[3] 역류성 식도염,리어카행상의 경영 20091109
DESCRIPTION
포항 속시원내과 직원 교육 자료 3 역류성 식도염 현대백화점에서 눈여겨 보는 리어카 행상의 고객경영TRANSCRIPT
- 1. [3]
- 2. / , , , functional chest pain, functional dysphagia. Esophageal disorder: Gastroduodenal disorders : functional dyspepsia, aerophagia, functional vomitting
- 3.
- 4. Spectrum of GERD Heartburn (Nonerosive Reflux Disease :NERD)
- 5. Spectrum of esophagitis
- 6. 0% , , , , , , , , ,
- 7. , (, )
- 8. : 1. (transient LES relaxation: tLESR) 2. 3. 4. 5.
- 9. citrus ? Anticholinergics Benzodiazepines (diazepam narcotics) -adrenergic agonists calcium channel blockers Opioids Progesterone Xanthines Aspirin & NSAID Quinidine tetracyclin
- 10. ( Savary -Miller ) Grade 1. Grade 4. , Grade 2. .( ) Grade 3. Grade 5.
- 11. LA Group A : mucosal break 5mm Group B : 1 mucosal break 5mm Group C : mucosal break (75%) Group D : (circumferential) mucosal break(75%) (z-line blurring), (indistinct erythema / hyperemia), (white turbid dislocation), (loss of vascularity) (minimal change) .
- 12. Group A : mucosal break 5mm
- 13. Group B : 1 mucosal break 5mm
- 14. Group C : mucosal break (75%)
- 15. Group D : (circumferential) mucosal break(75%)
- 16. 1. 2. alginic acid 3. 4. 5. 1) H2 2) PPI
- 17. . , . . . . , , , , , , . .
- 18. Step-up management : H2 brocker PPI Step-down management : PPI --> H2 brocker Maintenance treatment On-demand treatment
- 19. GERD Step 4: PPI twice daily+H2RA at bedtime PPI twice daily Step 3: PPI in A.M+H2RA at bedtime or PPI+Prokinetic agent PPI once daily (standard dose) Step 2: High dose H2RA or half dose PPI H2RA+Prokinetic agent H2RA or Prokinetic agent OTC (over-the-counter) H2RA Step 1: Life style modification
- 20. 1 (Step Up) History/Physical Exam : or H2 / H2 Or H2 PPI Step down : or
- 21. Alarming symptom, / 24 H2 PPI PPI PPI
- 22. GERD LA A
- 23. GERD LA B
- 24. GERD LA C
- 25. GERD LA D
- 26. ~
- 27. ( ) 1:30 ( ) 7:30 : 9:30 (TV ) 40
- 28. (66) 38 40-50 200-300 30
- 29. , . ( ~ ) , . . .( )
- 30. . . . ( )
- 31.