Case Study 5: Epigastric Pain - CRASH! Medical Review Series

[@TrollsAreFunny]

Excellent video, I think when you asked on Reddit what people were interested in seeing, this definitely aligns with most people (including myself) would enjoy

[@snowps1]

Epigastric pain is miserable.

[@waelfadlallah8939]

Excellent!!!!!! Love these cases :)

[@Katie-vy5rd]

Thank you!

[@RobertLevitPhD]

Nice summary with action items for knowledgable patients.

[@authentic_living]

What about getting an endoscopy without stopping PPIs, would you still have a firm belief in the biopsies? Lots and lots and lots of pud med publication will tell you that the biopsies would not be accurate. Lots of people are in ppis before they get to their Gastros and Gastros don’t follow the Stop ppis for a few weeks prior to endoscopy.. you didn’t talk about that. Lots of endoscopy mistakes due to that.. a simple stop of ppis prior to endoscopy.

[@woloabel]

(On Friday of January 27, 2023). On the Case Scenario of Chronic Abdominal Pain (lasting > than 3 Months), the Following Signs And Symptoms Predominate: 1) Alarm Symptoms: Anemia, Dysphagia, Hematemesis, Melena, Persistent Vomiting, or Involuntary Weight Loss; While Barrett's Esophagus (BE) Risk Factors: Age > 50, Male, White Race, Family History (FHx) of Such Disease, Or Esophageal Adenocarcinoma, Prolonged Reflux Sx, Smoking and Obesity (BMI in the Case 30; Positive); Also, Sore throat, Metallic/Bitter Taste, Hoarseness, Chronic Cough, and Wheezing (EKG will Exclude Myocardial Infarction (MI); The Barret's Esophagus is A Microbiological (Pathology) Diagnosis as such can only be visualized via a Stained (and processed) Tissue (Biopsy) showing Metaplasia (Dysplasia is certainly visible on Endoscopic Visualization) where the Normal Squamous-Lined Epithelium of the Esophagus is Replaced by Columnar Structures Typical of the Stomach Epithelium; Management (Mx) of GERD is with 1) Proton Pump Inhibitors Drug Class (Omeprazole, Esomeprazole and the like); Recommendations for GERD are 2) Losing Weight, Smoking Cessation, Alcohol Abstention, Exercise Program advice, Upright Siting Postprandial (for at least 3 hours prior to a Meal) along with a 3) Repeated, Scheduled Endogastroduodenoscopy (Gastroenterology Endoscopy and Referral (when Barrett's Esophagus Diagnosis) for Monitoring of Treatment and for Metaplasia Progression (Dysplasia entails a Progression to Anaplasia); Epigastrium Localization of Pain and Relevant Pathologies: 1) Acute Esophagitis (the case is Chronic); 2) Acute Pancreatitis (idem); 3) Acute Mesenteric Ischemia (idem); 4) Peptic Ulcer Disease (PUD); 5) Mallory-Weiss Syndrome (A Tear Within the Esophageal Mucosa); 6) Myocardial Infarction (MI) is preliminarily Excluded with an EKG; 7) Pericarditis (An Acute Inflammation of the Outer Layer of the Heart; 8) Abdominal Aortic Aneurysm (AAA) is an Acute Lesion; and 9) Aortic Dissection (AD) is also Acute; Therefore, when Gastroesophageal Reflux Disease (GERD) is a Possibility a Physical Examination will show no other Localization or Pathology on Review of Systems (ROS); DDx: 1) Gastroesophageal Reflux Disease (GERD); 2) Peptic Ulcer Disease (PUD); 3) Gastritis; 4) Biliary Colic; 5) Esophageal Carcinoma; 6) Gastric Carcinoma; 7) Functional Dyspepsia (A Diagnosis of Exclusion); and 8) Anemia (CBC); Dx: 1) Standard Preliminary Laboratory Post Physical Examination (Px) follow: 1) Complete Blood Counts (CBC); 2) Basic Metabolic Panel (A Standard of Eight Serum Investigations); 3) Liver Function Test (Gastrointestinal Signs and System Investigations Standard Diagnostic)Hepatitis or Cirrhosis Pattern; 4) Electrocardiogram (EKGorECG) for A Possible Myocardial Infarction (MI) or rather to Exclude this Possibility; 5) Upper Endoscopy With Biopsy (This Will Assess The Cytological Pattern Within the Tissue); Goodness. My First GERD Diagnosis. Not Really, the Biopsy Should Significant Dysplastic Features of High-Grade Dysplasia but my personally Reckoning is this is Adenocarcinoma of the Esophagus (High-Rate of Mitoses, Hyperchromatic Cells and Anisocytosis should always be Malignancy). MD Paul Bolin, es geht gut zu fahren langer und tiefer uber Gesundheit aber man kann nicht ewig sein. Heil!