Disorders of GI function (pptx 1) Flashcards
List 6 organs located in the RUQ of the abdominal cavity
1) Liver (majority)
2) Rt kidney
3) Colon
4) Pancreas (small portion)
5) Gallbladder
6) Small intestine
List 6 organs located in the RLQ of the abdominal cavity
1) Colon
2) Small intestine
3) Right ureter
4) Right ovary
5) Right fallopian tube
6) Appendix
List 7 organs located in LUQ of the abdominal cavity
1) Liver (small portion)
2) Spleen
3) Lt kidney
4) Stomach
5) Colon
6) Pancreas (majority)
7) small intestine
List 5 organs located in LLQ of the abdominal cavity
1) Colon
2) Small intestines
3) Left ureter
4) Left ovary
5) Left fallopian tube
List 3 GI disorders located in RUQ of the abdominal cavity
1) Hepatitis
2) Duodenal ulcer
3) Acute cholecystitis
List 4 GI disorders located in LUQ of the abdominal cavity
1) Gastric ulcer
2) ruptured spleen
3) Aortic aneurysm
4) Pancreatitis
List 11 GI disorders located in RLQ of the abdominal cavity
1) Hernia
2) Appendicitis
3) Ovarian cysts
4) Kidney stones
5) Pyelonephritis
6) Ectopic pregnancy
7) Salpingitis (female)
8) Mesenteric adenitis
9) Meckel’s diverticulitis
10) Bowel obstruction/ perforation/ ischemia
11) Inflammatory bowel disease
List 8 GI disorders located in LLQ of the abdominal cavity
1) Hernia
2) Diverticulitis
3) Ovarian cysts
4) Kidney stones
5) Pyelonephritis
6) Ectopic pregnancy
7) Bowel obstruction/ perforation/ ischemia
8) Inflammatory bowel disease
List 5 GI disorders located in epigastric region of the abdominal cavity
1) Esophagitis
2) Pancreatitis
3) Perforated ulcer
4) Acute cholecystitis
5) MI
Describe parietal abdominal pain
Localized
2) Described as knife-like, sharp pain
Describe visceral abdominal pain
Distention/ inflammation of body organs
1) Described as colicky, crampy
What is the 3rd type of abdominal pain?
Referred pain
How is abdominal pain produced?
Biochemical mediators of inflammatory response (Histamine, bradykinin, & serotonin) stimulate organic nerve endings that produce abd pain
List 2 things abdominal organs are sensitive to
1) Stretching
2) Distention
LISt 7 disorders of the esophagus
1) Dysphagia
2) Achalasia
3) Esophagitis
4) GERD
5) Upper GI bleed
6) Esophageal varices
7) Esophageal cancer
List 6 disorders of the stomach
1) Hiatal hernia
2) Pyloric stenosis
3) Peptic ulcer disease
4) Zollinger-Ellison syndrome
5) Bariatric surgery
6) Dumping syndrome
List 6 disorders of the SI
1) Hernia
2) Gastroenteritis
3) Celiac disease
4) Short-bowel syndrome
5) Small bowel obstruction
6) Peritonitis
What GI disorder affects ~ 20-40% of US population?
GERD
What is GERD?
A backward movement of gastric contents into esophagus
Contrast a normal functioning lower esophageal sphincter to one seen in someone with GERD
Normal → maintains a zone of high pressure to prevent chyme reflux
GERD → lower esophageal sphincter relaxes spontaneously 1-2 hrs after eating, which allows regurgitate into esophagus
Diagnosis of GERD Hint: 2
1) Endoscopy
2) Manometry
List 2 results of esophageal mucosal damage associated with GERD
1) Erosive esophagitis
2) Barrett’s esophagus
What is Barrett’s esophagus Hint: 3
1) Repeated injury causes metaplasia
2) Change to columnar epithelium
3) Precancerous (esophageal adenocarcinoma)
Cause of GERD
Certain conditions, substances, foods, & meds that weaken or hinder closure of lower esophageal sphincter
List 10 examples that cause GERD
1) Alcohol
2) Acidic foods
3) Fatty foods
4) Chocolate
5) Coffee
6) Nicotine
7) Obesity
8) Pregnancy
9) Hiatal hernia
10) Anticholinergics; Beta agonists; CCBs; Nitrates; Progesterone
List 9 clinical manifestations of GERD
1) Dysphagia
2) Heartburn
3) Regurgitation
4) Bitter taste
5) Upper abd pain within hr of eating
6) ↑ w lying or ↑ intra-abd pressures
7) Can have Sx w no acid
8) Cough, ↑ asthma Sx
9) May seem like angina
List 7 life style & dietary changes that can Tx GERD
1) ↓ dietary fats
2) Eat small meals
3) Stop smoking
4) Avoid lying down for 3 hrs after eating
5) Avoid alcohol
6) Weight loss
7) Elevate HOB
List 4 pharmacologic Tx options for GERD
1) Antacids
2) Histamine (H2) blockers
3) Proton pump inhibitors (PPI)
4) Prokinetic agents
What is celiac disease?
An autoimmune disorder triggered by gluten
List 8 clinical manifestations of celiac disease
1) Abdominal pain
2) Bloating
3) Diarrhea
4) Weight loss
5) Steatorrhea
6) Weakness
7) Flatus
8) Fatigue
List 5 labs to look at to help Dx celiac disease
1) H/H
2) CMP
3) Genetic testing
4) IgA
5) Ab testing
List 3 Tx options for celiac disease
1) Remove gluten from diet
2) Vitamin replacement
3) Corticosteroids
What GI disorders affects 50-75% of the world’s population?
Helicobacter pylori (H. pylori)
What ethnicities is H. pylori increased in?
Hispanics & African Americans
How is H. pylori transmitted?
Person to person → thru saliva, feces, vomiting
List 3 disorders H. pylori causes
1) Peptic ulcers
2) Gastritis
3) Gastric (stomach) cancer
True or false:
Most people Dx with H. pylori are symptomatic?
FALSE → most are asymptomatic
What kind of bacteria is H. pylori?
Gram-negative rods that colonize in mucus-secreting epithelial cells of stomach
Describe bacteria of H. pylori gastritis
Small, curved or spiral shaped gram-negative rods
What does H. pylori gastritis secrete?
Urease (enzyme) → converts urea to ammonia
How does ammonia function for bacteria to survive?
Ammonia neutralizes acidity of the stomach for bacteria to survive
Where is H. pylori gastritis located?
Burrows into mucus layer
List 3 things that production of enzymes & toxins in H. pylori gastritis causes
1) Impacts protection of mucosa to acidic environment
2) Intense inflammatory response
3) Create immune response (T & B cells)
List 7 Sx of H. pylori
1) Many are asymptomatic
2) Dull burning pain in abd
3) ↑ pain w empty stomach
4) N/V
5) Dyspepsia
6) Bloating
7) Weight loss
List 4 ways to Dx H. pylor
1) Urea breath test
2) Serologic tests
3) Stool Ag test
4) Endoscopic biopsy
List 4 Tx options for H. pylori
1) Abx
2) Bismuth (Antibacterial effect)
3) PPI (raise the pH)
4) H2 blockers
Where do peptic ulcers occur in GI tract?
Upper portion of GI tract
What is peptic ulcer disease?
Inflammatory erosion in stomach (gastric ulcer) or duodenal lining (duodenal ulcer)
Pathophysiology of peptic ulcer disease Hint: 3
1) Hypersecretion of HCL
2) Ineffective mucous production
3) Poor cellular repair
List 2 things to note about peptic ulcer disease
1) Periods of exacerbations & remissions
2) Commonly seen in middle aged individuals
List 4 causes of peptic ulcer disease
1) H. pylori infection
2) Use of ASA or NSAIDs
3) Stress
4) Alcohol
Patho of H. pylori PUD:
H. pylori Hint: 3
1) Secretes enzyme urease
2) Breaks down urea
3) Ammonium toxic to epithelial cells & neutralizes acid
Patho of H. pylori PUD:
Erosion of mucosal lining Hint: 3
1) HCL diffuses into stomach wall & BV
2) Creates inflammatory response
3) Release of histamine & prostaglandins
Patho of H. pylori PUD:
Histamine Hint: 2
1) Causes vasodilation & stimulates pepsin & gastrin release
2) Acid secretion stimulated which attacks unprotected lining
Patho of H. pylori PUD:
HCL Hint: 2
1) Released by parietal cell
2) Irritates & destroys lining & continues to trigger inflammation
Patho of H. pylori PUD:
Scarring & fibrosis of lining Hint: 2
1) Fibrosis inhibits healthy cell reproduction
2) Decreased mucus & bicarb production to protect lining
Patho of H. pylori PUD:
Development of… Hint: 2
1) Erosion
2) Ulcer → extends into muscularis layer
Gastric ulcer (PUD) Hint: 5
1) Occurs in stomach
2) Epigastric pain 1-2 hrs after eating
3) Causes hematemesis or melena
4) Heartburn, chest discomfort & early satiety common
5) Can cause gastric carcinoma
Duodenal ulcer (PUD) Hint: 5
1) Occurs in duodenum
2) Epigastric pain 2-3 hrs after eating
3) Can cause melena or hematochezia
4) Heartburn, chest discomfort less common
5) Pain may awaken pt during night
Where in the stomach do gastric ulcers tend to develop?
Antral region of the stomach, adjacent to the acid-secreting mucosa of the body
Common age to see gastric ulcers
Ages 55-65 male & female
Patho of gastric ulcers Hint: 3
1) Primary defect is ↑ mucosal permeability to H+ ions
2) Frequent H. pylori
3) Gastric secretion is normal or less than normal
What is the most common type of PUD?
Duodenal ulcer
List 5 causes of duodenal ulcers
1) H. pylori
2) Smoking
3) NSAIDs
4) Stress
5) Genetic predisposition
List 4 things that occur with presence of duodenal ulcers
1) ↑ gastrin levels that stay high after eating, continue to stim secretion of acid
2) Impaired duodenal bicarb secretion
3) Failure of feedback where acid in antrum inhibits gastrin release
4) Rapid gastric emptying overwhelms buffering
List 6 clinical manifestations of duodenal ulcers
1) Chronic intermittent pain in epigastric area
2) Pain ↑ ~ 30 min to 2 hrs after eating
3) Night time pain btwn 11p-2a
4) Spasm & acid
5) Relieves w food, antacids
6) Tx H. pylori, help acids, relieve pain
List 7 clinical manifestations of gastric ulcer
1) Pain tends to ↑ w eating
2) Belching
3) Early satiety
4) Anorexia
5) N/V
6) Weight loss
7) Tends to be chronic
List 2 things both duodenal & gastric ulcers can cause
1) Melena
2) Hematemesis
List 3 things both duodenal & gastric ulcers can lead to
1) Hemorrhage
2) Perforation
3) Gastric outlet obstruction
List 4 goals of Tx PUD
1) Promote healing
2) Relieve pain
3) Decrease acid levels
4) Prevent recurrence
List 4 Tx options for PUD
1) Lifestyle changes
2) Abx
3) PPI
4) H2 inhibitors
List 3 lifestyle changes for treating PUD
1) Avoid caffeine, alcohol, tobacco
2) Avoid spicy, high fat foods
3) Avoid ASA or NSAIDs
