Gastrointestinal and Hepatic Conditions: Diagnosis and Treatment

Posted on Mar 4, 2025 in Medicine & Health

GERD (Gastroesophageal Reflux Disease)

Diagnosis:

  • Exclude heart problems
  • Mostly clinical diagnosis (based on symptoms)
  • Barium Esophagram
  • EGD (Upper Endoscopy)
  • Motility & pH Testing
  • If chronic GERD or alarm symptoms are present:
    • Must do ECG & Biopsy

Treatment:

  1. Medications:
    • Proton Pump Inhibitors (PPIs) – Reduce the risk of Barrett’s Esophagus
    • Histamine Blockers
  2. Lifestyle Modifications:
    • Weight Loss
    • Avoid food or water 3 hours before bed
    • Avoid acidic foods
  3. Surgery:
    • If medical management fails
    • If biopsy proves Barrett’s Esophagus

Complications:

  1. Esophagitis
  2. Ulcers
  3. Barrett’s Esophagus, Cancer
  4. Pulmonary Problems: Asthma, cough, pneumonia, bronchitis caused by reflux
  5. Larynx problems

Esophageal Cancer

Types:

  1. Squamous Cell Carcinoma (SCC): Associated with smoking and alcohol use; affects the proximal 2/3 of the esophagus.
  2. Adenocarcinoma: Associated with long-standing GERD; affects the distal 1/3 of the esophagus.

Diagnosis:

  1. EGD & Biopsy: To confirm the diagnosis of esophageal carcinoma.
  2. Esophageal Ultrasound: For staging.
  3. CT Scan: For abdominal metastases.

Note: Esophageal US and CT are follow-up investigations.

Treatment:

  1. Palliative: 5-Fluorouracil to shrink the tumor.
  2. Surgical Resection (only curative option): Depends on the depth, spread, and presence of metastases.

Peptic Ulcer Disease

Diagnosis:

  1. H. pylori Testing:
    • Serology
    • Gastric Biopsy
    • Urea Breath Test
    • Stool Antigen Test
  2. Endoscopy (for alarm symptoms)
  3. CBC (Complete Blood Count)
  4. CMP (Comprehensive Metabolic Panel)
  5. Vitamin B12 levels
  6. Occult Stool (for bleeding ulcer)

Treatment:

  1. Stop NSAIDs; give COX-2 inhibitors if NSAIDs are necessary.
  2. Triple Therapy (for H. pylori infection):
    1. PPI
    2. Clarithromycin
    3. Amoxicillin

Complications:

  1. Perforation: Diagnose with an abdominal film.
  2. Gastric Adenocarcinoma: Requires surgery.
  3. Gastric Outlet Obstruction: Requires surgery.

Gastritis

Diagnosis:

  • Check for H. pylori (serology)
  • CBC
  • CMP
  • B12 levels
  • Occult Blood

Treatment:

  1. H. pylori Positive:
    • PPI + Clarithromycin + Amoxicillin
  2. H. pylori Negative:
    • B12 Replacement

Hepatitis

Diagnosis:

  • CBC: Increased atypical lymphocytes
  • Dark urine
  • Jaundice
  • Urine Test: Increased urobilinogen
  • Serology Panel:
    • Type A: Anti-HAV IgM
    • Type C: Anti-HCV IgM, IgG
    • Type B: HBV antigens
  • Liver Enzymes

Treatment:

  1. Acute: Supportive treatment.
  2. Chronic:
    • Hepatitis B: Interferon-alpha, Lamivudine, Entecavir
    • Hepatitis C: Interferon-alpha, Ribavirin

Note: Liver transplant is the only definitive cure.

Esophageal Varices

Symptoms:

  • Melena +/- Hematemesis
  • Jaundice
  • Ascites
  • Spider Angioma

Diagnosis:

  1. EGD (Best initial test)
  2. Laboratory Tests:
    • CBC (Anemia)
    • CMP (Elevated AST, ALT)
    • High Ammonium levels
    • Prolonged PT

Treatment:

  • Octreotide
  • Sclerotherapy/Banding
  • TIPS (Transjugular Intrahepatic Portosystemic Shunt)
  • Balloon Tamponade

Cholestasis

Types:

  • Hepatocellular (e.g., Estrogen-related)
  • Obstructive (e.g., Gallstones)

Symptoms:

  • Jaundice
  • Pruritus
  • Xanthoma (in obstructive cases)
  • Malabsorption
  • Light-colored stool

Laboratory tests:

  • ALP (Alkaline Phosphatase): Increased
  • GGT (Gamma-Glutamyl Transferase): Increased
  • Bilirubin: Increased
  • Ultrasound: Bile duct dilated (in obstructive cases)

Treatment:

  • Manage underlying condition
  • Removal of cysts
  • Cholecystectomy (only in case of gallstones)

Inflammatory Bowel Disease (IBD)

Diagnosis:

Both types require colonoscopy + biopsy.

  1. Crohn’s Disease (CD):
    • ASCA (Anti-Saccharomyces cerevisiae antibodies) positive
    • Patchy damage
  2. Ulcerative Colitis (UC):
    • ANCA (Antineutrophil Cytoplasmic Antibodies) positive
    • Linear damage

Treatment:

  1. Mesalamine derivatives (5-ASA)
  2. Steroid-sparing agents (e.g., Azathioprine)
  3. Biologics:
    • Monoclonal Antibodies: Block TNF-alpha (e.g., Infliximab)
  4. Steroids: Methylprednisolone
  5. Surgery:
    • Effective for UC
    • Not effective for CD; if performed, remove as little as possible.

Ischemic Colitis

Diagnosis:

  • CT angiography of the abdominal aorta
  • Elevated lactate, LDH/Creatine Kinase

Treatment:

Goal: Restore blood flow

  • Thrombolytic enzymes (if thrombi are present)
  • Supportive care: Fluids, analgesics, antibiotics
  • Surgery:
    1. Embolism: Embolectomy
    2. Thrombi: Arterial bypass
    3. Non-occlusive: Vasodilators