Chapter 26: Upper Gastrointestinal Tract Disorders Flashcards
upper esophageal sphincter (UES)
The high-pressure zone located in between the pharynx and the cervical esophagus. The physiological role of this sphincter is to protect against reflux of food into the airways as well as prevent entry of air into the digestive tract
lower esophageal sphincter (LES)
Located at the distal end where it meets the stomach, is composed of a bundle of smooth muscle and functions to protect the reflux of gastric contents into the esophagus.
achalasia
Characterized by a failure of esophageal neurons, resulting in a loss of ability to relax the LES and have normal peristalsis
gastroesophageal reflux (GER)
A normal physiologic process that occurs several times a day in healthy infants, children, and adults. GER generally is associated with transient relaxation of the LES independent of swallowing, which permits gastric contents to enter the esophagus
gastroesophageal reflux disease (GERD)
A more serious, chronic form of GER, with symptoms or complications resulting from the reflux of gastric contents into the esophagus or beyond, and even into the oral cavity or lung
esophagogastroduodenoscopy (EGD)
A procedure that uses a fiberoptic endoscope to directly visualize and examine the esophagus, stomach, and duodenum to classify severity of disease
esophagitis
Inflammation of the esophagus
acid pocket
A layer of unbuffered, highly acidic gastric juice at the esophagogastric junction, ready to reflux due to the absence of peristaltic contraction in the proximal stomach
barrett’s esophagus (BE)
A precancerous condition in which the normal squamous epithelium of the esophagus is replaced by an abnormal columnar-lined epithelium known as specialized intestinal metaplasia
hiatal hernia
The esophagus passes through the diaphragm by way of the esophageal hiatus or ring. The attachment of the esophagus to the hiatal ring may become compromised, allowing a portion of the upper stomach to move above the diaphragm
nissen fundoplication
The most commonly performed antireflux surgery. The fundus or top portion of the stomach is wrapped 360 degrees around the lower esophagus and sutured in place to limit reflux
esophagectomy
An operation to remove a portion of the esophagus.
dysphagia
Swallowing difficulty
gastric pull-up
A procedure that involves removal of a segment of or the entire esophageal tract and replacing it with the stomach tissue
odynophagia
Painful swallowing
parietal cells
Acid-producing cells
dyspepsia
Indigestion
Rome IV criteria
Criteria used to diagnose disorders of gut-brain interaction (DGBI)
functional dyspepsia (FD)
An umbrella term to include patients with postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS)
Helicobacter pylori
A gram-negative bacteria that is somewhat resistant to the acidic environment in the stomach. H. pylori infection is responsible for most cases of chronic inflammation of the gastric mucosa and peptic ulcer, gastric cancer, and atrophic gastritis, resulting in achlorhydria and loss of intrinsic factor
atrophic gastritis
Chronic inflammation with deterioration of the mucous membrane and glands
mucosa-associated lymphoid tissue (MALT)
The presence of lymphoid follicles
endoscopy
A common invasive diagnostic tool
peptic ulcer disease
Occurs when open sores (peptic ulcers) form as a result of the breakdown of then normal defense and repair mechanisms, and are differentiated as either gastric, or duodenal, depending on location
gastric ulcers
Typically associated with widespread gastritis, inflammatory involvement of parietal cells, and atropy of acid- and pepsin-producing cells occurring with advancing age
duodenal ulcer
Characterized by increased acid secretion throughout the entire day accompanied with decreased bicarbonate secretion
stress ulcers
May occur as a complication of metabolic stress caused by trauma, burns, surgery, shock, renal failure, or radiation therapy
achylia gastrica
Absence of HCl and pepsin
achlorhydria
Absence of HCl in gastric secretions
gastrectomy
A resection or removal of the stomach
Roux-en-Y
A procedure where the jejunum is pulled up and anastomosed to the esophagus. The duodenum is then connected to the small bowel so that bile and pancreatic secretions can flow into the intestines
Billroth I (gastroduodenostomy)
A procedure that involves removal of the pylorus and/or antrum, and an anastomosis of the proximal end of the duodenum to the distal end of the remnant stomach
Billroth II (gastrojejunostomy)
A procedure that involves removal of the stomach antrum and an anastomosis of the remnant stomach to the side of the jejunum, which creates a blind duodenal loop
vagus nerve
Responsible not only for motility, but also stimulation of parietal cells in the proximal stomach
vagotomy
A procedure often performed to eliminate gastric secretion
truncal vagotomy
Complete severing of the vagus nerve on the distal esophagus, decreases acid secretion by parietal cells in the stomach and decreases their response to the hormone gastrin
parietal cell vagotomy
Divides and severs only the vagus nerve branches that affect the proximal stomach where gastric acid secretion occurs, whereas the antrum and pylorus remain innervated
pyloroplasty
A surgery to widen the opening in the lower part of the stomach (pylorus) so that stomach contents can empty into the small intestine (duodenum)
dumping syndrome
A complex GI and vasomotor response to the presence of large quantities of hypertonic foods and liquids in the proximal small intestine
gastroparesis
A syndrome of delayed gastric emptying without evidence of mechanical obstruction and is a complex and potentially debilitating condition
scintigraphy
The gold-standard measure of gastric emptying. A nuclear test of gastric emptying
bezoar
Concentration of undigested material in the stomach
cannabinoid hyperemesis syndrom
Classified as a gastroduodenal disorder and included with other nausea and vomiting disorders. It is a syndrome of cyclic vomiting associated with cannabis use, with a common symptom improvement with hot bathing, and relief of symptoms with cessation of cannabis use
