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18 Cards in this Set

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GASTROESOPHAGEAL REFLUX DISEASE (GERD)
backflow (reflux) of gastric or duodenal contents or both into the esophagus through the lower esophageal sphincter (LES).
Etiology of GERD
•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)
S/S of GERD
•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
Prevention of GERD symptoms
•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
Peptic Ulcer Disease (PUD)
•Erosion / ulceration in the lining of the stomach or duodenum
•Two types:
-DU: Duodenal Ulcers
-GU: Gastric Ulcers
4(DU): 1(GU) ratio
•Gastric Mucosal Barrier (GMB)
Protective mechanism against corrosive action of stomach acids (Hydrochloric Acid [HCl] and Pepsin)
GMB composed of epithelial cells (EC) that are impermeable to acids because...
-EC connected by tight junction
-EC covered by impermeable hydrophobic lipid layer
-EC secretes thick layer of alkaline mucus
•GMB also protected by prostaglandin synthesis
-Improves blood flow
-Increases bicarb secretion
-Increases mucus production
A & P
•PUD can affect one or all layers of stomach or duodenum
•Layers: Mucosa, Submucosa, Muscle layer (oblique, circular, longitudinal) or Serosa
Helicobacter Pylori
•Most common cause of PUD
-spiral shaped
-only 10-20% who harbor pathogen develop ulcers
- 90% pts with gastric cancer harbor pathogen
•Mechanism by which H. Pylori produces PUD
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
NSAIDs
Ibuprofen
ASA
•2nd most common cause of PUD
•Mechanism:
Damages mucosal barrier so that acid is able to diffuse across the lipid layer
Inhibits prostaglandin synthesis
Duodenal Ulcer
-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)
PUD Complications
GI Bleed
Perforation with Peritonitis
Obstruction
Signs of GI bleeding
•Weak, Dizzy, fatigue
•Hematemesis (coffee ground emesis)
•Black, Tarry, Stools (Melena)
Signs of Perforation with Peritonitis
•Sudden, severe, sharp pain
•Rigid, board-like abdomen
•Guarding, Rebound Tenderness
•Absent BS, Fever, Increased WBC
Signs of Obstruction
•Ulcer blocks path of food
•Caused by edema, spasm, scar tissue
•Crampy Pain
•Abdominal Distension
•A, N, V
•High-pitched rumbling BS
IBD
both Crohn's disease and ulcerative Colitis