Upper GI Diseases

Question 1

What are the 3 parts of the stomach?

Answer 1

Fundus
Corpus (Body)
Antrum

Question 2

Mucous cells produce….

Parietal cells produce….

Chief cells produce….

Answer 2

Mucus

HCl and IF

Pepsinogen

Question 3

What stimulates mucous cells?

What stimulates chief cells?

Answer 3

Mechanical- chew and Bolus in stomach

Acetylcholine and gastrin

Question 4

What stimulates parietal cells?

Answer 4

Acetylcholine, gastrin, and histamine

Question 5

What do G cells produce?

What do D cells produce?

What do ECL cells produce?

Answer 5

Gastrin
Somatostatin
Histamine

Question 6

What stimulates D cells?
What stimulates ECL cells?
What stimulates G cells?

Answer 6

Acid
Acetylcholine and gastrin
Protein products and acetylcholine

Question 7

What 2 neurotransmitters are GI motility excitatory?

Answer 7

Acetylcholine and serotonin

Question 8

What peptides are inhibitory to the GI?

Answer 8

GIP, somatostatin, vasoactive intestinal peptide

Question 9

What does pepsinogen become?

Answer 9

It is inactive form of pepsin. Turns to pepsin when mixed with HCl. Splits and digests proteins

Question 10

What affect does Prilosec have?

Answer 10

It’s an anti-secretory, so decreases HCl from parietal cells. Less HCl means less IF and no binding to B12 so could lead to B12 deficiency.

Question 11

Which cells do Ach stimulate?

Answer 11

Parietal, chief, ECL, G-cells

Question 12

Which cells does gastrin stimulate?

Answer 12

Chief, parietal, and ECL

Question 13

What happens to somatostatin levels when pH decreases?

Answer 13

This means more acidic GI which means digestion needs to quit. Somatostatin is inhibitory so
More acid means more somatostatin (D cells)

Question 14

3 phases of secretions to meal response:

Answer 14

Cephalic: HCl and pepsinogen when taste, smell, and see food.
Gastric: food in stomach stretches vagus nerve
Intestinal: stop secretions once pH is less than 2

Question 15

What is UIE?

What is MALT?

Answer 15

Upper GI Endoscopy

Mucosa Associated Lymphoid Tissue (increased risk with PUD)

Question 16

What is Peptic Ulcer Disease?

Answer 16

PUD

Ulcers in gastric mucosa of Antrum or duodenum that penetrate sub mucosa (deep)

Question 17

What are C/C and #1 cause of PUD?

Answer 17

Epigastric pain that is sensitive but not specific to PUD.

80-90% ulcers from Helicobacter pylori bacteria (2/3 of world carries it)

Question 18

Where are H pylori and why are they dangerous?

Answer 18

Live under mucus layer in stomach
Break down urea to
Ammonia so decrease acidity of stomach and survive longer.
They produce proteins that damage mucus cells to attract lymphocytes and inflame the area.

Question 19

Why can excessive ASA and NSAIDS use cause PUD? Why smoking?

Answer 19

Inhibits COX2 which makes pro and anti inflammatory chemicals. Less anti and more pro.
Less bicarbonate secretion so more acidic, less anti acid function and lowers LES pressure.

Question 20

What is primary PUD Tx?

Answer 20

7-14 days of 2 antibiotics with bismuth and an PPI.

Hard to stick with b/c abdominal pain and N/V.

Question 21

What meds help decrease acidic environment to help PUD healing?

Answer 21

Anti acids (tums, Mylanta)
Histamine receptor blockers (cimetidine, ranitidine or Zantac)
Proton pump inhibitor (omeprazole, -azoles, nexium)
Stomach lining protector (pepto bismol)

Question 22

What 3 things should be managed nutritionally for PUD patients?

Answer 22

Electrolytes from diarrhea, Ca and Vit D status and bone Fx risk, B12 deficiency from PPI.

Question 23

What foods increase GI acid?

Answer 23

Black and red pepper
Caffeine
Coffee with or without caffeine
EtOH

Question 24

What is Melena?

What is atrophic gastritis?

Answer 24

Black, tarry stools from bleeding in stomach.

Less parietal cell function so possible B12 deficiency (HCl, IF)–can happen from LT Nexium use

Question 25

What esophageal problem causes GERD and heartburn?

Answer 25

Decreased esophagus integrity. This means LES lets esophagus pressure dip lower than stomach pressure. Regurgitate.

Question 26

What is GERD?

Answer 26

Backward flow of gastric contents into esophagus from transient abd pressure or relaxed LES.

Question 27

What can cause GERD?

Answer 27

High stomach pressure. High gastrin, estrogen or progesterone secretions. Smoking (weaker LES). Meds like morphine. Obesity.

Question 28

What foods lower LES pressure?

Answer 28

Spearmint, peppermint, chocolate, alcohol, caffeine, chocolate, high fat foods.

Question 29

What are GERD s/s?

Answer 29

Increased saliva, dysphagia, belching, neck/head/jaw pain, heartburn

Question 30

What is Barrett’s esophagus?

Answer 30

Metaplasia, epithelial cells of esophageal mucosa are changed. Squamous cells become columnar cells. Only seen with biopsy.

Question 31

2 MNT Goals for GERD?

Answer 31

Increase LES strength (no smoking, less high fat food, lose wt, limit EtOH/caffeine/mint)
Decrease vol and frequency of reflux (sm meals, lose wt, no fluids with meals, increase fiber-constipation=more abd pressure)

Question 32

2 more MNT goals for GERD?

Answer 32

Less irritation to inflamed esophagus (no citrus, tomato, spicy, fizzy beverages)
Increase esophageal clearing time (don’t lay after eating, stop eating 2-3 hr before bed, elevate bed head, loose clothes)

Question 33

What are med Tx for GERD?

Answer 33

Anti acids (diarrhea, constipation), H2 blockers (stop after 2 wks of use), PPI for short term, Prokinetics to speed gastric motility and emptying (reglan)

Question 34

What is the surgical Tx for GERD?

Answer 34

Nissen fundoplication

Fundus of stomach is wrapped around lower esophagus to strengthen and support LES, prevents reflux.
Done laparoscopically

Question 35

What is gastroparesis and S/S?

Answer 35

Delayed emptying of stomach. N/V, satiety too soon, bloating and reflux. Common in young adults and DM pts (neuropathy)

Question 36

What do fat and fiber do to gastric emptying?

Answer 36

Slow it down so want to eat

Question 37

Gastroparesis MNT tips:

Answer 37

No bedtime snack, tender meats with crockpot, liquid/purée diet, limit quantities of cheese at once, no EtOH or fizzy bev, no meal replacement bars, walk after meals