Review questions Upper GI Flashcards
- Identify the etiology for the symptoms of esophageal diseases. Describe the role of the LES
1 The role of the LES is to keep gastric juices in the stomach and provide appropriate movement of food throughout the GI tract. 2. The etiology of symptoms are +/- production of gastric acid or issues with the LES or Pyloric sphincter which leads to damage of the mucosa
- Define Achalasia
D: LES fails to open/close properly. persistent blockage; slow trickling of esophageal contents into the stomach, persistent spasm of LES; difficulty swallowing most commonly a secondary disorder. MNT: small frequent meals eat food slowly, dysphagia diet (pureed, mechanical, advanced) DX: esophageal manometry, esophageal motility studym endoscopy, upper GI x-ray
3a. Identify potential causes of acute esophagitis
d: reflux of gastric acid into the lower esophagus S: heartburn, regurgitation, dysphagia C; intubation, viral infection, irritating agents, and radiation treatments
3b. Identify potential etiologies and the symptoms of GERD. Why is successful treatment of GERD important?
C: transient LES relaxation, reduced LES pressure, increased intraabdominal pressure, delayed gastric emptying, recurrent vomiting, LTU of aspirin/NSAIDS NC: caffeine, chocolate, mints, carbonated beverages Prevention: avoid lying down after meals
3c. Define Barrett’s Esophagus
D: complication of GERD, a change in the epithelial cells of the esophageal mucosa approximately 10% of patients; S: similar to those seen in GERD
- Why is maintaining appropriate LES pressure important? Identify factors which can lower LES pressure
1) If esophageal pressure lower than gastric pressure, gastric contents will flow into the esophagus 2) Smoking, decreased LES and pyloric sphincter pressure; large meals, dietary fats, alcohol
- identify the etiology and symptoms of a hiatial hernia
D; herniation of a portion of the stomach into the chest through the esophageal hiatus of the diaphragm (sliding hiatial hernia most common, paraesophageal less common) MNT: Decrease consumption of alcohol, coffee (including decaffeinated), caffeine, black and red pepper (individualized). Avoid cigarette smoking. Avoid foods that are not tolerated.
- What are the MNT considerations for a patient with cancer/surgery of the oral cavity or esophagus?
Cancer: leads to eating difficulties (tumor mass and obstruction) 2) Med TX: surgery, radiation, chemo (effects chewing, swallowing, salivation, and taste acuity) 3) Esophagectomy: removal Gastric pull-up procedure
- ID medications utilized in the treatment of GERD, hiatal hernia, and peptic ulcers
H2B; proton pump inhibitors, antacids, surgery
- Identify dietary and behavioral considerations for treatment of GERD/hiatial hernia
avoid dietary fat, alcohol, large meals, avoid cigarette smoking, avoid tight fitting clothing, raise upper portion of the bed 6-8 inches, wait min 3 hours before sleep, avoid lying down after meals
- What is the most common cause of gastritis and peptic ulcers? How is it treated?
1) H. Pylori infection or 2) NSAIDS and Aspirin; 2) Antibiotics, H2B, Proton pump inhibitors, bismuth subsalicylate
gastritis
inflammation of the tissue and damage of the gastric mucosa
peptic ulcer
eroded lesion in the esophageal or gastric and duodenal mucosa resulting from too much action of gastric acid s: nausea malaise, anorexia, hemorrhage, or epigastric pain
- identify the behavioral/lifestyle considerations for peptic ulcer disease
1) alcohol/smoking/diet 2) Smoking reduces LES and pyloric sphincter pressure, inhibits pancreatic bicarbonate secretion, and decreases duodenal pH, and increases the likelihood of recurrence and perforation.
- ID stress ulcer
D: complication of severe burns, trauma, shock, radiation therapy, critical illness C: gastric ischemia, potential for significant hemorrhage Tx: proton pump inhibitors H2B, and antacids.
