PGY-3

Authored during my third year of internal medicine residency (PGY-3).

Stomach and Duodenal Disease

The stomach and duodenum comprise two well elucidated, critical organs in the digestive process.  I will review Peptic Ulcer Disease, Dyspepsia, H. pylori, gastroparesis, and other similar pathology in this post.     Peptic Ulcer Disease (PUD) Clinically: Typical symptoms = epigastric pain; eating may either hurt/help the pain, early satiety, nausea, bloating, nocturnal pain (suggesting duodenal …

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Esophageal Metaplasia and Neoplasia

Esophageal cancer accounts for a jaw-dropping amount of cancer-related deaths, and is now classified as the 6th-highest cause of death in this group.  In this installment of the study guide series, I will discuss Barrett Esophagus (I learned this entity as Barrett Metaplasia) and esophageal cancer (neoplasia).   Barrett Metaplasia Metaplasia:  columnar epithelium replaces the physiologic squamous epithelium …

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Gastroesophageal Reflux Disease (GERD)

GERD is incredibly common, with an estimated prevalence of 10-20% in the Western hemisphere.  It’s important to note that GERD has many overlap symptoms with cardiac chest pain, thus cardiovascular causes should be ruled out first before the diagnosis of GERD.   GERD Clinically Insomnia/poor sleep quality, diminished work output Typical heartburn, liquid regurgitation with resultant metallic or …

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Microscopic Colitis

In patients that complain of long-standing, watery diarrhea, consider Microscopic Colitis.   Microscopic Colitis 10-15% of patients with aforementioned symptoms. Typical profile:  Old people with unrevealing gross colonoscopy exam. MUST biopsy, since the differential includes Celiac and IBS. Subtypes Lymphocytic and Collagenous colitis Pathophysiology Unknown, may be due to PPIs or NSAIDs Important!  Test for other …

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Inflammatory Bowel Disease (IBD)

IBD is an important clinical entity, made up of two idiopathic processes:  Crohn Disease (CD) and Ulcerative Colitis (UC).  Risk factors involve both genetic (higher incidence in identical twins) and environmental sources.  Cigarette smoking = risk factor for CD, protective for UC.  Northern populations see higher rates of IBD.  Note:  may utilize ESR and CRP levels to …

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