Endicott College

Definition: GERD is characterized by the backflow of gastric contents into the esophagus, leading to symptoms like burning sensation and indigestion.
Mechanisms:
- Incompetent lower esophageal sphincter or pyloric valve can allow gastric acid to reflus.
- Increased gastric acid production can worsen the reflux.
Symptoms:
- Heartburn, regurgitation, excessive salivation, esophageal erosions, ulcers, and pain that may mimic a heart attack.
- Differential diagnosis can be aided by administering nitroglycerin (for heart issues) versus GI cocktails (including antacids for GERD).
Diagnostic Procedures:
- Endoscopy, barium swallow for erosion evaluation, and pH monitoring for acidity levels.
Lifestyle Modifications:
- Low fat diet, avoid caffeine, nicotine, and carbonated beverages.
- Recommended to avoid eating/drinking two hours before lying down and wearing loose-fitting clothes.
Medications:
- H2 blockers (e.g., Pepcid, Zantac) and proton pump inhibitors (PPIs) like Nexium and omeprazole should be taken in the morning before meals.
- Prokinetic agents like Reglan (metoclopramide) may be used for gastric emptying.

Definition: An abnormal opening in the diaphragm allowing part of the esophagus to move into the thoracic cavity.
Types:
- Sliding Hiatal Hernia: Comes and goes, generally asymptomatic.
- Paraesophageal Hernia: More concerning due to potential incarceration.
Symptoms:
- Heartburn, regurgitation, and dysphagia (difficulty swallowing).
Risk Factors: Include age, pregnancy, obesity, and chronic coughing.
Diagnosis and Treatment:
- Diagnosed via X-ray or barium swallow; managed with lifestyle changes and, in severe cases, surgical repair.

Types: Predominantly adenocarcinoma and squamous cell carcinoma.
Risk Factors:
- Chronic conditions such as GERD, alcohol use, tobacco consumption, hot food intake, nutritional deficiencies, and poor oral hygiene.
Symptoms:
- Often asymptomatic until swallowing difficulties or pain arises, possibly leading to weight loss and nutritional deficiencies.
Diagnosis:
- Endoscopy, CT scans, PET scans, and biopsies to assess type and stage.
Treatment:
- Aim for cure if detected early; may include surgery, radiation, and chemotherapy.
- NG tubes post-surgery, strict dietary adjustments, and careful monitoring.

Types: Gastric, duodenal, and esophageal ulcers.
Etiology: Correlation with H. pylori infection, NSAIDs, and lifestyle factors (stress, diet).
Symptoms:
- Dull or gnawing epigastric pain, sometimes mimicking cardiac pain.
Diagnosis:
- Endoscopy is the gold standard; stool testing, and barium studies can also be utilized.
Treatment:
- Antibiotics for H. pylori, PPIs, lifestyle modifications (dietary changes, smoking cessation).
Complications: Perforation, hemorrhage, and blockage if ulcers worsen.

Indications: For patients with a BMI over 40 or comorbid conditions affecting health.
Types:
- Roux-en-Y gastric bypass: reducing stomach size significantly.
- Gastric banding: adjustable banding to limit food intake.
- Vertical banded gastroplasty and gastric sleeve are increasingly common.
Post-Operative Care:
- Nutritional monitoring, management of complications such as ulcers, pneumonia, and strict dietary adherence.

Types: Includes ulcerative colitis, Crohn's disease, and diverticulitis.
Symptoms:
- Severe diarrhea, abdominal pain, weight loss, and bleeding.
Diagnosis:
- Imaging studies to identify inflammation, scopes for direct visualization, and biopsies.
Management:
- Dietary modifications (high protein, low fiber for Crohn's), IV fluids, antibiotics, and possible surgical intervention.

Bowel Obstruction: Examples include mechanical (tumors, adhesions, fecal impactions) and non-mechanical causes. Symptoms vary based on the obstruction site.
Diverticulitis: Can lead to perforation and infection; management includes dietary adjustments, possible antibiotics, and surgery if severe.
Peritonitis: Surgical emergency; requires immediate intervention if perforations occur.