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…

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…

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…

Esophageal Motility and Esophagitis

Motility Disorders and Esophagitis are must-know esophageal pathologies are NOT inherently malignant (cancerous), but may be associated with increased risk for malignancy.     Motility Disorders Achalasia – failure of the lower esophageal sphincter (LES) to relax. Pathophysiology:  ganglion cell and myenteric plexus breakdown, cholinergic nerve predominance leading to persistent contraction of muscle. Cancer risk:  squamous…

Introduction to Esophageal Problems

The very first entry in my GI & Hepatology study outline series will set the stage/define major descriptors of proximal GI (esophageal) symptoms and help with categorizing pathology. Dysphagia = the sensation that food and/or liquid is not appropriately going through the mouth/throat/esophagus.  Typical symptoms:  “food is getting stuck / impeded.” Oropharyngeal phase – food bolus…

ACLS Protocols

As a senior internal medicine resident on night float and overnight call, I’m responsible for running to codes and rapid responses.  Rapid responses at my institution are critical patient situations that require urgent bedside attention for things like symptomatic supraventricular tachycardia, new typical chest pain, hemodynamic instability, etc.  Today after work, I wanted to brush up…

HFpEF Treatment

These patients tend to be very VOLUME SENSITIVE. Daily weight checks – get an accurate bathroom scale. No medications have proven mortality benefit. Treat causes Hypertension – lower the patient’s blood pressure Tachycardia – AV nodal blockade depending on etiology.   Bibliography ACP MKSAP 17:  Cardiovascular Medicine, pp. 32-34 Image credit (follow link)