Upper GI Problems Flashcards
4 layers of GI tract
mucosa, submucosa, muscularis, serosa
Enteric nervous system
can work independently of CNS, regulates motility and secretion along entire GI tract (parasympathetic vs sympathetic)
Peritoneum
membrane that lines the abdominal cavity
peritoneal cavity
potential space between the 2 layers
omentum
fatty sheet that covers the organs
Controls ingestion and propulsion of food
appetite center in hypothalamus and hormone ghrelin
gastric secretions
chief cells secrete pepsinogen in the stomach
parietal cells secrete HCL acid in the stomach
intrinsic factor
helps us process and absorb vit B12
Effects of aging on GI system
xerostomia decreased appetite decreased taste decreased HCL constipation smaller liver size gallbladder disease low food intake
GERD
gastroesophageal reflux disease
(not a disease but a syndrome)
a symptom of mucosal damage in the esophagus
causes of GERD
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
predisposing factors of GERD
- Incompetent lower esophageal sphincter (LES)
- decreased LES pressure
- increased intraabdominal pressure
- hiatal hernia
PUD (peptic ulcer disease)
group of upper GI disorders
degrees of erosion on the gut wall
caused by imbalance between mucous and aggressive factors
defensive factors against ulcers
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
first most common cause of ulc
H.pylori
second most common cause of ulcers
NSAID use
GERD lifestyle modifications
avoiding triggers maintain appropriate weight smoking cessation stress management small meals avoid late meals
Proton pump inhibitors
promote esophageal healing
prescription and OTC
Side effect :headaches
*don’t stop GERD but help symptoms
How do proton pump inhibitors work?
irreversible inhibition of the H+, K+ and ATPase proton pump
Take with food
(this drug blocks the pump)
Consequences of long term use of proton pump inhibitors
- 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
Histamine-2 receptor blockers
decrease HCL acid
reduce symptoms and promote esophageal healing
no side effects
How do Histamine-2 blockers work?
Blocks H2 receptors on parietal cells (parietal cells produce gastric acid)
take this drug with food
4 categories of Antacids
- Aluminum hydroxide
- Magnesium hydroxide
- Calcium carbonate
- Sodium bicarbonate
Which OTC should be used with caution in a patient with osteoporosis?
omeprazole
PUD Drug therapy
PPIs H2 R blockers antibiotics antacids anticholinergics cyto-protective therapy
Antibiotic therapy for PUD
eradicates H.pylori
combination therapy with a proton-pump inhibitor
Clarithromycin
antibiotics
suppressed growth of H.pylori by inhibiting protein synthesis
Cimetidine
blocks H2 receptors
Oral
Cimetidine side effects
uncommon
binds to androgen receptors causing estrogen side effects in very rare cases
elevates gastric pH and may increase pneumonia
Confusion in elderly
Omeprazole
first available PPI inhibits gastric secretion short half-life used for short-term therapy take before first meal of the day
Omeprazole teaching
used in the hospital as an ulcer prophylaxis
dont use long term
prilosec
Omeprazole
Proton Pump Inhibitor
Adverse effects of prilosec
uncommon in short term use headache Gi effects pneumonia fractures C.diff
Antacids in PUD
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
Aluminum hydroxide antacids
relatively low acid neutralizing long duration used in combination with magnesium or hydroxide has tons of sodium causes constipation interacts with antibiotics
Magnesium hydroxide antacids
rapid acting an antacid of choice cause diarrhea combination with aluminum used as a laxative use with caution in patients with renal failure
Calcium carbonate antacids
rapid acting High acid neutralizing long duration causes constipation belching and flatulence
Sodium bicarbonate antacids
used for acidosis
not appropriate for use of PUD
Sucralfate in PUD
creates protective barrier for up to 6 hours
Anticholinergics in PUD
Lowers HCL
lowers gastric motility
what are the 4 defensive factors against PUD
mucus- protective barrier
bicarb- neutralizes stomach acid
blood flow- low blood flow causes vulnerability
prostaglandins- make mucus and bicarb
common causes of ulcers
- H. pylori
- NSAID use
- stress-related
