GI Disorders Flashcards
Which GI disorder is most likely to be confused with angina?
GERD
GERD
- reflux or backwards movement of gastric contents into esophagus
- occurs during \trnaient relaxation of esophageal sphincter or delayed gastric emptying
- reflux of acid and pepsin is injurious to esophageal lining
Causative agents of GERD
Agents that decrease the tone of esophageal sphincter
- foods
- CNS depressants
- obesity
- pregnancy
- hiatal hernia
- delayed gastric emptying
- increased gastric volume
Dx of GERD
History of reflux symptomatology
Radiographic studies using a contrast medium
Esophagoscopy
TX of GERD
Conservative methods
- avoid positions
- avoid large meals
- weight loss
- drugs
- small thickened meals and antacids for children
Presentation of GERD
HEartburn 30-60min after eating Relieved by sitting upright -chest pain (confused with angina) -respiratory symptoms
Causes of achalasia
Incomplete relaxation of lower esophageal sphincter in response to swelling: functional obstruction with consequent dilation of proximal esophagus
Primary achalsia
Mesenteric ganglia that carry vagaries fibers from esophagus are absent
Hiatal hernia
Herniation of stomach through the esophageal hiatus of diaphragm
- small ones are asymptomatic
- large hernias require surgery
How can GERD or Barretts lead to esophageal cancer
Barretts: 30-40% increase in adenocarcinoma because of high grade dysplasia and needs periodic screening
GERD can lead to Barrett;s
How can you prevent or minimize GI disorders
Proper nutrition or changes in health practices
Lower sphincter is a ______ sphincter
Physiologic
Lower sphincter is a _____ valve
One way valve
Types of hiatal hernia
Sliding
Paraesophageal
Dx of hiatal hernia
Accidental diagnosis
TX of achalasia
Antiacids
Then treat surgically
What is GERD associated with
Eating
How does GERD present
- heartburn and pyrosis usually related with eating
- normal mechanism is one way
- weak or incompetent lower esophageal sphincter causes gastroesopaheal reflux disease or GERD
Why is GERD common in infants
Small stomach and lying position
Complications like esophageal damage and secondary respiratory disease
-can cause damage to lungs
Distal esophageal squamous cells replaced by columnar repithelium containing goblet cells
Barrett’s esophagus
Main problem with GERD
Heartburn associated with eating
Complication of chronic GERD
Barrett’s esophagus
What is Barretts common in
Males
What type of cells are normally in the esophagus
Squamous cells
Complications of Barrett’s esophagus
Strictures and ulcers
Esophageal cancer
- uncommon
- directly related to diet and environment
- 2 types: adenocarcinoma, squamous cell carcinoma
Adenocarcinoma )esophageal cancer)
Complications of GERD and BArrett esophagus and occur in the distal third of the esophagus, common in Caucasian males, ratio is 7:1 in males and females
Squamous cell carcinoma esophageal cancer
Occurs in the middle part of esophagus and risk factors are alcohol, tobacco, injury, achalasia and consumption of hot beverages
Main presenting complaint that occurs late in the disease of esophageal cancer
Dysphagia
- weight loss
- anorexia
- fatigue
- pain on swallowing may occur
Reservoir to contents entering digestive tract and lies in upper abdomen
Stomach
Acute gastritis
Complaints vary with cause
- aspirin: no symptoms or heartburn
- alcohol: abdominal distress, vomiting and hematemesis
- toxins: staph aureus causes abrupt and violent onset with gastric…distress and vomiting
- in cases of hemorrhage, black, tarry stool
- self limiting with complete regeneration within several days of removal of inciting factor
Gastric mucosal barrier
- lining impermeable to acid
- coupled secretion of H+ and HCO3-
- gastric mucus
- cells closely packed tight and covered with an impermeable hydrophobic layer
- no diffusion of ionized water soluble molecules
- aspirin and bile disrupt
- PGs protect stomach wall
Common causes of gastritis
- aspirin, alcohol, NSAIDs
- toxins
- steroids
- illness or trauma
- radiotherapy and chemotherapy
Chronic gastritis
Presence of chronic inflammation leading to atrophy and absence of grossly visible erosions (as compared to acute version)
Major types of chronic gastritis
- Helicobacter pylori gastritis
- Autoimmune gastritis
- Chemical gastropathy
What is the most common cause of chronic gastritis int he US?
Helicobacter pylori gastritis
Helicobacter pylori is gram neg or pos?
Gram negative
Shows up hot pink
TX for helicobacter pylori gastritis
Combination therapy with two or three ABx with a proton pump inhibitor
What does H pylori cause
Atrophic mucosa decreases parietal chief cells (MALT)
-B cell lymphoma risk
Autoimmune chronic gastritis
- 10% of people
- Associated with other autoimmune disorders (DM type I)
- anemia, atrophy leading to adenocarcinoma
- -macrocytic anemia due to lack of B12 absorption, no intrinsic factor
Chemical gastropathy gastritis
Chronic injury due to alkaline duodenal reflux (pancreatic secretions and bile)
Number one cause of ulcers and predict the most likely cancer it may cause
Peptic ulcer disease
Gastronomes
Who is most likely to get peptic ulcer disease
Blood group O
Zollinger-Ellison syndrome
Rare condition with irrespective gastrinoma induodenum and pancreas 2/3 are malignant and 1/3 have metastasized at time of Dx
Stress ulcers
Curling ulcers
Cushing ulcers
Risk factors for stomach cancer
Genetic predisposition
Carcinogens like N-nitroso compounds in preserved and smoked foods
Autoimmune gastritis
Gastric adenoma and polyps
Symptoms are vague when they occur: detection is difficult
What disorder is associated with food and drink not going down
Achalasia
What cancer is associated with achalasia
Esophageal adenocarcinoma
