Diferencia entre revisiones de «Gastroesophageal reflux disease»
(Text replacement - "==Diagnosis==" to "==Evaluation==") |
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| Línea 20: | Línea 20: | ||
*High-fat food | *High-fat food | ||
== | ==Evaluation== | ||
*Pain and discomfort with meals | *Pain and discomfort with meals | ||
*[[Chest pain]] with features similar to [[ACS]]: | *[[Chest pain]] with features similar to [[ACS]]: | ||
Revisión del 22:27 21 jul 2016
Background
- 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
- Meds (mintrates, CCBs, anticholinergics, progesterone/estrogen)
- Pregnancy
- Decreased esophageal motility
- Achalasia
- Scleroderma
- Diabetes
- Prolonged gastric emptying
- Anticholinergics
- Outlet obstruction
- Diabetic gastroparesis
- High-fat food
Evaluation
- Pain and discomfort with meals
- Chest pain with features similar to ACS:
- Exertional, associated with diaphoresis, nausea/vomiting, radiating to arm
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
Disposition
- Home (outpatient treatment)