Diferencia entre revisiones de «Gastroesophageal reflux disease»
(Addition to the clinical features.) |
Sin resumen de edición |
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| Línea 1: | Línea 1: | ||
==Background== | ==Background== | ||
*Abbreviation: GERD | |||
*Affects up to 20% of population | *Affects up to 20% of population | ||
*Assume chest pain is cardiac origin until proven otherwise | *Assume chest pain is cardiac origin until proven otherwise | ||
===Causes=== | ===Causes=== | ||
*Decreased pressure of lower esophageal sphincter | *Decreased pressure of lower esophageal sphincter | ||
| Línea 8: | Línea 10: | ||
**[[Ethanol]] | **[[Ethanol]] | ||
**Caffeine | **Caffeine | ||
** | **Medications (mintrates, [[calcium-channel blockers]], [[anticholinergics]], progesterone/estrogen) | ||
**Pregnancy | **[[Pregnancy]] | ||
*Decreased esophageal motility | *Decreased esophageal motility | ||
**Achalasia | **[[Achalasia]] | ||
**Scleroderma | **[[Scleroderma]] | ||
**[[Diabetes]] | **[[Diabetes]] | ||
*Prolonged gastric emptying | *Prolonged gastric emptying | ||
Revisión del 11:12 3 nov 2016
Background
- Abbreviation: GERD
- Affects up to 20% of population
- Assume chest pain is cardiac origin until proven otherwise
Causes
- Decreased pressure of lower esophageal sphincter
- High-fat food
- Nicotine
- Ethanol
- Caffeine
- Medications (mintrates, calcium-channel blockers, anticholinergics, progesterone/estrogen)
- Pregnancy
- Decreased esophageal motility
- Prolonged gastric emptying
- Anticholinergics
- Outlet obstruction
- Diabetic gastroparesis
- High-fat food
Clinical Features
Patients who come to the Emergency may present with various symptoms, both typical and atypical.
- Typical symptoms, may include: heart burn, regurgitation of food or dysphagia.
- Atypical symptoms include noncardiac chest pain, asthma, pneumonia, hoarseness, and aspiration.
- Pain and discomfort with or right after meals
- typically described as burning pain
- often worse when lying flat
- Chest pain with features similar to ACS:
- Exertional, associated with diaphoresis, nausea/vomiting, radiating to arm
Pediatric GERD
- Reflux is physiologic in infants
- Pathologic only if it causes complications, such as:
Differential Diagnosis
Epigastric Pain
- Gastroesophageal reflux disease (GERD)
- Peptic ulcer disease with or without perforation
- Gastritis
- Pancreatitis
- Gallbladder disease
- Myocardial Ischemia
- Splenic Infarctionenlargement/rupture/aneurysm
- Pericarditis/Myocarditis
- Aortic dissection
- Hepatitis
- Pyelonephritis
- Pneumonia
- Pyogenic liver abscess
- Fitz-Hugh-Curtis Syndrome
- Hepatomegaly due to CHF
- Bowel obstruction
- SMA syndrome
- Pulmonary embolism
- Bezoar
- Ingested foreign body
Management
- Avoid GERD exacerbating agents (ETOH, caffeine, nicotine, chocolate, fatty foods)
- Sleep with head of bed elevated
- Avoid eating within 3hr of sleep
- PPI or H2 blocker
- Infants: small frequent feeds, avoid semi-supine position (e.g. carseat, carrier) right after feeds
- medications only if significant complications
Disposition
- Home (outpatient treatment)