Upper GI Flashcards
Who is most likely to experience esophagitis?
Immunocompromised pt;
HIV/AIDS pts
Cancer therapeutics
immunodeficiency disorders
What is the most common irritation/ inflammation in GI?
GERD
Are swallowing disorders espophagitis?
No; Lack of neuromuscular coordination of the voluntary or involuntary muscles associated with swallowing
What is the feeling of somethings tuck in the throat?
Globus
Where does the esophagus meet the stomach?
Lower esophageal sphincter
What can occur when esophagus is constantly inflammed/ exposed to the stomach acid?
Metaplasia
T or F GERD can mimic a heart attack chest pain
True
What is the risk of Barret’s esophagus? What is it?
15%
Metaplasia pre-cancerous and must be monitored as its a higher risk of esophageal cancer
What are some non-pharmacological treatments of GERD?
Weight loss, extra pillow for sleep, earlier supper, avoiding trigger foods
What medications can be used to reduce acid for GERD treatment?
H2 receptor antagonists, PPI’s
Antacids can cause rebound acidiity but still a good choice to try
How do the H2 receptors work to treat GERD? What are drug names?
Bind H2 receptor reducing H/K ATPase activity
used to treat GERD and peptic ulcers, duration is not as long as PPI’s
Drugs: Rantidine, Famotidine, Cimetidine, Nizatidine
How do PPI’s work to treat GERD? what are the drug names?
Bind to H/K ATPase of the gastric parietal cell, preventing acid secretion
Used to treat GERD, peptic ulcers, pylori-related ulcers, duodenal ulcers, and Zolliner-Ellison disorder
Drugs: Pantoprazole, Omeprazole, Rabeprazole, Estomeprazole, Lansoprazole, Dexlansoprazole
What do pareiral cells do?
Secrete acid into stomach
What do ECL cells do?
Secrete histamine and peptide homrones
What is Gastritis?
Inflammation of the stomach can be Acute or Chronic
What can cause Gastritis?
infection (h. pylori)
Irritation from food
Medications such as NSAIDs, antibiotics
alcohol as direct irritant
atrophy via old age
major stress
autoimmune
What is the number one reason for hospitalization due to GI bleeding?
Chronic NSAID use
What are some signs and symptoms of Gastritis?
Pain
bloating
burning sensation
heavy stomach
belching and flatulence
Nausea and Vomitting
loss of apetite
weigth loss (chronic)
blood in vomit or stool
coffee-ground emesis
Melena (tar stool)
How do you manage H pylori infections associated with gastric ulcers?
Triple antibiotic therapy + PPI is typical
T or F. H2 antagonists should be used for gastritis from irritations (foods)
False; H2 antagonists and antacids should be avoided
What are the 3 parts of treatment for gastric ulcers?
1-2 antibiotics (amox, tetra, clarithromycin, metronidazole) depending on sensitivity and allergies
Bismuth can be added
H2 antagonist or PPI for 2-3 weeks
When is surgery done for gastric ulcers?
Only if perforated or nonhealing
What are risk factors for gastric cancer?
infections (h pylori, EBV)
Genetic factors
prior stomach surgery/ radiation exposure
smoking
alcohol
high salt diet
overweight
What is the most commonly seen gastric cancer type?
Adenocarcinomas
WHat is the treatment for gastric cancer?
SUrgery in early stages, radiation and chemo for later stages
What are early symptoms of gastric cancer? What symptoms arise as it progresses?
early symptoms are vague and similar to gastric ulcers, but systemic symptoms like fatigue and weight loss and anemia can develop. Lymph node involvement vomitting, pain, abdominal blaoting, fullness, and blockage may occur
what are the 3 parts of the pancreas?
head
body
tail
What is the exocrine function of the pancreas?
produce bicarbonate and digestive enzymes such as lipase, amylase, and protease to break down fats, carbs, and proteins
Where does pancreatic fluid enter the duodenum through?
papilla (major and minor) which is near the common bile duct
Why is pancreatic cancer of the head so problematic?
can impinge on the ducts and duodenum leading to digestive problems
What is acute pancreatitis?
Acinar cell injury and duct obstruction resulting in inappropriate extracellular leakage of activated digestive enzymes and thus autodigestion of pancreatic and extra-pancreatic tissues
T or F Pancreatitis is a minor disease with little severity?
False; ranges from miled to fatal, can have hemorrhagic pancreastitis with massive necrosis
What does necrosis of acinar cells lead to?
Inflammation which releases oxygen free radicals that damage tissue leading to patches of necrotic adipocytes that cause fibrosis upon healing
What are symptoms of acute pancreatitis?
Severe epigastric pain radiating to upper back, nausea, vomiting
What are signs of acute pancreatitis?
elevated serum amylase and lipase, going into shock or collapsing
What is the management for acute pancreatitis?
pain management
avoiding alcohol
supportive care
What complications can occur with acute pancreatitis?
repeated incidences can cause chronic pancreatitis and fibrosis
In some cases necrotic pancreas becomes infected with intestinal bacteria greatly increasing risk of death
What is the main cause of chronic pancreatitis?
Alcoholism (80%)
What are some presentations of chronic pancreatitis?
poor digestion
pain upon eating
greasy/smelly stools
malnutrition
recurrent or persistent epigastric pain
What is saponification?
areas of fat necrosis becoming calcified
how does alcohol lead to obstruction of ducts?
alcohol acts as a secretagogue stimulating secretion but, these extra proteins can clog up the pancreatic ducts
What enzyme supplement is given when pancreatic function declines?
pancreatin
what is the mortality rate of chronic pancreatitis patients per year? over 20 years?
3-4%/year
25% by 20 years
What can occur in chronic pancreatitis patients that can have fatal complications?
Acute pancreatitis episodes
Compare and contrast Acute vs Chronic pancreatitis.
Acute occurs suddenly and goes away within a few days vs Chronic developing over many years does not go away andleaves permanet injury or scarring to pancreas
Acute may involve a short hospital stay to heal pancreas vs chronic have a good outlook if they follow management plan
Acute most cases are mild and pancreas returns to normal vs chronic calcification can appear on a CT scan; damage can be seen even when flare up is not occuring
