Friday, October 21, 2022: Gastroenterology: Gastroesophageal Reflux Disease (GERD), is Pathology of the Lower Esophageal Junction (LEJ) having excessive relaxation therein and resulting in Acidic Backflow of Stomach Acid onto the Esophagus, otherwise "Heartburn"; Ax: 1) Idiopathic; Risk Factors (RFx): 1) Obesity, 2) Older Age (> 50), 3) Family History (FHx), 4) Hiatal Hernia, 5) Certain Drugs (Calcium Channel Blockers [CCB]); SSx: 1) Epigastric Pain, 2) "Sore Throat", 3) Hoarseness, 4) Cough, 5) Wheezing, 6) "Bad Taste in Mouth", 7) Vomiting, 8) Alarm Symptoms: 1) Weight Loss/Cachexia, 2) Anemia, 3) Heme Positive Stool (Stool Texture/Color is Tarry and Dark), 4) Dysphagia, 5) Odynophagia, 6) Long-Standing GERD (Chronic), 7) Age (> 50); Epigastric Pain Differential: 1) Idiopathic (MCC), 2) GERD, 3) Peptic Ulcer Disease (PUD), 4) Gastritis, 5) Pancreatitis, 6) Other Causes, 7) Neoplasia/Cancer (Gastric, Esophageal, Pancreatic, etc), 8) Referred or Misappropriated Pain (Pelvic Pain, etc); DDx: 1) Angina Pectoris (Stable, Unstable, Coronary Artery Disease and EKG Diagnosis) otherwise Chest Pain, 2) Esophageal Motility Disorder (Achalasia and Dysphagia), 3) Peptic Ulcer; Cx: 1) Aspiration Pneumonia (Wheezing, Hoarseness and Cough on Px and Documentation of such); 2) Eroded Tooth Enamel (Longstanding GERD); Dx: 1) Upper Endoscopy (All Subjects > 50 and those with Alarm Symptoms), 2) Clinical Diagnosis (Clear GERD Symptomatology), 3) 24 Hour pH Monitoring and Manometry (Persistent Symptoms and Treatment or Those with Questionable GERD); Tx: Proton Pump Inhibitors (PPIs as in Esomeprazole,. Omeprazole, etc) is the Standard of Care (SOC); 2) Histamine 2 Antagonists/Inhibitors (Second Line Tx and Less Effective); 3) Lifestyle Modifications is always advisable: 1) Weight Loss, 2) Food and Water Avoidance within 3 Hours of Bedtime, 3) Avoidance of Caffeine, Nicotine, Alcohol, Chocolate, Fried/Fatty Foods, 4) Smaller Meals, 5) Head Elevation at Night (~ 8 inches), 6) Left Lateral Decubitus Position Sleep Advice; 4) Surgery as the most precise and Late-stage Treatment: 1) Nissen Fundoplication for Chronic and Refractory GERD; and Complications (Cx) of GERD: 1) Strictures and 2) progression to Barrett's Esophagus (Squamocolumnar Metaplasia due to Chronic Acid Exposure; Dx is made with Upper Endoscopy and Biopsy [Goblett's Cells are indicative of the Colonification of the Esophagus) and 3) Malignancy (Dysplasia and Anaplasia) as in Adenocarcinoma of the Esophagus. For Low-Grade Dysplasia Upper Endoscopy q6 Months thereafter; High Grade Dysplasia warrants Distal Esophagectomy. When Histologic Changes are the only finding Endoscopy is mandated every 2-3 Years thereafter. PPIs are always Indicated in these Patients/subjects. Goodness, my first Francoanaplastic Diagnosis. Just Kidding. The Subject was successfully treated with intermittent PPIs Therapy and later developed Gastric Adenocarcinoma demanding a Gastrectomy. MD Paul Bolin, zu essen natuerlich ist aber zu Leben zu essen schade und verboden ist. Heil!
@user-ld3do8ye5g
5 жыл бұрын
Thank you very much... We are waiting you to update other videos please....
@imperiusss
5 жыл бұрын
Sir please make a playlist of Dermatology. It would help us out a lot!! thank you
@fatetakamachi77
5 жыл бұрын
Thank you for reuploading it, Paul!
@cmetube
5 жыл бұрын
Merry Christmas Paul and everybody watching!
@vksharma1131
3 жыл бұрын
video is so good and explanation is so easy
@DrDinooshDeLivera
5 жыл бұрын
Thank you so much! I absolutely loved the whole series!
@umairaarif6535
5 жыл бұрын
Thanks for your hard work, Dr. Bolin.
@DrSulaimaan
2 жыл бұрын
Thanks doctor 👨⚕️
@Almedicosis
Жыл бұрын
thank you so much😄
@marwaa2895
3 жыл бұрын
Thank you for your efforts doctor 👏 very helpful
@samphonnetgamgee5625
6 ай бұрын
I watched this about 1 year ago and now suddenly the volume is too low.
@sabiaafreen4481
5 жыл бұрын
Thank you so much for your videos, Dr Bolin!
@deedeefleur
5 жыл бұрын
Thank you Dr. Paul! ♥️
@Idlaff
5 жыл бұрын
Thanks so much
@juansebz
11 ай бұрын
Thank you very much for the video upload Doc. Paul. I have an endoscopy/colonoscopy procedure coming up on the 19th of this month. First time doing an endoscopy so I have a question. How long do you have to have an acid reflux issue to chronically damage the esophagus?. This is my biggest concern here. Personally, I’ve been having issues with it since late march 2023 (7 months!). And last but not least, does having a gurgling sensation in the throat quite often and numbness or sensitiveness in the lower gum also means there’s problem with the esophagus?. It will really help if you could answer me. Thank you!.
@sarahsen6504
4 жыл бұрын
Thank u
@siavashkhazali5842
Жыл бұрын
Eroded tooth enamel could be a sign of bulimia as well.
@brittanygulker2051
Жыл бұрын
No mention of pregnancy as a risk factor for developing GERD?
@Hasan-wp9qw
5 жыл бұрын
Some videos don’t have sound, why don’t you reupload them ?
@intimaaabueid8461
5 жыл бұрын
Thank you ☘️☘️
@mennaassal2882
5 жыл бұрын
thank you so much ! would you please review the cardiology videos? alot of them has no audio :( :( :(
@mikkelbakjensen2350
5 жыл бұрын
Thank you for the video - now with sound ;-)
@yemjoe525
3 жыл бұрын
Nice videos , by the way, what textbook do you prepare your slides from
@pritamshil5765
16 күн бұрын
Sir, are there risks of a woman in pregnancy with Chronic calcific pancreatitis?
@komaddog
5 жыл бұрын
Just in time
@mehmetkaya3711
4 жыл бұрын
You need to add Acute Pancreatitis into the differential diagnosis.
@clarewu8125
5 жыл бұрын
I keep trying to become a patron but the webpage won't load.
@omidceazar5951
5 жыл бұрын
What are the long term consequences of Chronic PPI use? Should patients with GERD but without Barretts be on chronic PPIs
@queerveganmedstudent9893
5 жыл бұрын
Hypomagnesemia has been coming up lately.
@samreenmulla3926
5 жыл бұрын
Does this work for Australian Medical Council excluding the screening criteria.
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