Upper GI Problems

Question 1

4 layers of GI tract

Answer 1

mucosa, submucosa, muscularis, serosa

Question 2

Enteric nervous system

Answer 2

can work independently of CNS, regulates motility and secretion along entire GI tract (parasympathetic vs sympathetic)

Question 3

Peritoneum

Answer 3

membrane that lines the abdominal cavity

Question 4

peritoneal cavity

Answer 4

potential space between the 2 layers

Question 5

omentum

Answer 5

fatty sheet that covers the organs

Question 6

Controls ingestion and propulsion of food

Answer 6

appetite center in hypothalamus and hormone ghrelin

Question 7

gastric secretions

Answer 7

chief cells secrete pepsinogen in the stomach

parietal cells secrete HCL acid in the stomach

Question 8

intrinsic factor

Answer 8

helps us process and absorb vit B12

Question 9

Effects of aging on GI system

Answer 9

xerostomia
decreased appetite
decreased taste
decreased HCL
constipation
smaller liver size
gallbladder disease
low food intake

Question 10

GERD

Answer 10

gastroesophageal reflux disease
(not a disease but a syndrome)
a symptom of mucosal damage in the esophagus

Question 11

causes of GERD

Answer 11

NO ONE SINGLE CAUSE
something happens that lowers the defense systems of the esophagus or the esophagus is overwhelmed by reflux of acidic gastric contents
- HCL acid and pepsin causes inflammation

Question 12

predisposing factors of GERD

Answer 12

• Incompetent lower esophageal sphincter (LES)
• decreased LES pressure
• increased intraabdominal pressure
• hiatal hernia

Question 13

PUD (peptic ulcer disease)

Answer 13

group of upper GI disorders
degrees of erosion on the gut wall
caused by imbalance between mucous and aggressive factors

Question 14

defensive factors against ulcers

Answer 14

mucus- forms barrier
bicarb- neutralizes acid
blood flow- poor blood flow to gut (makes it harder to make mucus and bicarb)
prostaglandins- stimulate the secretion of mucus + bicarb

Question 15

first most common cause of ulc

Answer 15

H.pylori

Question 16

second most common cause of ulcers

Answer 16

NSAID use

Question 17

GERD lifestyle modifications

Answer 17

avoiding triggers
maintain appropriate weight
smoking cessation
stress management
small meals
avoid late meals

Question 18

Proton pump inhibitors

Answer 18

promote esophageal healing
prescription and OTC
Side effect :headaches
*don’t stop GERD but help symptoms

Question 19

How do proton pump inhibitors work?

Answer 19

irreversible inhibition of the H+, K+ and ATPase proton pump
Take with food
(this drug blocks the pump)

Question 20

Consequences of long term use of proton pump inhibitors

Answer 20

• long term or high doses may increase the risk of fractures
• Risk of C. diff because the stomach acid can’t kill bacteria
• they may decrease calcium absorption

Question 21

Histamine-2 receptor blockers

Answer 21

decrease HCL acid
reduce symptoms and promote esophageal healing
no side effects

Question 22

How do Histamine-2 blockers work?

Answer 22

Blocks H2 receptors on parietal cells (parietal cells produce gastric acid)
take this drug with food

Question 23

4 categories of Antacids

Answer 23

1. Aluminum hydroxide
2. Magnesium hydroxide
3. Calcium carbonate
4. Sodium bicarbonate

Question 24

Which OTC should be used with caution in a patient with osteoporosis?

Answer 24

omeprazole

Question 25

PUD Drug therapy

Answer 25

PPIs
H2 R blockers
antibiotics
antacids
anticholinergics
cyto-protective therapy

Question 26

Antibiotic therapy for PUD

Answer 26

eradicates H.pylori

combination therapy with a proton-pump inhibitor

Question 27

Clarithromycin

Answer 27

antibiotics

suppressed growth of H.pylori by inhibiting protein synthesis

Question 28

Cimetidine

Answer 28

blocks H2 receptors

Oral

Question 29

Cimetidine side effects

Answer 29

uncommon
binds to androgen receptors causing estrogen side effects in very rare cases
elevates gastric pH and may increase pneumonia
Confusion in elderly

Question 30

Omeprazole

Answer 30

first available PPI
inhibits gastric secretion
short half-life
used for short-term therapy
take before first meal of the day

Question 31

Omeprazole teaching

Answer 31

used in the hospital as an ulcer prophylaxis

dont use long term

Question 32

prilosec

Answer 32

Omeprazole

Proton Pump Inhibitor

Question 33

Adverse effects of prilosec

Answer 33

uncommon in short term use
headache
Gi effects
pneumonia
fractures
C.diff

Question 34

Antacids in PUD

Answer 34

adjunct therapy
increase gastric pH
interact unfavorably with a lot of drugs
can effect absorption of drugs
health care provider should know what meds are being taken

Question 35

Aluminum hydroxide antacids

Answer 35

relatively low acid neutralizing
long duration
used in combination with magnesium or hydroxide
has tons of sodium
causes constipation
interacts with antibiotics

Question 36

Magnesium hydroxide antacids

Answer 36

rapid acting
an antacid of choice
cause diarrhea
combination with aluminum
used as a laxative
use with caution in patients with renal failure

Question 37

Calcium carbonate antacids

Answer 37

rapid acting
High acid neutralizing
long duration
causes constipation
belching and flatulence

Question 38

Sodium bicarbonate antacids

Answer 38

used for acidosis

not appropriate for use of PUD

Question 39

Sucralfate in PUD

Answer 39

creates protective barrier for up to 6 hours

Question 40

Anticholinergics in PUD

Answer 40

Lowers HCL

lowers gastric motility

Question 41

what are the 4 defensive factors against PUD

Answer 41

mucus- protective barrier
bicarb- neutralizes stomach acid
blood flow- low blood flow causes vulnerability
prostaglandins- make mucus and bicarb

Question 42

common causes of ulcers

Answer 42

1. H. pylori
2. NSAID use
3. stress-related