Damn, we're working out a patiënt recently hospitalisted on gastro-enterology and all of the alarm symptoms for peptic ulcers fit almost perfectly with his clinical presentation.... thank you for clearing my mind
Friday, October 21, 2022. Gastroenterology: 1) Peptic Ulcer Disease (PUD) is Ulceration of the Stomach/Duodenum Mucosa and 2) Gastritis (Generalized Inflammation of the Stomach); Ax: 1) Non-Steroidal Anti-Inflammatory Drug (NSAIDs) Long Term Use and 2) Helicobacter pylori Bacteria Infection; 3) Other Causes (Crohn's Disease and Zollinger-Ellison Syndrome [Gastrin Secreting Tumor]); 4) Head Trauma (Cushing's Ulcer), 5) Burns (Curling's Ulcer), 6) Mechanical Ventilation; SSx/ Gastrointestinal Alarm Symptoms: 1) Weight Loss, 2) Anemia, 3) Hemoglobin Positive Stool (Melena) and/or Hematemesis, 4) Early Satiety, 5) Odynophagia or Dysphagia, 6) Age (> 45) can warrant Endoscopy; and Above all 1) Epigastric Pain permits a Differential Diagnosis of which Myocardial Infarction and Malignancy must be Excluded; Dx: 1) H. pylori Infection Diagnostics: 1) Serology (most Sensitive Testing Modality), 2) Gastric Biopsy via Endoscopy is the Most Specific/Accurate Testing Modality; 3) Stool Antigen (Ideal for Monitoring PPI Therapy and Active Infection Diagnosis); and 4) Urea Breath Test; 2) Basic Laboratory Tests: 1) Complete Blood Count (CBC), 2) Complete Metabolic Panel (CMP) for any Liver Abnormality; 3) Vitamin B 12 Levels (Low Intake or Pernicious Anemia); and 4) Methyl Malonic Acid (MMA) Levels; and 5) Occult Stool Blood Test; When there is Alarm Symptoms and Active Bleeding 3) Endoscopy is warranted; Tx: 1) All Subjects merit Proton Pump Inhibitors (PPIs) Therapy; 2) If H. Pylori Positive Antibiotics Clarithromycin and Amoxicillin are Indicated (Triple Therapy; Alternate Therapy is Metronidazole and Tetracycline with Endoscopy); 3) NSAIDs Discontinuation (COX-2 Inhibitors if Necessary; Cardiology Referral maybe Warranted); 4) Stool Antigen Test for Resolution of Infection at 2-4 Wees Thereafter; 5) Non-H. pylori PUD warrants Endoscopy (6-8 Weeks Post Therapy); It is useful to note Tobacco and Alcohol Consumption do not Cause PUD, but do delay Healing (Ulceration appears to be perpetual rather than a Sequela of Disease); Cx: 1) Perforation is a Surgical Emergency (Perforating Ulcer becomes Worse and Pain is Significantly More; Dx: Abdominal Film showing Subdiaphragmatic Air; Tx: Surgery Stat Thereafter); 2) Malignancy Risk Factor and Development: 1) Gastric Adenocarcinoma, and 2) Mucosa Associated Lymphoid Tissue (MALT) Lymphoma (SSx: Refractory to Therapy; Dx: Biopsy, Tx; Surgical Resection); 3) Gastric Outlet Obstruction (Rare Incidence, SSx: Early Satiety, Weight Loss, Vomiting; Dx: Endoscopy; Tx: Surgical Resection); In Gastritis: SSx are Similar to PUD with Epigastric Pain; DDx: 1) Vitamin B 12 Deficiency Gastritis (Low B 12, High MMA, Macrocytic Anemia [ MCV. 100] and Negative for 1) Anti-parietal Cell Antibodies and 2) Anti-Intrinsic Factor Antibodies) is usually caused by 1) Malnutrition and 2) Alcoholism; Tx: Vitamin B 12 Replacement (Usually Intravenous Infusion); 2) Pernicious Anemia (Autoimmune Gastritis) is an infiltrative Disease Process of an Autoimmune Mechanism where antibodies against the Parietal Cell of the Stomach are Made; Hx: 1) Usually a Family History of Pernicious Anemia or some other Autoimmune Disease is Present (FHx Positive); SSx: 1) Epigastric pain; 2) Fatigue; 3) Pallor, 4) Reduced Peripheral Vibratory Sensation on Physical Examination is Positive/Present; Dx: 1) Low Vitamin B 12; 2) High Methyl Malonic Acid; 3) Macrocytic Anemia is Present; 4) Hypochlorhydria (Low Stomach Acid); 5) Positive Anti-parietal Cell Antibodies and Anti-intrinsic Factor Antibodies (Intrinsic Factor Protein Antibodies); Tx: Vitamin B 12 Replacement/Replenishment. 3) Atrophic Gastritis (AG) is the End-Stage of Chronic Gastritis irrespective of Aetiology; Dx: 1) Endoscopy and 2) HIstological Assessment via Biopsy (Showing Decrease Rugal Folds): 1) Achlorhydria/Hypochlorhydria and 2) Low Vitamin B 12 (Cobalamin) due to Chronic Inflammation and Decreased Secretion of Intrinsic Factor (IF); Tx: 1) Elimination of the Aetiologic Agent (Usually H. pylori Bacteria Infection with Triple Therapy or what not); 2) Complication Correction is Standard of Care (Gastric Carcinoma Association is High and therefore warrants Monitoring for such Disease Process). Goodness, such a morbid Disease Process and with such predictable complications. MD Paul Bolin, es geht gut. Heil!
Amazing video Sir. I have one thing to perhaps add simple basic thing - In the visceral organs we cannot feel pain due to cuts - that is the reason we don't feel sharp pain due to ulcers in stomach; the pain felt infact is burning type which is due to localised inflammation which occurs after ulcers.
Hello Dr Bolin, these videos are amazing. I'm going through these one by one these days. Umm. I would also like to request one thing if it's possible. In future, if you have plan to fix or update any of these, would you use pale blue or pale green background please, like avocado green or surgical mask blue color, or like the one u have used in ophthalmology or psychiatry. I don't know if it's only me. I get drowsy and sleepy at this color. That's the reason I'm requesting. Thanks in advance. :D
Thanks, Dr. Bolin for your great videos on youtube and Patreon.However, we need two more videos for statistics as questions only , so please if you could add review stat question videos, we will be so grateful.
what if you have ulcers on the back wall of the stomach also known as posterior penetrating peptic ulcers? What is the solution there? It seems even surgery wouldn't be an option there since it's hard to perform it on that area of the stomach? plus surgery is associated with high mortality rate. can you do a video on that? You'd be doing a favor for a lot of people since there is hardly any information on this subject. Thanks.
Omg I have gastritis right and it’s painful! Omg I went to Korea and drank their whiskey and been very sick since then! I also was drinking a lot of coffee on my trip there. Never had this type of stomach pain before, horrible burning sensation with chills. Luckily my liver and kidney are okay 😢 learned my lesson. I’m quitting alcohol
If someone having H pylori positive, devolps severe diarrhea with amoxicillin and is resistant to quadruple regime(Omeprazole,bismuth, metronidazole and tetracycline) what should be the plan for him.
celecoxib is selective nsaid tht inhibits cox-2 only, not cox-1 that has role as gastric surface protectant.. so we still can use it without worrying the med will further worsen the situations
lexusfan100 - In most types of pernicious anemia, acid secreting (parietal) cells are lost and cannot respond to gastrin. But the cells that secrete gastrin (in the antrum) are not. It’s basically a loss of negative feedback. Much like how you get a high TSH when you have a non-functioning thyroid gland.
Thank you. Your videos really helped me a lot in my struggles in medschool.
Damn, we're working out a patiënt recently hospitalisted on gastro-enterology and all of the alarm symptoms for peptic ulcers fit almost perfectly with his clinical presentation.... thank you for clearing my mind
Friday, October 21, 2022. Gastroenterology: 1) Peptic Ulcer Disease (PUD) is Ulceration of the Stomach/Duodenum Mucosa and 2) Gastritis (Generalized Inflammation of the Stomach); Ax: 1) Non-Steroidal Anti-Inflammatory Drug (NSAIDs) Long Term Use and 2) Helicobacter pylori Bacteria Infection; 3) Other Causes (Crohn's Disease and Zollinger-Ellison Syndrome [Gastrin Secreting Tumor]); 4) Head Trauma (Cushing's Ulcer), 5) Burns (Curling's Ulcer), 6) Mechanical Ventilation; SSx/ Gastrointestinal Alarm Symptoms: 1) Weight Loss, 2) Anemia, 3) Hemoglobin Positive Stool (Melena) and/or Hematemesis, 4) Early Satiety, 5) Odynophagia or Dysphagia, 6) Age (> 45) can warrant Endoscopy; and Above all 1) Epigastric Pain permits a Differential Diagnosis of which Myocardial Infarction and Malignancy must be Excluded; Dx: 1) H. pylori Infection Diagnostics: 1) Serology (most Sensitive Testing Modality), 2) Gastric Biopsy via Endoscopy is the Most Specific/Accurate Testing Modality; 3) Stool Antigen (Ideal for Monitoring PPI Therapy and Active Infection Diagnosis); and 4) Urea Breath Test; 2) Basic Laboratory Tests: 1) Complete Blood Count (CBC), 2) Complete Metabolic Panel (CMP) for any Liver Abnormality; 3) Vitamin B 12 Levels (Low Intake or Pernicious Anemia); and 4) Methyl Malonic Acid (MMA) Levels; and 5) Occult Stool Blood Test; When there is Alarm Symptoms and Active Bleeding 3) Endoscopy is warranted; Tx: 1) All Subjects merit Proton Pump Inhibitors (PPIs) Therapy; 2) If H. Pylori Positive Antibiotics Clarithromycin and Amoxicillin are Indicated (Triple Therapy; Alternate Therapy is Metronidazole and Tetracycline with Endoscopy); 3) NSAIDs Discontinuation (COX-2 Inhibitors if Necessary; Cardiology Referral maybe Warranted); 4) Stool Antigen Test for Resolution of Infection at 2-4 Wees Thereafter; 5) Non-H. pylori PUD warrants Endoscopy (6-8 Weeks Post Therapy); It is useful to note Tobacco and Alcohol Consumption do not Cause PUD, but do delay Healing (Ulceration appears to be perpetual rather than a Sequela of Disease); Cx: 1) Perforation is a Surgical Emergency (Perforating Ulcer becomes Worse and Pain is Significantly More; Dx: Abdominal Film showing Subdiaphragmatic Air; Tx: Surgery Stat Thereafter); 2) Malignancy Risk Factor and Development: 1) Gastric Adenocarcinoma, and 2) Mucosa Associated Lymphoid Tissue (MALT) Lymphoma (SSx: Refractory to Therapy; Dx: Biopsy, Tx; Surgical Resection); 3) Gastric Outlet Obstruction (Rare Incidence, SSx: Early Satiety, Weight Loss, Vomiting; Dx: Endoscopy; Tx: Surgical Resection); In Gastritis: SSx are Similar to PUD with Epigastric Pain; DDx: 1) Vitamin B 12 Deficiency Gastritis (Low B 12, High MMA, Macrocytic Anemia [ MCV. 100] and Negative for 1) Anti-parietal Cell Antibodies and 2) Anti-Intrinsic Factor Antibodies) is usually caused by 1) Malnutrition and 2) Alcoholism; Tx: Vitamin B 12 Replacement (Usually Intravenous Infusion); 2) Pernicious Anemia (Autoimmune Gastritis) is an infiltrative Disease Process of an Autoimmune Mechanism where antibodies against the Parietal Cell of the Stomach are Made; Hx: 1) Usually a Family History of Pernicious Anemia or some other Autoimmune Disease is Present (FHx Positive); SSx: 1) Epigastric pain; 2) Fatigue; 3) Pallor, 4) Reduced Peripheral Vibratory Sensation on Physical Examination is Positive/Present; Dx: 1) Low Vitamin B 12; 2) High Methyl Malonic Acid; 3) Macrocytic Anemia is Present; 4) Hypochlorhydria (Low Stomach Acid); 5) Positive Anti-parietal Cell Antibodies and Anti-intrinsic Factor Antibodies (Intrinsic Factor Protein Antibodies); Tx: Vitamin B 12 Replacement/Replenishment. 3) Atrophic Gastritis (AG) is the End-Stage of Chronic Gastritis irrespective of Aetiology; Dx: 1) Endoscopy and 2) HIstological Assessment via Biopsy (Showing Decrease Rugal Folds): 1) Achlorhydria/Hypochlorhydria and 2) Low Vitamin B 12 (Cobalamin) due to Chronic Inflammation and Decreased Secretion of Intrinsic Factor (IF); Tx: 1) Elimination of the Aetiologic Agent (Usually H. pylori Bacteria Infection with Triple Therapy or what not); 2) Complication Correction is Standard of Care (Gastric Carcinoma Association is High and therefore warrants Monitoring for such Disease Process). Goodness, such a morbid Disease Process and with such predictable complications. MD Paul Bolin, es geht gut. Heil!
Amazing video Sir. I have one thing to perhaps add simple basic thing - In the visceral organs we cannot feel pain due to cuts - that is the reason we don't feel sharp pain due to ulcers in stomach; the pain felt infact is burning type which is due to localised inflammation which occurs after ulcers.
Hello Dr Bolin, these videos are amazing. I'm going through these one by one these days. Umm. I would also like to request one thing if it's possible. In future, if you have plan to fix or update any of these, would you use pale blue or pale green background please, like avocado green or surgical mask blue color, or like the one u have used in ophthalmology or psychiatry. I don't know if it's only me. I get drowsy and sleepy at this color. That's the reason I'm requesting. Thanks in advance. :D
Thanks, Dr. Bolin for your great videos on youtube and Patreon.However, we need two more videos for statistics as questions only
, so please if you could add review stat question videos, we will be so grateful.
Thank you Dr. Bolin!
Thank you Dr. Bolin
Absolutely outstanding
Greatest lectures ever
Sire ur previous lectures.. gerd and esophageal disorders have no audio.. please help us sir
what if you have ulcers on the back wall of the stomach also known as posterior penetrating peptic ulcers?
What is the solution there? It seems even surgery wouldn't be an option there since it's hard to perform it on that area of the stomach? plus surgery is associated with high mortality rate.
can you do a video on that? You'd be doing a favor for a lot of people since there is hardly any information on this subject.
Thanks.
Thank you
Omg I have gastritis right and it’s painful! Omg I went to Korea and drank their whiskey and been very sick since then! I also was drinking a lot of coffee on my trip there.
Never had this type of stomach pain before, horrible burning sensation with chills. Luckily my liver and kidney are okay 😢 learned my lesson. I’m quitting alcohol
There is no audio and the video is buffering. That's a shame...seemed like a good lecture on epigastric physiology.
Thank you sir
If someone having H pylori positive, devolps severe diarrhea with amoxicillin and is resistant to quadruple regime(Omeprazole,bismuth, metronidazole and tetracycline) what should be the plan for him.
Gastric carcinoma treatment sir ? Only treatmented for causative agents?
From where i can get your slides Sir
If patients have alarm sx, should they get upper or lower endoscopy?
Legend ❤️
How do you treat gastritis ?
my doctor gives me antacids mostly
Celecoxib can as well cause PUD, I'm sorry if I'm being rude, but is it OK to use them as alternative to, let's say, Acetaminophen?!
celecoxib is selective nsaid tht inhibits cox-2 only, not cox-1 that has role as gastric surface protectant.. so we still can use it without worrying the med will further worsen the situations
Good
What's the most appropriate test to ensure H pylori eradication? Is it urea breath test or the stool antigen?
Urea has higher specificity.
i dont understand hypochloridia or high gastrin in pernicious anemia. I thought high gastrin means high acid ...therefore hyperchloridia? confused..
lexusfan100 - In most types of pernicious anemia, acid secreting (parietal) cells are lost and cannot respond to gastrin. But the cells that secrete gastrin (in the antrum) are not. It’s basically a loss of negative feedback. Much like how you get a high TSH when you have a non-functioning thyroid gland.
12:12 >50y
Good by dr.paul bolin high yeild
Nothing on here talks about diet change or fasting. Most (if not all) diseases are metabolic. Change your diet, change your life.
Thank you Dr. Bolin!