Upper GI Flashcards
Upper GI organs
Esophagus, stomach, beginning of small intestine
2 categories of UGI probs
esophagus problems and influx disorders
How does dysphagia begin?
With solids, then moves to liquids
Mechanical causes of dysphagia
Structural probs like tumor, diverticula, stenosis and strictures
Neuromuscular causes of dysphagia
CVA, achalasia (LES doesn’t open well)
Can ppl recover from dysphagia
Yes, even with trach/intubation
GERD
LES does not close well so lower stomach gastric contents does not go back up
- lack of strength or inc ab pressure
Triggers for GERD
very acidic - fatty, spicy, tomato, citrus, caffeine, lots of alc, smoking, sleep pattern, obesity, pregnancy, pharmacologic agents
GERD CM
burning feel (pyrosis), dyspepsia, regurgitating, dysphagia, chest pain, pulmonary symptoms, mouth problems (gingivitis, sore throat, laryngitis), earache
Complications of GERD
Ulcers, scars, strictures, Barrett’s esophagus
Barrett’s esophagus
Develop abnormal metaplastic cells (premalignant)
- 3x risk of developing adenocarcinoma
Treatment for Barrett’s eso
No great tx; prevention bc very low survival
Hiatal hernia
defect in the diaphragm that lets part of the stomach pass into the thorax
Sliding hernia
small hernia that leaves the peritoneum intact
- no tx
Paraesophageal hernia
Part of the stomach pushes through the diaphragm and stays there permanently; can protrude into the chest if peritoneum is thin
Can there be mixed type hiatal hernia
Yes
Causes of hiatal hernia
Age related, injury or damage may weaken diaphragm muscle, excess pressure on muscle and/or stomach (cough, vom, BM strain), obesity, smoking
CM of hiatal hernia
Belching, dysphagia, chest or epi pain or asymptomatic
CM that only goes with paraeso hernia
GERD
Tx for hiatal hernias
CONSERVATIVE
- small frequent meals
- sit up after eating
- avoid tight clothes and abdominal supports
- wt control
- antacids for GERD/esophagitis
Surgery as last resort
Gastritis
Inflammation of the stomach
Acute gastritis
Temporary inflammation, no intestine function
- lasts 2-10d
Chronic gastritis
Progressive inflammation from H. pylori or autoimmune (parietal cells attacked)
- lasts weeks to years
Acute gastritis is r/t…
Drugs, alcohol and irritating substances, NSAIDs, infectious agents like H. pylori
Complications of chronic gastritis
PUD, bloating, anemia, gastric cancer
H. pylori
Gram - spirobacteria
- needs acid
- overgrowth causes chronic gastritis, PUD, stomach cancer
- asymptomatic at first
- transmitted with fluids or food and water
CM of gastritis
Burning, vomiting, anorexia, postprandial discomfort (after eating), gas, hematemesis
Acute gastroenteritis
Inflammation of the stomach and small intestine
- viral (Norovirus or rotovirus)
- bacterial (E. coli, Salmonella, campylobacter)
- parasitic infx
- lasts 1-3 days up to 10 days
CM of acute gastroenteritis
diarrhea (bloody if bacterial), abdominal pain, N/V, fever, malaise
BIG risk for acute gastroenteritis
FVD
Tx for acute gastroenteritis
Usually let it play out
Locations of ulcers
eso, stomach (gastric), or duodenum (peptic ulcer)
What causes PUD
Often after exposure to acid and H. pylori, injury causing substances (NSAIDs), alcoholic
What can worsen PUD
NSAIDs, smoking, pepsin
Protective factors for PUD
Mucus, bicarb, BF, prostaglandins
Does the body try to balance factors for PUD
YES
Risk factors for PUD
family, stress (not a cause), SMOKING
Why does stress worsen PUD
Increases gastric acid secretion
NSAIDs-induced PUD
lose protective prostaglandin layer when you take NSAIDs
Risk fx for NSAID-induced PUD
Older, higher and more freq doses, take chronic steroids, anticoags, PUD hx, serious system diagnosis, H. pylori
Patho of PUD
Damage mucosa –>histamine secreted–>inc acid and pepsid secretions–>further damage–>vasodilation which bring WBCs to the area and edema–>damaged BVs can cause bleeding
Duodenal ulcers
- more common
- any age, often early adulthood
- often from NSAIDs
Gastric ulcers
- 50-70Y
- bc inc use of NSAIDs, stomach, anticoags
- more like to have serious systemic illnesses
CM of PUD
none or N/V, anorexia, wt loss, bleeds
- burning pain in the middle of the ab when stomach is empty
CM for gastric PUD
burning, cramping, gas-like, epigastrum, back
- 1-2h post eating
Duodenal CM
Same as gastric but 2-4h post eating
Complications of PUD
- Hemorrhage - stomach and int pretty vascular
- Obstruction
- Perforation and peritonitis