1. Relief of symptoms: H2 blockers or PPIs (x4-6 weeks). 2. If H Pylori positive, treat with antibiotics. 3. Change in habits, smoking cessation, ETOH cessation. 4. Effective pain management —> try to get off NSAIDs.

GI Stomach.Secretions Flashcards by JHope .

What are the 2 gastric secretions?

Acid and pepsinogen (which is then turned into pepsin).

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What are the 3 phases of the digestive process?

Cephalic phase 2. Gastric phase 3. Intestinal phase

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What occurs during the cephalic phase?

The thought of food (within the cerebral cortex) —> stimulates taste and smell receptors —> hypothalamus and medulla stimulate the vagus nerve —> stimulates parietal cells to increase stomach secretory activity.

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What occurs during the gastric phase?

Eat food —> stomach distends and activates stretch receptors —>

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What stimulates the intestinal phase?

Chyme entering the duodenum and acid (low pH).

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What occurs during the intestinal phase?

Gastrin is released into the blood via the intestine.

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What are the protective mechanisms within the stomach?

Mucus - Bicarbonate - Prostaglandins - Epithelial renewal (our entire gut lining turns over every few weeks).

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When there is pathology of the alimentary canal, there is an imbalance of what?

Protective and aggressive factors.

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Why do NSAIDs affect the GI tract?

Because prostaglandins are needed for protection of the GI tract, so inhibiting these —> increased acid, decreased bicarbonate, and decrease mucus production —> damage mucosal layer and weaken the barrier of the GI tract.

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What is H Pylori?

A spiral shaped, flagellated, gram negative bacteria.

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How is H Pylori spread?

Exact route is unknown, but likely fecal/oral or oral/oral. **We are likely colonized with this bacteria very early.

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What is the hallmark symptom of peptic ulcer disease?

Epigastric pain, described as gnawing, dull, aching, or “hunger-like.” Present in 80-90% of all patients.

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What are common methods of relief of epigastric pain with PUD?

Antacids and food.

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What symptom is unusual to be seen with PUD, and should make you think malignancy?

Weight loss

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Is fecal occult blood commonly seen in patients with PUD?

No, it is only seen in 1/3 of patients.

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What 3 habits must you ask patients about if you are concerned about PUD?

Use of OTC pain medications - ETOH use - Smoking

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How is a peptic ulcer diagnosed?

Definitive diagnosis —> Gastric biopsy via endoscopy. Can also do serum assay or urea breath test for H Pylori, but these are not diagnostic.

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How is PUD treated?

Relief of symptoms: H2 blockers or PPIs (x4-6 weeks). 2. If H Pylori positive, treat with antibiotics. 3. Change in habits, smoking cessation, ETOH cessation. 4. Effective pain management —> try to get off NSAIDs.

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What is Zollinger-Ellison syndrome?

Gastrinoma (gastrin secreting tumor) and hypergastrinemia.

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What are the diagnostic tests for Zollinger-Ellison syndrome?

Occult blood test 2. Fasting gastrin level > 150pg/mL. 3. Secretin test: IV secretin given —> gastrin level spikes over 200. 4. Imaging (preferably CT or PET, endoscopy not likely to be positive).

What is the definition of diarrhea?

3 or more liquid or semi-solid stools daily for 2-3 days. - Increase in the frequency of defecation and the fluidity and volume of feces.

What are the 3 major mechanisms of diarrhea?

Osmotic 2. Secretory 3. Motility

What are the 3 causes of diarrhea?

Infection 2. Toxin 3. Dietary (changes, allergies, or issues).

What is osmotic diarrhea?

A nonabsorbable substance in the intestine draws excess water into the lumen —> increases stool weight and volume.

What can cause osmotic diarrhea?

Lactase, pancreatic enzyme deficiency, and ingestion of excessive amounts of nonabsorbable sugars.

What are the most common viral causes of infectious diarrhea?

Norovirus, rotovirus, and adenovirus.

What are the most common bacterial causes of infectious diarrhea? Are these common?

Salmonella, campylobacter, shigella, E. coli, and C Diff. <10% of all diarrhea cases.

What are the most common parasitic causes of infectious diarrhea?

Cryptosporidium, giardia, and entamoeba.

What is the most common cause of inflammatory diarrhea? What are the common symptoms?

E Coli! Characterized by blood and pus in stool, as well as fever.

What is secretory diarrhea?

Excessive mucosal secretion of fluid and electrolytes produce large-volume diarrhea without inflammation.

What is small-volume diarrhea?

When a patient has inflammatory bowel disease or a fecal impaction, and has a small amount of diarrhea that is making its way around this occlusion.

What is the cause of cholera?

Infection through contaminated food/water.

What type of diarrhea does cholera cause?

An infectious diarrhea with an osmotic process.

What is motility diarrhea?

Increased peristalsis —> improperly mixed foods and impaired digestion —> diarrhea.

What are common causes of motility diarrhea?

Surgical resection, bypass of the small bowel, fistula formation between loops of bowel, or gastroparesis of diabetes.

What are systemic effects of prolonged diarrhea?

—> Dehydration, electrolyte imbalance, weight loss.

If a patient has inflammatory bowel disease, what are common associated symptoms with their diarrhea?

Fever, cramping pain, and blood stools.

What is steatorrhea? What causes this?

Fat in the stool. Caused by malabsorption syndrome.

What is your first treatment in question when a patient comes in with diarrhea?

Fluid and electrolyte replacement (this may be only treatment needed).

What populations should you be more likely to treat with fluid and electrolyte replacement?

**Infants and children because they get dehydrated very quickly.

What is celiac disease?

An immune response to gluten —> causes diffuse damage to proximal small intestine with malabsorption —> "permanent" dietary disorder.

What population group has the highest risk for Celiac disease?

Caucasians (1:100)

What is the pathophysiology of Celiac?

Antibody to gluten cross-reacts with structures related to smooth muscle connective tissues in the small intestine.

How is celiac diagnosed?

Definitive diagnosis is biopsy. Autoantibodies can also be detectable now in serum.

What is the difference between diverticulosis and diverticulitis?

- Diverticulosis is the simple herniation of colonic mucosa, ie the presence of diverticula. - Diverticulitis is the inflammation of a diverticulum; it presents w some similarities to appendicitis.

Of those with diverticulitis, many people present with rectal bleeding. Who is most likely to bleed?

Those over age 60, with hx of HTN, atherosclerosis, or regularly use NSAIDs.

What is the treatment of diverticulitis?

- Bowel rest (NPO) until bleeding stops. Then advance diet slowly. - If febrile, use antibiotics.

If you get diverticulitis once, are you likely to get it again?

Yes, 25% of people get recurrence.