Hypo/achlorhydria

Question 1

4 stimuli for gastrin secretion

Answer 1

thinking about, smelling or chewing food
hypoglycemia
anger, EPI
proteins, calcium, milk, caffeine

Question 2

what does HCl trigger the release of when it enters where?

Answer 2

HCl triggers the release of CCK and secretin once the acid enters the duodenum

Question 3

what are the effects of CCK? (3 things it increases, 3 things it decreases)

Answer 3

increases: GB contraction, mucosal and pancreatic growth, pancreatic enzyme, bicarb and insulin release
decreases: gastric emptying, tone of sphincter of Oddi, appetite and GI immunity

Question 4

7 major fxns of gastric acid

Answer 4

1. converts pepsinogen to pepsin
2. kills some ingested bac and parasites
3. prevents SIBO
4. aids in digestion of vit B12 and folic acid
5. aids in mineral digestion
6. stimulates release of CCK and secretin
7. may affect leukocyte fxn

Question 5

name 4 dzs associated w/low stomach acid levels

Answer 5

osteoporosis, DM, cholelithiasis, cholecystitis, childhood asthma, hypo/hyperthyroidism, RA, SLE, adrenal exhaustion, chronic hepatitis, chronic atrophic gastritis, chronic urticaria, eczema, vitiligo, rosacea, SIBO

Question 6

name 4 causes of low stomach acid

Answer 6

AI, chronic unremitting stress, H. pylori overgrowth, devitalized diet, chronic overeating (fat, sugar), salt restrictive diet, sympathetic dominance/low vagal tone, use of PPI or H2 receptor antagonist

Question 7

what are 6 tests you can use to dx hypo/achlorhydria? which one is definitive, which is a screening test and which two are fxnal?

Answer 7

1. Heidelberg’s test (definitive)
2. gastric string test (screening)
3. riddler’s gastric acid point (fxnal)
4. BL weakness of pec major (fxnal)
5. clinical picture
6. HCl challenge

Question 8

definition of hypochlorhydria? achlorhydria?

Answer 8

hypo: pH >3
achlo: pH> 6-7

Question 9

describe Riddler’s test

Answer 9

1 human inch inferior to the tip of the xyphoid process on the inferior L costal border (will elicit pain/tenderness)

Question 10

describe the clinical sx picture of a pt with hypo/achlorhydria

Answer 10

pyrosis cc/pc
indigestion cc/pc including gas, bloating, eructations, nausea
delayed gastric emptying presenting as heavy, full sensation in the stomach pc, easy satiety, nausea

Question 11

describe the clinical signs of a pt w/hypo/achlorhydria

Answer 11

soft, brittle, "clouds" or peeling nails
diffuse hair loss in women
maxillary telangiectasia
coated tongue
halitosis
SIBO
gastric acid Riddler's pt tenderness
BL pec major weakness
Lowenber's test may be (+)

Question 12

lab findings w/hypo/achlorhydria?

Answer 12

low serum levels of TP, globulin, ferritin, calcium, magnesium, BUN, B12

Question 13

list 4 tx options for hypo/achlorhydria

Answer 13

avoid overeating and excessive fluids w/meals
avoid excess fat and sugar
basics of food combining (simplify meals, combine protein w/veggies or non-sweet fruits, limit starch in a meal, sweet fruits alone)
consider leisurely walks pc
eat breakfast like a queen, lunch like a princess and dinner like a pauper
only a light snack after 8 pm
avoid excess and icy drinks cc
drink 2 L of water ic
chew foods until liquid
simplify meals
calm down before meals
enhance the cephalic phase of digestion
sit and take time for meals
pleasant environment and company for eating
avoid tight waistbands
clear unresolved early memories of stressful eating

Question 14

list 4 tx options

Answer 14

bitter herbs or vinegar 10-20 mins ac
gentian and scutellaria
gentian and ginger
bitters plus healing/inflammatory modulators
add bitter foods to diet: lime or lemon pickle, black coffee, capers
betaine hydrochloride w/pepsin
supplement minerals, B12, folate
tx underlying unresolved stress and improve coping skills
mindfulness techniques