Week 10

Question 1

What is gastro-esophageal reflux disease?

Answer 1

Syndrome caused by overwhelmed lower esophageal defences. Caused by predisposing conditions including hiatal hernias, incompetent LES, decreased esophageal clearance.

Question 2

What do acidic gastric secretions cause?

Answer 2

Esophageal irritation and inflammation,

Question 3

What chemicals are corrosive to esophageal mucosa?

Answer 3

Pepsin, intestinal enzymes, and bile salts.

Question 4

What is an incompetent LES?

Answer 4

A decrease in pressure in the distal portion of the esophagus. This allows gastric contents to move from an area of high pressure to an area of low pressure. Can be caused by certain foods (caffeine, chocolate, drugs).

Question 5

What are the CM of GERD?

Answer 5

Heartburn, caused by irritation of esophagus from the gastric secretions.
Wheezing, coughing and dyspnea may also occur.
Regurgitation is common. Gastric symptoms like bloating, nausea, vomiting, also occur due to delayed gastric emptying.

Question 6

What are complications of GERD?

Answer 6

Esophagitis, barrett’s esophagus (precancerous lesion =), Bronchospasm, laryngospasm, cricopharyngeal spasm and pneumonia, and dental errosion.

Question 7

What diagnostic studies are used to diagnose GERD?

Answer 7

History and physical examination, barium swallow, motility, pH monitoring, upper GI endoscopy.

Question 8

What collaborative therapies are used to treat GERD?

Answer 8

Elevate head of bed, high protein, low fat diet.

Question 9

What drug therapies can be used for GERD?

Answer 9

Antacids, antisecretory drugs, cholinergic drugs, H2 receptor blockers, proton pump inhibitors, prokinetic drug therapy.

Question 10

What surgical therapies may be used to treat GERD?

Answer 10

Belsey fundoplication, hill gastropexy, nissen fundoplication, toupet fundoplication.

Question 11

What is a hiatal hernia?

Answer 11

Herniation of a portion of the stomach into the esophageous through an opening.

Question 12

What is peptic ulcer disease?

Answer 12

Characterized by erosion of GI mucosa from action of HCl and pepsin. May cause ulcers in lower esophagus, stomach, duodenum.

Question 13

What are the classifications of peptic ulcers?

Answer 13

Acute or chronic and gastric or duodenal.

Question 14

What are acute ulcers?

Answer 14

Characterized by superficial erosion and minimal inflammation. Short in duration and resolve quickly.

Question 15

What are chronic ulcers?

Answer 15

Long in duration, they erode through muscular wall and form fibrous tissue.

Question 16

What do acids/bile salts/ ASA/ NSAIDS/alcohol/ischemia cause?

Answer 16

Breakdown of gastric mucosal barrier.

Question 17

What does the breakdown of the gastric mucosal barrier cause?

Answer 17

Acid back-diffusion into mucosa.

Question 18

What does the acid-back diffusion into the mucosa cause?

Answer 18

Destruction of mucosal cells, which leads to mucosal erosion, destruction of blood vessels, bleeding and ulceration.

Question 19

The acid back-diffusion into the mucosa causes histamine to be released. What does histamine cause?

Answer 19

Increased vasodilation, increased capilary permeability, which leads to loss of plasma proteins into gastric lumen, mucosal edema.

Question 20

What mechanisms protect against damage to the GI system?

Answer 20

Mucus is secreted by superficial mucous cells, forms a layer that traps and slows the diffusion of H+. Bicarbonate is secreted by gastric and duodenal mucosa which neutralizes HCl in the lumen of the GI tract.

Question 21

What causes the hypersecretion of HCl?

Answer 21

Increased vagal nerve stimulation.

Question 22

What are gastric ulcers?

Answer 22

Ulcers that occur in the stomach, less common than duodenal ulcers. May be caused by drugs (NSAIDs, ASA,), chronic alcohol abuse, chronic gastritis, and bile reflux gastritis.

Question 23

What are duodenal ulcers?

Answer 23

80% of peptic ulcers. Caused by COPD, cirrhosis, chronic pancreatitis, hyperparathyroidism, CKD. H. pylori is found in 90% of patients with duodenal ulcers.

Question 24

What is stress-related mucosal disease?

Answer 24

Ulcers caused by trauma or surgery. Gastric mucosa may be disturbed due to hypotension, severe burns, injury and surgery. Results as a compensatory mechanism to hypotension or shock

Question 25

What are the clinical manifestations of peptic ulcers?

Answer 25

Can be asymptomatic, because areas do not have sensory neurons to conduct pain. Ulcers located posteriorly may manifest as back pain.

Question 26

what are complications from gastric ulcers?

Answer 26

hemorrhage, perforation, gastric outlet obstruction.

Question 27

What is hemorrhage?

Answer 27

Most common complication of PUD. Develops as a result of erosion of the granulation tissue at the base of the ulcer during healing or erosion through a major blood vessel.

Question 28

What is perforation?

Answer 28

Most lethal complication. Common in large penetrating dudodenal ulcers that have not healed and are located on the posterior mucosal wall. Occurs when ulcer penetrates the serosal surface with spillage of gastric continents into periotenial cavity.

Question 29

What are the clinical manifestations of perforation?

Answer 29

Sudden severe upper abdominal pain that spreads, shoulder pain, shallow resps, bowel sounds absent, nausea and vomiting may occur.

Question 30

What is gastric outlet obstruction?

Answer 30

Obstruction near the pyloric areas of the stomach can cause increased contractile force, which causes scar tissue to form. CM include upper abdo pain, relief may be caused by belching, self induced vomiting, may have caused swelling, dilation of the stomach.

Question 31

What are some diagnositic studies used for PUD?

Answer 31

History, physical exam, CBC, h. pylori testing, liver enzyme measurements, serum electrolyte, upper GI endoscopy and biopsy, urinalysis.

Question 32

What is conservative therapy for PUD?

Answer 32

Adequet rest, bland diet, stop smoking, drug therapy, stress reduction.