Gi - Hb Disorders

Front 1

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Back 1

backflow (reflux) of gastric or duodenal contents or both into the esophagus through the lower esophageal sphincter (LES).

Front 2

Etiology of GERD

Back 2

•Weak, incompetent LES
-Fails to close tightly after you swallow food

•Increased intra-abdominal pressure due to
-Obesity
-Pregnancy (80%)
-Supine Position
-Bending Forward

•Relaxation or Lowering of LES pressure
-Smoking
-Foods (Fruit, Chocolate, Peppermint, Tomato-Based Foods, Onions, Garlic)
-Beverages (Coffee, Alcohol, Citrus drinks)

Front 3

S/S of GERD

Back 3

•Heartburn, Regurgitation of gastric contents, Sour Taste

-Occurs 30-60 min after easting, esp. large, fatty meal
-Worse in supine position or bending forward
-Often occurs at night
•Epigastric discomfort may be confused with angina
•Other Sx
-Cough, Wheezing
-Chronic Sore Throat

Front 4

Prevention of GERD symptoms

Back 4

•Eat frequent small meals
•Avoid foods that cause sx
•Avoid fatty meals
•Avoid eating before HS
•Avoid supine position x 3 hours after meal
•Elevate head of the bed (HOB) on blocks
•Stop smoking
•Reduce alcohol intake
•Weight Loss

Front 5

Peptic Ulcer Disease (PUD)

Back 5

•Erosion / ulceration in the lining of the stomach or duodenum
•Two types:
-DU: Duodenal Ulcers
-GU: Gastric Ulcers
4(DU): 1(GU) ratio

Front 6

•Gastric Mucosal Barrier (GMB)

Back 6

Protective mechanism against corrosive action of stomach acids (Hydrochloric Acid [HCl] and Pepsin)

Front 7

GMB composed of epithelial cells (EC) that are impermeable to acids because...

Back 7

-EC connected by tight junction
-EC covered by impermeable hydrophobic lipid layer
-EC secretes thick layer of alkaline mucus

Front 8

•GMB also protected by prostaglandin synthesis

Back 8

-Improves blood flow
-Increases bicarb secretion
-Increases mucus production

Front 9

A & P

Back 9

•PUD can affect one or all layers of stomach or duodenum
•Layers: Mucosa, Submucosa, Muscle layer (oblique, circular, longitudinal) or Serosa

Front 10

Helicobacter Pylori

Back 10

•Most common cause of PUD
-spiral shaped
-only 10-20% who harbor pathogen develop ulcers
- 90% pts with gastric cancer harbor pathogen

Front 11

•Mechanism by which H. Pylori produces PUD

Back 11

Spiral-shape permits pathogen to burrow itself into gastric mucous layer
HP produces enzymes that increase the permeability of mucus layer
allows acid to penetrate gastric mucosal barrier

Front 12

NSAIDs
Ibuprofen
ASA

Back 12

•2nd most common cause of PUD
•Mechanism:
Damages mucosal barrier so that acid is able to diffuse across the lipid layer
Inhibits prostaglandin synthesis

Front 13

Duodenal Ulcer

Back 13

-95% caused by H. Pylori
- peak age 35-55
-90% located in first section of duodenum
-spontaneous remission and exacerbation
-Occurs when stomach is empty
(1-3 hours after a meal)

Front 14

PUD Complications

Back 14

GI Bleed
Perforation with Peritonitis
Obstruction

Front 15

Signs of GI bleeding

Back 15

•Weak, Dizzy, fatigue
•Hematemesis (coffee ground emesis)
•Black, Tarry, Stools (Melena)

Front 16

Signs of Perforation with Peritonitis

Back 16

•Sudden, severe, sharp pain
•Rigid, board-like abdomen
•Guarding, Rebound Tenderness
•Absent BS, Fever, Increased WBC

Front 17

Signs of Obstruction

Back 17

•Ulcer blocks path of food
•Caused by edema, spasm, scar tissue
•Crampy Pain
•Abdominal Distension
•A, N, V
•High-pitched rumbling BS

Front 18

IBD

Back 18

both Crohn's disease and ulcerative Colitis