By A.B.R. Thomson
This evaluation booklet has been designed as a refresher for examination reasons for gastroenterology and inner drugs citizens and fellows, in addition to practicing physicians. GI perform overview covers the most important details in chapters concentrating on the esophagus, belly, small bowel, colon, liver, pancreas and nutrients. This functional consultant seems at diverse diagnoses inside gastroenterology problems, and covers themes corresponding to bariatric surgical procedure, Crohn’s ailment, diverticular ailment, hepatitis, pancreatitis and consuming issues. This publication enhances Endoscopy and Diagnostic Imaging, components I and II.
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Give 5 indications for open or laparoscopic surgical fundoplication in the patient with GERD. GERD symptoms responding to PPI, (penalty for failure of PPI as an indication) Intolerance to PPIs Cost of PPIs Patient preference, desire for a “cure” Persistent large volume regurgitation Large symptomatic hiatus hernia Respiratory complications from recurrent aspiration Recurrent peptic strictures in a young person Abbreviations: GERD, gastroesophageal reflux disease; PPI, proton pump inhibitor 18.
R. Thomson Esophageal motility (manometry) cases Desribe the manometric findings, and give a differential diagnosis. Case 1: Clinical history: Presenting symptom of heartburn Describe the following esophageal motility studies; give the differential diagnosis, and state the most likely manometric diagnosis. R. R. 8) Lower amplitude contractions: 0% (<30%) Spontaneous activity between swallows: none Acid infusion test: Felt pharyngeal burning by two minutes of infusion, which became stronger by three minutes and radiated to epigastric area.
Adapted from: Mayo GI page 23. 21. Outline suggested recommendations for endoscopic surveillance of persons with Barrett’s esophagus (BE). R. Thomson o LGD Dysplasia o HGD – Focal (<5 crypts) o Repeat EGD with biopsy, when erosive esophagitis healed, confirm by two expert pathologists, confirm with #3 EGD plus biopsies to exclude HED/EMC q 1 year until no dysplasia Documentation Repeat EGD with biopsy to rule out cancer/document HGD expert pathologist confirmation Follow-up EGD q 3 months HGD – Multifocal Radiofrequency ablation, PDT, (>5 crypts) cryosurgery, EMR, esophagectomy in surgical candidate Abbreviations: BE, Barrett’s epithelium; EGD, esophageal gastroduodenoscopy; EMR, endoscopic mucosal resection; EUS, endoscopic ultrasound; GERD, gastroesophageal reflux disease; HGD, high grade dysplasia; LGD, low grade dysplasia; PDT, photodynamic therapy 22.