Kelompok 10

Pmicu 1

GERD
Gastroesophageal reflux refers to the backward flow of acid from the stomach up into the esophagus. People will experience heartburn, also known as acid indigestion, when excessive amounts of acid reflux into the esophagus. Most people describe heartburn as a feeling of burning chest pain, localized behind the breastbone that moves up toward the neck and throat. Some even experience the bitter or sour taste of the acid in the back of the throat. The burning and pressure symptoms of heartburn can last as long as 2 hours and are often worsened by eating food.

 Symptoms of acid indigestion are more common among the elderly and women during pregnancy.

The physiologic and anatomic factors that prevent the reflux of gastric juice from the stomach into the esophagus include the following: The lower esophageal sphincter (LES) must have a normal length and pressure and a normal number of episodes of transient relaxation (relaxation in the absence of swallowing). The gastroesophageal junction must be located in the abdomen so that the diaphragmatic crura can assist the action of the LES, thus functioning as an extrinsic sphincter. The presence of a hiatal hernia disrupts this synergistic action and can promote reflux Esophageal clearance must be able to neutralize the acid refluxed through the LES. (Mechanical clearance is achieved with esophageal peristalsis. Chemical clearance is achieved with saliva.) The stomach must empty properly.

 Approximately 50% of patients with gastric reflux develop esophagitis Esophagitis is classified into the following 4 grades based on its severity: Grade I Erythema Grade II Linear nonconfluent erosions Grade III Circular confluent erosions Grade IV Stricture or Barret esophagus. Barrett esophagus is thought to be caused by the chronic reflux of gastric juice into the esophagus. Barrett esophagus occurs when the squamous epithelium of the esophagus is replaced by the intestinal columnar epithelium

 Lab
Laboratory tests are seldom useful in establishing a diagnosis of gastroesophageal reflux disease (GERD) Barium esophagogram Esophagogastroduodenoscopy (EGD)

 Treatment
Antacids Histamine H2-receptor antagonists (ranitidine, cimetidine, famotidine, nizatidine) PPIs (omeprazole, lansoprazole) Prokinetic agents (methocloperamid) Surgical care

Gastritis
Gastritis technically refers to endoscopic or histological findings of inflammatory changes in the gastric mucosa; however, the term is often used clinically to refer to the symptoms of dyspepsia. The most common causes are H elicobacter pylori bacterial infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin. Other medications that have been associated with gastritis include potassium and iron supplements. Ethanol has been implicated in the development of gastritis in both chronic and binge drinkers. Less common causes include autoimmune disorders; radiation; noxious irritants; reflux of bile and pancreatic fluids; and infections with bacterial, viral, parasitic, and fungal organisms.

 Gastritis can be divided into two category: Chronic gastritis Acute gastritis

Patients typically present with abdominal pain that has the following characteristics: Epigastric to left upper quadrant Frequently described as burning May radiate to the back Usually occurs 1-5 hours after meals May be relieved by food, antacids (duodenal), or vomiting (gastric) Typically follows a daily pattern specific to patient

"Alarm features" that warrant prompt gastroenterology referral5 include the following: Bleeding or anemia Early satiety Unexplained weight loss Progressive dysphagia or odynophagia Recurrent vomiting Family history of GI cancer