GI disorders Flashcards
GERD
Gastroesophageal reflux disease - Long-term condition where acid from the stomach comes up into the esophagus – due to weakening or inappropriate opening of the sphincter between stomach and esophagus
Chronic GERD?
> 2x a week
GERD symptoms
Bad breath
Nausea
Pain in your chest or the upper part of your abdomen
Problems swallowing or painful swallowing
Respiratory problems
Vomiting
Wearing away of your teeth
GERD diagnosing
Reviewing of symptoms/medical history
GI endoscopy/biopsy
Upper GI series: drink Barium to line GI tract
Esophageal pH (pill or attached surgically)
Factors that affect GERD
Obesity
Smoking
Certain medicines: asthma, Ca2+ channel blockers, antihistamines, painkillers, sedatives, antidepressants
Hiatal hernia
Opening in your diaphragm lets the upper part of the stomach move up into your chest, which lowers the pressure in the esophageal sphincter.
GERD treatment
Loose weight
Loose fitting clothing
Stay upright 3hrs after a meal
Sleep on a slight angle (head 6-8in higher than body)
GERD treatment
Antacids, H2 blockers, Proton-pump inhibitors, prokinetics, antibiotics, surgery (fundoplication) to sew the top of the stomach around the esophagus which adds pressure to the lower end of the esophagus
Antacids
Neutralize acid in the esophagus by raising the pH
H2 blockers
Acts by preventing the effects of histamine on parietal cells to produce acid
Proton pump inhibitors
Act to reduce acid production in stomach
Long term use – increase risk of hip, wrist or spinal fractures
Prokinetics
Help empty stomach faster (side effects: nausea, diarrhea, depression, anxiety)
Barret’s Esophagus
Potentially serious complication of GERD where tissue lining the esophagus thickens and becomes red.
Is thought to be a major risk factor for the development of esophageal adenocarcinoma.
PUD
Peptic ulcer disease - Ulcers develop in the lining of the stomach (Gastric ulcers), or duodenum (duodenal ulcers)
Symptoms of PUD
Stomach pain Feeling of fullness Bloating Intolerance to fatty food Heartburn Nausea
PUD Causes
Helicobacter pylori infection
Long-term NSAID usage
PUD diagnosis
Lab test for H. pylori (blood, stool or breath)
Upper GI endoscopy and biopsy
An upper GI series: drink Barium to line the GI tract, and X-ray
PUD treatment
Antibiotic to kill H. pylori
PPI, H2 blockers or antacids (help allow lining to heal)
Diarrhea
Defined as abnormally loose stool accompanied by change in frequency or volume
Diarrhea causes
Virus Food poisoning Food contamination Medications Lactose intolerance
Diarrhea leads to…
Acidosis (pH >7) and Acid-Base and electrolyte abnormalities
Constipation
Infrequent defecation
Hardened or reduced caliber of stool
Sensation of incomplete evacuation or need to strain with stools
Three bowel movements or less per week
Constipation complications
Abdominal discomfort Loss of appetite Nausea and vomiting Excessive straining Hemorrhoids, anal fissures, and rectal prolapse Intestinal obstruction Colonic ulceration Overflow incontinence with stool leakage
What is Celiac disease?
Gluten-sensitive enteropathy where one has an immune reaction to gluten which is a protein found in barley, wheat and rye (Precise cause is unknown)
What does Celiac disease cause
flattening of the villi lining the small intestine
Celiac disease symptoms
Diarrhea Fatigue Weight loss Bloating and gas Abdominal pain Nausea and vomiting Constipation
Celiac disease risk factors
A family member with celiac disease Type 1 diabetes Down syndrome or Turner syndrome Autoimmune thyroid disease Microscopic colitis (lymphocytic or collagenous colitis) Addison's disease
Diagnosing Celiac disease
Blood test (looks for specific antibodies) Genetic testing (human leukocyte antigen detection can rule out the disease Endoscopy (looks at the lining of the small intestine)
Celiac disease treatments
No effective treatment for celiac disease, only management with gluten-free diet
Celiac disease can cause
Malnutrition Bone weakening Infertility/Miscarriage Lactose intolerance Cancer Nervous system problems
Inflammatory bowel disease
(AKA Chron’s disease & Ulcerative Colitis) characterized by chronic inflammation of the GI tract
Ulcerative colitis
typically begins in the rectum and extends continuously to involve the entire colon (only involves the inner layer)
Chron’s disease
involves the end of the small intestine and ginning of the colon (may affect part of the GI tract in a patchy pattern). Affects all layers of the bowel wall.
Symptoms of IBD
Diarrhea Fever and fatigue Abdominal pain and cramping Blood in your stool Reduced appetite Unintended weight loss
IBD risk factors
Race/ethnicity Family history Cigarette smoking NSAID's Where you live (northern climates and diet)
diagnosing IBD
done through exclusion:
Blood test - for anemia
Fecal occult blood test - test for blood in stool
Colonoscopy/endoscopy
Xray/CT/MRI - used to detect complications of IBD
IBD complications (in both ulcerative colitis & Chron’s disease)
Colon cancer Skin, eye, joint complications Medication side effects Primary sclerosing cholangitis Blood clots
Chron’s disease complications
Bowel obstructions Malnutrition Ulcers Fistulas Anal fissure
Ulcerative colitis complications
Toxic megacolon
A hole in the colon (perforation)
Severe dehydration (due to excessive diarrhea)
IBD treatment
Anti-inflammatory drugs Immune system suppressors Antibiotics Supplements (iron, calcium, VitD) Nutritional support Surgery (to remove affected areas)
Pancreatitis
Inflammation of the pancreas that occurs when digestive enzymes start to digest the pancreas itself (acute/chronic)
Causes of Pancreatitis
Many causes including gallstones (block the pancreatic duct) and chronic heavy alcohol use (acinar cells metabolize alcohol to toxic byproduct)
Acute pancreatitis
Upper abdominal pain Abdominal pain that radiates to your back Abdominal pain that feels worse after eating Fever Rapid pulse Nausea Vomiting Tenderness when touching the abdomen
Chronic pancreatitis
Upper abdominal pain
Losing weight without trying
Oily, smelly stools (steatorrhea)
Diagnosing pancreatitis
Blood tests (looking for elevated levels of pancreatic enzymes, pancreatic amylase, and pancreatic lipase) Stool tests (to measure fat levels) CT, ultrasound, endoscopy or MRI (purpose is to look for gallstones and inflammations)
Pancreatitis treatment
Fasting, pain meds, IV fluids
Once under control the aim is to remove obstruction/affected tissue from pancreas through surgery
If chronic pancreatic enzymes are used for management
Pancreatic enzyme insufficiency (PEI)
Reduction in pancreatic enzyme activity in the intestinal lumen
PEI treatment
PERT – pancreatic enzyme replacement therapy
hepatocyte damage
Increases in aspartate or alanine aminotransferase (AST or ALT respectively)
cholangiocyte damage/cholestasis
Gamma-glutamyltranspeptidase (GGT), alkaline phosphatase (ALP) or bilirubin
R factor
> 5 suggests hepatocellular pattern of liver injury
2-5 mixed pattern of liver injury
<2 suggests cholestatic liver injury
Cholestatic liver diseases
Due to impaired secretion by hepatocytes or to obstruction of bile flow through intra or extrahepatic bile ducts (decrease in bile flow)
Primary sclerosing cholangitis
Scaring of the bile ducts that may eventually lead to liver failure or tumors in the bile duct (only treatment in liver transplant)
Primary biliary cholangitis
Autoimmune disease causing progressive destruction of the small bile ducts
Affects mainly women
Transplant is the only treatment
Jaundice
due to cholestatic liver disease and is apparent through the yellowing of the skin, sclera and mucous of the membrane (due to excess of bilirubin - breakdown product of red blood cells that are filtered through the liver)
Consequences of cholestatic liver disease
Fibrosis: deposition of an extracellular matrix containing collagen – leading to stiffening and scarring of the liver.
Cirrhosis: severe bridging fibrosis that significantly impacts liver function
