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143 Cards in this Set
- Front
- Back
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GERD is a disorder of what?
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the esophagus
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Gastrointestinal tract is a tube within a what?
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tube
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Gastrin, Somatostatin, and Histamine are hormones released where in the GI tract?
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stomach
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What is anorexia?
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a GI disorder...a loss of appetite
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What is nausea?
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A GI disorder...a subjective sensation from stimulation of medullary vomiting center...often precedes or accompanies vomiting
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Nausea is activated by what?
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Sympathetic activation from vagus nerve
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Another name for vomiting?
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emesis
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Describe emesis?
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vomiting...sudden and forceful oral expulsion of stomach contents...stomach has to be relaxed...occurs via skeletal muscle contraction
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Gastrointestinal bleeding is observed where?
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in vomitus or feces
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3 possible causes of GI bleeding?
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1. Disease/trauma to gi tract
2. blood vessel abnormalities 3. blood clotting disorders |
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What is hematemesis?
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GI bleeding...IN VOMITUS
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What is Melena?
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GI bleeding...BLACK, TARRY STOOL
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What is occult blood?
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related to melena...hidden in stools, detected only via chemical tests that change the color or the stool
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Name 4 esophagus disorders?
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1. Dysphagia
2. Esophageal Diverticulum 3. Esophageal Tears 4. Gastroesophageal reflux disease (GERD) |
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What is dysphagia?
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abnormal swallowing...esophagus disorder
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What is esophageal diverticulum?
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esophagus disorder...outpouching of esophageal wall
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What is esophageal tears?
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an esophagus disorder...aka mallory weiss syndrome...often associated with alcoholism
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What is the Gastroesophageal sphincter aka?
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LES...lower esophageal sphincter
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How are the stomach and esophagus different?
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esophagus is just for movement (peristaltis)
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Prevalence of GERD in the US?
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3-7% of pop. in 85...in 2002 it was up to 20%
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Mortality due to gerd in 84-88?
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1000 deaths
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What is high and what is low relative to GERD?
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morbidity is high but mortality is low
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What is the mortality rate for GERD?
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low...1/100,000
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Hospitalizations for gerd in 1985?
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1 million
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Physician office visits for GERD in 1985?
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4-5 million
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What is Hiatal hernia?
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A GERD risk factor...when the upper part of the stomach is pushing up into the diaphragm
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6 risk factors associated with GERD?
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1. Hiatal hernia
2. Alcohol use 3. Overweight 4. Pregnancy 5. Smoking 6. Certain foods |
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Where is acid produced?
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HCl...from parietal cells (there are multiple triggers)
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Components involved with acid secretion?
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H+ / K+ ATPase = proton pump required
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3 stimuli for acid secretions?
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1. Histamine
2. Gastrin 3. Vagus nerve |
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What cells produce histamine?
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ECL cells
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What cells produce gastrin?
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G cells
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The vagus nerve is cholinergic, what does this mean?
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it means it is either stimulated by or releases acetylcholine
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Any ? causes stomach contents to move back up?
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relaxation
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Relative to GERD when you have decreased salivation what do you lose for HCl?
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buffer
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In GERD where might impaired tissue resistance occur, explain?
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in the esophagus...stomach is built to handle acids, etc...esophagus is not
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GERD may be caused by impaired esophageal clearance, what is that?
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LES stays open
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Transient LES relaxation may cause what?
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GERD
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Describe how delayed gastric emptying may cause gerd?
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give stomach contents more of an opportunity to slosh back up
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What is the most imortant cause of GERD?
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Decreased LES tone...decreased tone causes it to open slightly and the stomach contents can slosh back up
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Number one sypmtom of GERD and its pervasiveness?
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Heartburn (70-80%)
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Heartburn is increased by what?
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bending, stooping, lying down, eating
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What is heartburn relieved by?
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antacids
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When may heartburn be more frequent or worse?
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at night...because you are lying down in the prone position...easier for contents to slosh back up
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The intenstity of the symptom of Heartburn is not necessarily indicative of what?
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the severity of the GERD disease
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What is water brash?
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a symptom in 60% of people with GERD...regurgitation of sour fluid (stomach contents)
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What is regurgitation of food?
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An atypical symptom of GERD present in about 10%
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What is dyspepia?
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an atypical symptom of GERD present in about 20%...gastric pain, indigestion
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What is aspiration?
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atypical symptom of GERD...27%...inhalation of stomach contents
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Laryngitis, cough, and recurrent pneumonia are what in relation to gerd?
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atypical symptoms
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How many asthma pts. have gerd?
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20 - 70%
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Dental erosions in relation to GERD?
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5 - 50%...atypical
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6 symptoms of GERD that require immediate medical attention?
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1. Dysphasia (unable to speak)
2. choking 3. odynophagia (swallow=pain) 4. bleeding 5. wt. loss 6. chest pain |
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What is the most common pathologic manifestation of GERD?
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esophagitis
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What is esophagitis?
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inflammation...injury in GERD from acids...common...can cause narrowing of esophageal structures
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What is an esophageal stricture?
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complication related to GERD...fibrosis and narrowing...a lost of elasticity
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What occurs in severe forms of esophagitis?
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ulceration, bleeding, perforation
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What is Barrett's esophagus essentially?
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complication of GERD...essentially metaplasia...conversion of cells to different type to protect themselves
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Someone with Barrett's esophagus has a 30 - 100X increased risk for developing what?
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Esophageal Adenocarcinoma (deadly)
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4 ways to diagnose GERD?
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1. history of symptoms
2. barium swallow radiograph 3. upper endoscopy 4. ambulatory pH monitoring...is there a decrease |
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How would one diagnose a history of GERD symptoms as true GERD?
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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
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5 Goals of GERD treatment?
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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 |
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3 ways to decrease reflux?
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1. lifestyle modification
2. prokinetic (promotility) agents 3. surgery (nissen fundoplication) |
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What does nissen fundoplication accomplish?
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Surgery that changes actual structure...last resort
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What do prokinetic (promotility) agents accomplish?
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increases motility of stomach
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3 treatments for reducing acid?
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1. Antacids
2. Histamine H2 receptors antagonists 3. Proton pump inhibitors (PPI) |
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What is a PPI?
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Proton pump inhibitior...PPI
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6 possible lifestyle modifications that may relieve gerd symptoms?
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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 |
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Some possible triggers thay may decrease LES tone?
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-chocolate, peppermint, fatty foods
-caffeine, alcohol, smoking -calcium channel blockers |
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What does the data show about lifestyle modifications to relieve the symptoms of GERD?
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LIMITED data showing they are effective
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Where does histamine have a receptor...what does it stimulate? (DRUGS TX)
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on the parietal cell...it stimulates HCl release
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What pump is involved with histamine and drug tx of gerd?
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PPI
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Source of gastrin?
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g cells of stomach
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Primary stimulus for secretion of gastrin?
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protien in the stomach
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6 functions of gastrin?
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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 |
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What is the source of secretin?
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endocrine cells in the duodenal mucosa
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What is the primary stimulus for the secretion of secretin?
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acid in the duodenal lumen
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3 functions of secretin?
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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 |
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What is the source of cholecystokinin?
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endocrine cells in the duodenal mucosa
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What is the primary stimulus for the secretion of cholecystokinin?
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nutrients in the duodenal lumen, esp. fat products and to a lesser extent protein products
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6 functions of cholectcystokinin?
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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 |
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What is PUD aka?
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peptic ulcer disease
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What is PUD?
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erosion of the upper GI tract...gastric ulcers...duodenal ulcers
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What is the cause of PUD?
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helicobacter pylori...not stress...or chronic use of NSAIDS and ASA
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Signs and symptoms of PUD? (7)
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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 |
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General complication of PUD? (4)
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1. Hemorrhage (sudden and severe or slow and chronic)
2. Anemia, hypovolemic shock 3. Obstruction 4. Perforation |
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4 possible types of hemorrhage that are a complication of PUD?
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1. Coffee ground emesis
2. Hematemesis 3. Melena 4. Hematochezia |
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What is coffee ground emesis?
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complication of PUD...Hemorrhage...brown vomiting b/c it is blood exposed to stomach secretions
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What is Hematemesis?
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hemorrhage complication of PUD...red blood in vomit because newer and fresher
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What is melena?
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Hemorrhage complication of PUD resulting in black tarry stools
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What is Hematochezia?
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hemorrhage complication of PUD resulting in red bloody stools
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Why might you become anemic as a result of PUD?
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because of slow chronic blood loss
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An obstruction related to PUD may result in what?
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the feeling of being full (because of swelling)
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What is a perforation caused by PUD?
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a hole (rare, 5%)
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5 ways to diagnose PUD?
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1. S&S, history
2. Hypochromic microcytic anemia 3. endoscopy 4. H. Pylori test: Serologic of breath 5. Tagged RBC scan |
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4 tx for PUD?
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1. H. pylori antibiotics
2. acid blockers and PPIs 3. Stop NSAIDS/ASA 4. Surgery for severe bleeding |
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What is Zollinger-Ellison Syndrome?
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Gastrinoma...gastrin secreting tumor
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Is Zoll-Ell common?
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no...rare
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What occurs in Zoll-Ell?
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massive H+ production...ulcers are inevitable
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3 signs and symptoms of Zoll-Ell?
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1. peptic ulcers
2. diarrhea 3. malabsorption |
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Diagnose Zoll-Ell how?
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check stomach pH (is it low)
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Tx for Zoll-Ell?
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1. PPIs to control acid secretion
2. Remove tumor(s) |
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Stress ulcers are what?
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ulceration of the upper GI tract (physical stress, not psychological)
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Causes of Stress ulcers?
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1. Mucosal hypoperfusion and ischemia
2. Acidosis, decreased motility, and bile salts |
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Stress ulcers have generalized ? and superficial ? ?
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generalized inflammation and superficial ulcerations
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Some physilogically stressful risks for stress ulcers?
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1. hospital ICU pts.
2. Mechanical intubation 3. burns, major trauma 4. Sepsis (severe live failure) |
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Tx for stress ulcers?
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PPIs (H2 receptors antagonists)...but more important to heal physiological stressor
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Inflammatory bowel disease includes what?
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2 related inflammatory disorders
1. Chron's disease 2. Ulcerative colitis |
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Cause of inflammatory bowel disease?
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UNKNOWN...maybe genetic predisposition, environment, or psychogenic
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Inflammation in Chron's disease vs Ulcerative colitis?
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Chron's = granulomatous
Ulc. col. = Ulcerative, exudate |
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Involvement level of Chron's vs Ulcerative colitis?
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Chron's = submucosal
Ulcerative = mucosal |
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Involvement extent of Chron's vs. ulcerative colitis?
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chron's = skip lesions (normal areas interrupted by diseased)
Ulcerative = continous |
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Involvement area of chron's vs. ulcerative colitis?
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chron's = ileum, colon
Uclerative = rectum, left colon |
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Diarrhea in chron's vs ulcerative colitis?
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common in both disorders
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Rectal bleeding in chron's vs ulcerative colitis?
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chron's = rare
ulcerative = common |
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Fistulas in chron's vs ulcerative colitis?
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chron's = common
ulcerative = rare |
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Strictures in chrons' vs. ulcerative colitis?
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chrons = common
ulcerative = rare |
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perianal abscess in chron's vs ulcerative colitis?
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chron's = common
ulcerative = rare |
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Cancer dev. in chron's vs ulcerative colitis?
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chron's = rare
ulcerative = more common |
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What is Chron's disease?
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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)
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Characterics of Chron's disease? (5)
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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 |
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3 signs and symptoms of chron's disease?
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1. diarrhea
2. lower right quadrant pain 3. weight loss (anorexia) |
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Course of chron's disease?
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variable, exacerbation and remission
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8 complications of chron's disease?
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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) |
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What are fistulas?
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passages from one section of GI tract to other
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Ulcerative colitis is limited to where?
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the rectum and large intestine
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Ulcerative colitis begins where and spreads how?
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begins at rectum and spreads proximally and continously (no skip lesions)
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Ulcerative colitis primarily affects what layer? Where can it extend to?
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primarily mucosal but can spread to submucosal
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3 characteristics of ulcerative colitis?
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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) |
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Course of ulcerative colitis?
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remissions and exacerbations (diarrhea, cramping, incontinence, weakness, fatigue)
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Severity of ulcerative colitis?
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variable
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5 complications of ulcerative colitis?
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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) |
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Diagnosis for both chron's and ulc. colitis?
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1. sigmoidoscopy with biopsy
2. CT scan with contrast to id. abscesses and fistulae |
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tx for both chron's and ulc. colitis? (4)
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1. antiinflammatory 5-ASA compounds (mesalamine, olsalazine)
2. immunosuppression (corticosteroids) 3. nutrition 4. surgery |
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Why is there not much you can do tx-wise for chron's and ulc. colitis?
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because they are chronic conditions, people live with them
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What is diverticulosis?
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(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 |
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Where is diverticulosis common?
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in western society...increasing prevalence with age...barely see it in other cultures...so diet may be factor...or phys. activity
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What is diverticulitis?
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a complication of diverticulosis with inflammation and perforation of diverticula...a serious condition
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Signs and symptoms of diverticulitis?
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lower left quadrant pain with nausea and vomiting...tenderness...slight fever...elevated WBC count
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3 complications associated with diverticulitis?
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1. abscess
2. perforation (always serious) with peritonitis, hemorrhage, obstruction 3. fistulae (tubelike structures) |
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When would you not give dye?
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if you think diverticulitis is an issue
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Diagnosis of diverticular disease?
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1. signs and symptoms, history
2. CT scan 3. barium enema and x-ray (not if diverticulitis suspected) |
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Tx for diverticular disease?
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1. bulk diet (high fiber)
2. tx diverticulitis with antibiotics 3. surgery for complications |
