GI Disorders - GERD Overview

GI Disorders - GERD (Gastroesophageal Reflux Disease)

• Pathophysiology: Stomach acid flows back into the esophagus due to a weak or relaxed lower esophageal sphincter (LES). This acid irritates the esophageal lining.
• Signs & Symptoms: Heartburn (burning in chest), regurgitation (acid in mouth or throat), difficulty swallowing, chronic cough or sore throat.
• Complications: Esophagitis (inflammation of esophagus), Barrett's esophagus (pre-cancerous changes), strictures (narrowing of esophagus).
• Diagnostic Tests: Endoscopy (views esophageal lining), pH monitoring (measures acid in esophagus), barium swallow (X-rays after drinking contrast liquid).
• Treatment & Management: Lifestyle changes (avoid triggers like spicy/fatty foods, caffeine, weight loss, no smoking), medications (antacids, H2 blockers, proton pump inhibitors like omeprazole), surgery (fundoplication if severe).
• Rationale: Reduce acid and irritation to prevent complications.

Peptic Ulcers

• Pathophysiology: Open sores in the stomach or duodenum caused by H. pylori bacteria or NSAIDs weakening the protective lining.
• Signs & Symptoms: Stomach or abdominal pain (may be relieved by food or antacids), nausea, vomiting, and black/tarry stools (bleeding ulcers).
• Complications: Bleeding ulcers, perforation (hole in the stomach wall), and gastric outlet obstruction (blocking food movement).
• Diagnostic Tests: Endoscopy (identifies ulcers), H. pylori testing (blood, breath, or stool tests), barium swallow (highlights ulcers on X-rays).
• Treatment & Management: Medications (PPIs, antibiotics for H. pylori, antacids), lifestyle changes (avoid NSAIDs, smoking, and alcohol), surgery (rare, for complications).
• Rationale: Heal the ulcer and prevent recurrence.

Crohn's Disease

• Pathophysiology: Chronic inflammation of any part of the digestive tract (commonly the ileum and colon), likely autoimmune.
• Signs & Symptoms: Diarrhea (sometimes bloody), abdominal pain/cramping, weight loss, fatigue, and mouth sores.
• Complications: Bleeding ulcers, perforation, and gastric outlet obstruction.
• Diagnostic Tests: Endoscopy (identifies ulcers), H. pylori testing (blood, breath, or stool tests), barium swallow (highlights ulcers on X-rays).
• Treatment & Management: Medications, lifestyle changes, and surgery.
• Rationale: Heal the ulcer and prevent recurrence.

Ulcerative Colitis

• Pathophysiology: Chronic inflammation and ulcers in the colon and rectum, likely autoimmune.
• Signs & Symptoms: Bloody diarrhea, abdominal pain/cramps, urgency to defecate, fatigue, and weight loss.
• Complications: Toxic megacolon (colon dilation), increased colon cancer risk, and severe bleeding.
• Diagnostic Tests: Colonoscopy (identifies inflammation and ulcers), blood tests (anemia, inflammation markers).
• Treatment & Management: Medications, diet, and surgery.
• Rationale: Reduce inflammation, manage symptoms, and prevent complications.

Liver Cirrhosis

• Pathophysiology: Scar tissue replaces healthy liver tissue due to chronic liver damage (e.g., alcohol, hepatitis), impairing function.
• Signs & Symptoms: Fatigue, jaundice (yellowing skin/eyes), ascites (fluid in abdomen), spider angiomas (red spots on skin), and easy bruising/bleeding.
• Complications: Portal hypertension (increased pressure in portal vein), esophageal varices (bleeding veins), hepatic encephalopathy (confusion from toxins).
• Diagnostic Tests: Liver function tests, imaging (ultrasound, CT), and biopsy.
• Treatment & Management: Lifestyle changes, medications, procedures (paracentesis, liver transplant).
• Rationale: Slow progression, treat complications, and maintain liver function.

Cushing Syndrome

• Pathophysiology: Your body has too much cortisol (a stress hormone) due to prolonged steroid use or adrenal gland overproduction.
• Etiology (Causes): Long-term use of corticosteroid medications, adrenal gland tumors, pituitary gland tumors, and ectopic ACTH production from lung cancer.
• Signs & Symptoms: Weight gain (face, abdomen, upper back), thin arms and legs, purple stretch marks, fragile skin, high blood pressure, weak muscles and bones, mood changes (depression).
• Complications: Diabetes, hypertension, osteoporosis, infections, cardiovascular issues.
• Diagnostic Tests: 24-hour urinary free cortisol test, low dose dexamethasone suppression test, salivary cortisol levels, and imaging (CT/MRI).
• Treatment & Management: Reduce cortisol levels and address the underlying cause (surgery).

Addison Disease

• Pathophysiology: Adrenal glands don't produce enough cortisol and aldosterone, affecting stress response, blood pressure, and electrolyte balance.
• Etiology (Causes): Autoimmune destruction of adrenal glands, infections, cancer metastasis to adrenal glands, and medications.
• Signs & Symptoms: Fatigue, weight loss, decreased appetite ,darkening of skin, low blood pressure, dizziness, salt cravings, nausea, vomiting and diarrhea.
• Complications: Addisonian crisis (severe low cortisol, life-threatening), shock (low blood pressure), and electrolyte imbalances
• Diagnostic Tests: ACTH stimulation test, cortisol levels, electrolyte levels, and imaging of adrenal glands.
• Treatment & Management: Replace missing hormones and manage symptoms.

Hyperthyroidism

• Pathophysiology: Thyroid gland produces too much thyroid hormone, speeding up metabolism.
• Etiology (Causes): Graves' disease (autoimmune), thyroid nodules, thyroiditis (inflammation), and excessive iodine intake.
• Signs & Symptoms: Weight loss, fast/irregular heartbeat, sweating, anxiety/nervousness, tremors, enlarged thyroid, and bulging eyes.
• Complications: Heart problems, osteoporosis, and thyroid storm.
• Diagnostic Tests: TSH levels (low), free T3 and T4 levels (high), thyroid scan and uptake test, and antibody tests.
• Treatment & Management: Slow down thyroid hormone production (antithyroid medications, radioactive iodine therapy, surgery).

Hypothyroidism

• Pathophysiology: Thyroid gland doesn't produce enough thyroid hormone, slowing down metabolism.
• Etiology (Causes): Autoimmune disease (Hashimoto's thyroiditis), iodine deficiency, thyroid surgery/radiation, and medications.
• Signs & Symptoms: Fatigue, weight gain, cold intolerance, dry skin/hair, depression, constipation, slow heart rate, and puffy face.
• Complications: Myxedema (severe hypothyroidism, life-threatening), infertility, and heart disease.
• Diagnostic Tests: TSH levels (high), free T3 and T4 levels (low), and thyroid antibody tests.
• Treatment & Management: Replace missing thyroid hormones (levothyroxine).

Pelvic Inflammatory Disease (PID)

• Pathophysiology: Infection of the upper genital tract (uterus, fallopian tubes, ovaries, cervix) primarily caused by Chlamydia trachomatis and Neisseria gonorrhoeae.
• Signs & Symptoms: Often asymptomatic, but may include adnexal tenderness, pain during intercourse, uterine tenderness, fever, chills, and unusual bleeding.
• Complications: Ectopic pregnancy, infertility, and abscess formation.
• Diagnostic Tests: Pelvic exam, swabs for bacterial infections, ultrasound, and laparoscopy.
• Treatment & Management: Antibiotic treatment, abstinence from intercourse, pain management, and safe sex education.

Polycystic Ovarian Syndrome (PCOS)

• Pathophysiology: Excessive androgen production leading to irregular ovulation and cyst formation in ovaries.
• Signs & Symptoms: Irregular menstrual cycles, hirsutism (excess hair growth), weight gain, and acne.
• Etiology: Insulin resistance linked to obesity and genetic predisposition.
• Complications: Increased risk of high blood pressure, diabetes, and fertility issues.
• Diagnostic Tests: Ultrasound, blood tests (hormone levels), and possibly a pelvic exam.
• Treatment & Management: Lifestyle changes, hormonal treatments, and possibly surgery.

Benign Prostatic Hyperplasia (BPH)

• Pathophysiology: Non-malignant enlargement of the prostate gland often leading to lower urinary tract symptoms (LUTS) in men.
• Prevalence: Increases with age, common in men over 50.
• Symptoms: Nocturia (frequent urination at night), poor urine stream, hesitancy (difficulty starting urination), and prolonged micturition (urination).
• Diagnostic Tests: Medical history, physical exam, urine tests, blood tests (PSA), imaging (ultrasound), and possibly a pelvic exam.
• Treatment & Management: Medications (alpha-blockers, 5-alpha reductase inhibitors), or surgery in severe cases.

Erectile Dysfunction (ED)

• Definition: Persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance.
• Causes: Alcohol use, depression, vascular disease, diabetes, prostate injuries, hypertension, atherosclerosis.
• Diagnosis: Medical & sexual history review, physical exam, and laboratory tests (blood count, urinalysis, lipid profile hormone levels).
• Treatment Options: Address underlying causes, medications (like sildenafil), and possibly testosterone replacement therapy.