATUS AND ENTER INTO THE CHEST

achalasia

• DECREASED OR ABSENT PERISTALSIS IN THE DISTAL PORTION OF ESOPHAGUS
• NORMAL PATTERN OF SWALLOWING DOES NOT OCCUR
• LOWER ESOPHAGEAL SPHINCTER MUSCLE DOES NOT RELAX PROPERLY
• THUS, PREVENTS THE PASSAGE OF SWALLED FOOD

• Teeth 

• Tongue 

• Salivary glands

• Liver

• Gallbladder

• Pancreas

Accessory Organs