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143 Cards in this Set

  • Front
  • Back
GERD is a disorder of what?
the esophagus
Gastrointestinal tract is a tube within a what?
Gastrin, Somatostatin, and Histamine are hormones released where in the GI tract?
What is anorexia?
a GI disorder...a loss of appetite
What is nausea?
A GI disorder...a subjective sensation from stimulation of medullary vomiting center...often precedes or accompanies vomiting
Nausea is activated by what?
Sympathetic activation from vagus nerve
Another name for vomiting?
Describe emesis?
vomiting...sudden and forceful oral expulsion of stomach contents...stomach has to be relaxed...occurs via skeletal muscle contraction
Gastrointestinal bleeding is observed where?
in vomitus or feces
3 possible causes of GI bleeding?
1. Disease/trauma to gi tract

2. blood vessel abnormalities

3. blood clotting disorders
What is hematemesis?
GI bleeding...IN VOMITUS
What is Melena?
What is occult blood?
related to melena...hidden in stools, detected only via chemical tests that change the color or the stool
Name 4 esophagus disorders?
1. Dysphagia

2. Esophageal Diverticulum

3. Esophageal Tears

4. Gastroesophageal reflux disease (GERD)
What is dysphagia?
abnormal swallowing...esophagus disorder
What is esophageal diverticulum?
esophagus disorder...outpouching of esophageal wall
What is esophageal tears?
an esophagus disorder...aka mallory weiss syndrome...often associated with alcoholism
What is the Gastroesophageal sphincter aka?
LES...lower esophageal sphincter
How are the stomach and esophagus different?
esophagus is just for movement (peristaltis)
Prevalence of GERD in the US?
3-7% of pop. in 2002 it was up to 20%
Mortality due to gerd in 84-88?
1000 deaths
What is high and what is low relative to GERD?
morbidity is high but mortality is low
What is the mortality rate for GERD?
Hospitalizations for gerd in 1985?
1 million
Physician office visits for GERD in 1985?
4-5 million
What is Hiatal hernia?
A GERD risk factor...when the upper part of the stomach is pushing up into the diaphragm
6 risk factors associated with GERD?
1. Hiatal hernia

2. Alcohol use

3. Overweight

4. Pregnancy

5. Smoking

6. Certain foods
Where is acid produced?
HCl...from parietal cells (there are multiple triggers)
Components involved with acid secretion?
H+ / K+ ATPase = proton pump required
3 stimuli for acid secretions?
1. Histamine

2. Gastrin

3. Vagus nerve
What cells produce histamine?
ECL cells
What cells produce gastrin?
G cells
The vagus nerve is cholinergic, what does this mean?
it means it is either stimulated by or releases acetylcholine
Any ? causes stomach contents to move back up?
Relative to GERD when you have decreased salivation what do you lose for HCl?
In GERD where might impaired tissue resistance occur, explain?
in the esophagus...stomach is built to handle acids, etc...esophagus is not
GERD may be caused by impaired esophageal clearance, what is that?
LES stays open
Transient LES relaxation may cause what?
Describe how delayed gastric emptying may cause gerd?
give stomach contents more of an opportunity to slosh back up
What is the most imortant cause of GERD?
Decreased LES tone...decreased tone causes it to open slightly and the stomach contents can slosh back up
Number one sypmtom of GERD and its pervasiveness?
Heartburn (70-80%)
Heartburn is increased by what?
bending, stooping, lying down, eating
What is heartburn relieved by?
When may heartburn be more frequent or worse?
at night...because you are lying down in the prone position...easier for contents to slosh back up
The intenstity of the symptom of Heartburn is not necessarily indicative of what?
the severity of the GERD disease
What is water brash?
a symptom in 60% of people with GERD...regurgitation of sour fluid (stomach contents)
What is regurgitation of food?
An atypical symptom of GERD present in about 10%
What is dyspepia?
an atypical symptom of GERD present in about 20%...gastric pain, indigestion
What is aspiration?
atypical symptom of GERD...27%...inhalation of stomach contents
Laryngitis, cough, and recurrent pneumonia are what in relation to gerd?
atypical symptoms
How many asthma pts. have gerd?
20 - 70%
Dental erosions in relation to GERD?
5 - 50%...atypical
6 symptoms of GERD that require immediate medical attention?
1. Dysphasia (unable to speak)

2. choking

3. odynophagia (swallow=pain)

4. bleeding

5. wt. loss

6. chest pain
What is the most common pathologic manifestation of GERD?
What is esophagitis?
inflammation...injury in GERD from acids...common...can cause narrowing of esophageal structures
What is an esophageal stricture?
complication related to GERD...fibrosis and narrowing...a lost of elasticity
What occurs in severe forms of esophagitis?
ulceration, bleeding, perforation
What is Barrett's esophagus essentially?
complication of GERD...essentially metaplasia...conversion of cells to different type to protect themselves
Someone with Barrett's esophagus has a 30 - 100X increased risk for developing what?
Esophageal Adenocarcinoma (deadly)
4 ways to diagnose GERD?
1. history of symptoms

2. barium swallow radiograph

3. upper endoscopy

4. ambulatory pH there a decrease
How would one diagnose a history of GERD symptoms as true GERD?
put the pt. on lifestyles changes and drugs for acid reduction...if there are no relief of symptoms in 4 - 6 weeks you give them a barium test, upper endoscopy, and pH monitoring
5 Goals of GERD treatment?
1. relieve symptoms

2. heal esophageal lesion/ esophagitis

3. maintain symptom and disease free state, prevent recurrence

4. provide cost effective management

5. prevent complications
3 ways to decrease reflux?
1. lifestyle modification

2. prokinetic (promotility) agents

3. surgery (nissen fundoplication)
What does nissen fundoplication accomplish?
Surgery that changes actual structure...last resort
What do prokinetic (promotility) agents accomplish?
increases motility of stomach
3 treatments for reducing acid?
1. Antacids

2. Histamine H2 receptors antagonists

3. Proton pump inhibitors (PPI)
What is a PPI?
Proton pump inhibitior...PPI
6 possible lifestyle modifications that may relieve gerd symptoms?
1. elevate head of bed

2. avoid tight fitting clothing

3. weight loss

4. Avoid triggers the decrease LES tone

5. avoid large meals

6. avoid lying down after meals
Some possible triggers thay may decrease LES tone?
-chocolate, peppermint, fatty foods

-caffeine, alcohol, smoking

-calcium channel blockers
What does the data show about lifestyle modifications to relieve the symptoms of GERD?
LIMITED data showing they are effective
Where does histamine have a receptor...what does it stimulate? (DRUGS TX)
on the parietal stimulates HCl release
What pump is involved with histamine and drug tx of gerd?
Source of gastrin?
g cells of stomach
Primary stimulus for secretion of gastrin?
protien in the stomach
6 functions of gastrin?
1. stim. secretion by the parietal and chief cells

2. enhances gastric motility

3. stimulates ileal motility

4. relaxes the ileocecal sphincter

5. induces colonic mass movements

6. is trophic to the stomach and small intestine mucosa
What is the source of secretin?
endocrine cells in the duodenal mucosa
What is the primary stimulus for the secretion of secretin?
acid in the duodenal lumen
3 functions of secretin?
1. inhibits gastric emptying and gastric secretion

2. stimulates NaHCO3 secretion by the pancreatic duct cells and by the liver

3. Is trophic to the exocrine pancreas
What is the source of cholecystokinin?
endocrine cells in the duodenal mucosa
What is the primary stimulus for the secretion of cholecystokinin?
nutrients in the duodenal lumen, esp. fat products and to a lesser extent protein products
6 functions of cholectcystokinin?
1. inh. gastric emptying and gastric secretion

2. stimulates digestive enzyme secretion by the pancreatic acinar cells

3. causes gallbladder contraction and relaxation of the sphincter of Oddi

4. is trophic to the exocrine pancreas

5. may cause long-term adaptive changes in the proportion of pancreatic enzymes

6. contributes to satiety
What is PUD aka?
peptic ulcer disease
What is PUD?
erosion of the upper GI tract...gastric ulcers...duodenal ulcers
What is the cause of PUD?
helicobacter pylori...not stress...or chronic use of NSAIDS and ASA
Signs and symptoms of PUD? (7)
same as all GI disorders

1. Abd. pain (burning, gnawing, esp. when stomach empty)

2. nausea, vomiting

3. weight loss

4. fatigue

5. Heartburn, indigestion, belching

6. vomiting blood

7. bloody or tarry stools
General complication of PUD? (4)
1. Hemorrhage (sudden and severe or slow and chronic)

2. Anemia, hypovolemic shock

3. Obstruction

4. Perforation
4 possible types of hemorrhage that are a complication of PUD?
1. Coffee ground emesis

2. Hematemesis

3. Melena

4. Hematochezia
What is coffee ground emesis?
complication of PUD...Hemorrhage...brown vomiting b/c it is blood exposed to stomach secretions
What is Hematemesis?
hemorrhage complication of blood in vomit because newer and fresher
What is melena?
Hemorrhage complication of PUD resulting in black tarry stools
What is Hematochezia?
hemorrhage complication of PUD resulting in red bloody stools
Why might you become anemic as a result of PUD?
because of slow chronic blood loss
An obstruction related to PUD may result in what?
the feeling of being full (because of swelling)
What is a perforation caused by PUD?
a hole (rare, 5%)
5 ways to diagnose PUD?
1. S&S, history

2. Hypochromic microcytic anemia

3. endoscopy

4. H. Pylori test: Serologic of breath

5. Tagged RBC scan
4 tx for PUD?
1. H. pylori antibiotics

2. acid blockers and PPIs


4. Surgery for severe bleeding
What is Zollinger-Ellison Syndrome?
Gastrinoma...gastrin secreting tumor
Is Zoll-Ell common?
What occurs in Zoll-Ell?
massive H+ production...ulcers are inevitable
3 signs and symptoms of Zoll-Ell?
1. peptic ulcers

2. diarrhea

3. malabsorption
Diagnose Zoll-Ell how?
check stomach pH (is it low)
Tx for Zoll-Ell?
1. PPIs to control acid secretion

2. Remove tumor(s)
Stress ulcers are what?
ulceration of the upper GI tract (physical stress, not psychological)
Causes of Stress ulcers?
1. Mucosal hypoperfusion and ischemia

2. Acidosis, decreased motility, and bile salts
Stress ulcers have generalized ? and superficial ? ?
generalized inflammation and superficial ulcerations
Some physilogically stressful risks for stress ulcers?
1. hospital ICU pts.

2. Mechanical intubation

3. burns, major trauma

4. Sepsis (severe live failure)
Tx for stress ulcers?
PPIs (H2 receptors antagonists)...but more important to heal physiological stressor
Inflammatory bowel disease includes what?
2 related inflammatory disorders

1. Chron's disease

2. Ulcerative colitis
Cause of inflammatory bowel disease?
UNKNOWN...maybe genetic predisposition, environment, or psychogenic
Inflammation in Chron's disease vs Ulcerative colitis?
Chron's = granulomatous

Ulc. col. = Ulcerative, exudate
Involvement level of Chron's vs Ulcerative colitis?
Chron's = submucosal

Ulcerative = mucosal
Involvement extent of Chron's vs. ulcerative colitis?
chron's = skip lesions (normal areas interrupted by diseased)

Ulcerative = continous
Involvement area of chron's vs. ulcerative colitis?
chron's = ileum, colon

Uclerative = rectum, left colon
Diarrhea in chron's vs ulcerative colitis?
common in both disorders
Rectal bleeding in chron's vs ulcerative colitis?
chron's = rare

ulcerative = common
Fistulas in chron's vs ulcerative colitis?
chron's = common

ulcerative = rare
Strictures in chrons' vs. ulcerative colitis?
chrons = common

ulcerative = rare
perianal abscess in chron's vs ulcerative colitis?
chron's = common

ulcerative = rare
Cancer dev. in chron's vs ulcerative colitis?
chron's = rare

ulcerative = more common
What is Chron's disease?
infl. disease affecting GI tract from mouth to anus (but more common to small intestine and large intestine) (rarer to have it farther up in GI)
Characterics of Chron's disease? (5)
1. sharply demarcated, granulomatous lesions surrounded by normal mucosa

2. patchy, skip lesions

3. surface fissures and crevices = "cobblestone"

4. submucosal edema

5. smooth muscle usually spared
3 signs and symptoms of chron's disease?
1. diarrhea

2. lower right quadrant pain

3. weight loss (anorexia)
Course of chron's disease?
variable, exacerbation and remission
8 complications of chron's disease?
1. fistulas

2. abscesses

3. low grade fever

4. malaise

5. less bleeding than ulcerative colitis (because not ulcerative)

6. infection

7. obstruction (inflammatory and growths)

8. toxic megacolon (dilation, life threatening)
What are fistulas?
passages from one section of GI tract to other
Ulcerative colitis is limited to where?
the rectum and large intestine
Ulcerative colitis begins where and spreads how?
begins at rectum and spreads proximally and continously (no skip lesions)
Ulcerative colitis primarily affects what layer? Where can it extend to?
primarily mucosal but can spread to submucosal
3 characteristics of ulcerative colitis?
1. micro-hemorrhages in mucosa develop into abscesses, may become necrotic, ulcerate

2. polyp-like projections from mucosa, psuedopolyps

3. bowel thickens (because of repeated episodes of inflammation)
Course of ulcerative colitis?
remissions and exacerbations (diarrhea, cramping, incontinence, weakness, fatigue)
Severity of ulcerative colitis?
5 complications of ulcerative colitis?
1. cancer (20 - 30 times more at risk then gen. pop.)

2. hemorrhage

3. anemia

4. infection

5. perforation

(2-5 are same for any type of ulceration in GI tract)
Diagnosis for both chron's and ulc. colitis?
1. sigmoidoscopy with biopsy

2. CT scan with contrast to id. abscesses and fistulae
tx for both chron's and ulc. colitis? (4)
1. antiinflammatory 5-ASA compounds (mesalamine, olsalazine)

2. immunosuppression (corticosteroids)

3. nutrition

4. surgery
Why is there not much you can do tx-wise for chron's and ulc. colitis?
because they are chronic conditions, people live with them
What is diverticulosis?
(aka diverticular disease)
condition in which the mucosal layer of colon herniates thru muscularis layer...pouch develops between muscle rings...often asymptomatic and found on x-ray for other purpose
Where is diverticulosis common?
in western society...increasing prevalence with age...barely see it in other diet may be factor...or phys. activity
What is diverticulitis?
a complication of diverticulosis with inflammation and perforation of diverticula...a serious condition
Signs and symptoms of diverticulitis?
lower left quadrant pain with nausea and vomiting...tenderness...slight fever...elevated WBC count
3 complications associated with diverticulitis?
1. abscess

2. perforation (always serious) with peritonitis, hemorrhage, obstruction

3. fistulae (tubelike structures)
When would you not give dye?
if you think diverticulitis is an issue
Diagnosis of diverticular disease?
1. signs and symptoms, history

2. CT scan

3. barium enema and x-ray (not if diverticulitis suspected)
Tx for diverticular disease?
1. bulk diet (high fiber)

2. tx diverticulitis with antibiotics

3. surgery for complications