Hiatal Hernia, Gastritis, and GI Ulcers

Hiatal Hernia:- Portion of the stomach slides into the thorax through the diaphragmatic hiatus - Sliding type (95%): Gastroesophageal junction slides above diaphragm — causes GERD - Rolling/paraesophageal type (5%): Fundus herniates beside esophagus; may strangulate — more dangerous - Symptoms: heartburn, regurgitation, chest pain (mimics cardiac), dysphagia - Treatment: lifestyle modifications (first-line), PPIs/H₂ blockers; surgery for symptomatic paraesophageal hernia Gastritis: - Inflammation of the gastric mucosa - Acute: NSAIDs, alcohol, H. pylori, stress, steroids - Chronic Type A (autoimmune/fundal): Autoimmune destruction of parietal cells → achlorhydria, intrinsic factor deficiency → pernicious anemia - Chronic Type B (antral/H. pylori): Most common; H. pylori (gram-negative); peptic ulcer risk - Symptoms: nausea, vomiting, epigastric pain, GI bleeding (hematemesis, melena) - H. pylori treatment: Triple therapy (PPI + clarithromycin + amoxicillin × 14 days); confirm eradication at 4 weeks Peptic Ulcer Disease (PUD): | Feature | Gastric Ulcer | Duodenal Ulcer | |---|---|---| | Pain timing | DURING meals (food worsens pain) | 2–3 hours AFTER meals; pain wakes at night; relieved by food/antacids | | Associated factors | NSAIDs, H. pylori,...