GI PBS

Esophageal Reflux Disease

• Definition: A condition characterized by the backflow of stomach contents into the esophagus, leading to symptoms such as heartburn and difficulty swallowing.

Cholecystitis

• Definition: Inflammation of the gallbladder.

• Symptoms:
    - Right upper quadrant pain, which may radiate to the right shoulder.
    - Fever.
    - Tachycardia.

• Risk Factors:
    - High-fat diet.
    - Obesity.
    - Age over 40 years.

• Management:
    - Medications such as nepa aura to alleviate pain during eating.
    - Treatments:
      - Lithotripsy:
        - Definition: A non-invasive procedure using shock waves to break up gallstones.
      - Surgery:
        - Open cholecystectomy.
        - Laparoscopic cholecystectomy.
    - Post-operative care:
      - Early ambulation to prevent complications like pneumonia.
    - Lifestyle Modifications:
      - Weight loss.
      - Healthy diet.
      - Avoidance of fatty and fried foods.

Cirrhosis

• Definition: Scarring of liver tissue due to long-term damage, impairing liver function.

• Normal Liver Functions:
    - Production of ammonia.
    - Synthesis of coagulation factors.
    - Detoxification of ammonia.
    - Metabolism.

• Causes:
    - Alcohol abuse.
    - Viral hepatitis.
    - Cystic fibrosis.

• Signs and Symptoms:
    - Jaundice: yellowing of skin and eyes.
    - Portal hypertension: increased blood pressure in the portal venous system.
    - Ascites: accumulation of fluid in the abdominal cavity.
    - Esophageal varices: swollen veins in the esophagus which can rupture and be life-threatening.
    - Hepatic encephalopathy: accumulation of ammonia leading to mental status changes and confusion.

• Management:
    - Diagnostic Tests:
      - Liver biopsy.
    - Interventions for Ascites:
      - Abdominal paracentesis: a procedure to remove fluid from the abdominal cavity.
        - Pre-procedure: patient should empty bladder to avoid injury during the procedure.
    - Dietary Recommendations:
      - Low protein diet to prevent hepatic encephalopathy.
      - Low sodium diet.
      - Avoidance of alcohol.
    - Bleeding Precautions:
      - Use of soft-bristled toothbrush and electric razor.
      - Monitor for blood in stool.
      - Avoid Valsalva maneuver to prevent complications.
  
    - Pharmacological Interventions:
      - Lactulose: helps remove ammonia via bowel movements.
      - Monitor electrolytes due to risk of hypokalemia (low potassium levels).
      - Pruritus management: calamine lotion, nail cutting to prevent skin injury.

End-stage Liver Disease

• Alcoholic Cirrhosis Stages:
    - Stage 1: Fatty liver (can be reversed with lifestyle changes).
    - Stage 2: Irreversible damage without fibrosis.
    - Stage 3: Complete liver failure.

• Procedural Considerations:
    - Patient should fast for 8 hours before procedures.
    - Expect abdominal cramping during esophagogastroduodenoscopy and chalky white stools due to barium contrast.

Peptic Ulcer Disease

• Causes:
    - H. pylori bacteria (major contributor).
    - Non-steroidal anti-inflammatory drugs (NSAIDs).
    - Stress.

• Antibiotic Treatment:
    - Example: Tetracycline or other suitable antibiotics to eradicate H. pylori.

• Medications:
    - Acid reducers: antacids, histamine receptor blockers, proton pump inhibitors.
    - Mucosal protectants: Sucralfate, Misoprostol (avoid in pregnant patients).

• Lifestyle Recommendations:
    - Avoid spicy, fatty, and fried foods.
    - Decrease stress levels.
    - Avoid alcohol and NSAIDs.

Pancreatitis

• Definition: Inflammation of the pancreas.

• Functions of the Pancreas:
    - Endocrine: regulates blood sugar levels.
    - Exocrine: produces digestive enzymes.