Week 5 - Disorders of the Stomach and Upper Small Intestine Flashcards
list 3 different disorders of the stomach and upper small intestine (3)
- gastritis (acute and chronic)
- upper GI bleeding
- peptic ulcer disease
what is peptic ulcer disease
- ulcerative lesions in the stomach or duodenom caused by exposure of the mucosa to acid-pepsin secretions and hydrochloric acid
what are the 3 parts of the small intestine
- duodenum (first part)
- jejunum
- ileum
what is pepsin? what is it’s inactive form
- protein digesting enzyme
- active form of pepsinogen
what is the GI mucosa
- the innermost layer of the GI tract
how is the GI mucosa normally protected from acid-pepsin secretion
protected by:
- mucus made by the mucosa which contains HCO3- and mucin
how does HCO3- protect from acid-pepsin secretion
- neutralizes the acid
what is mucin? how does it protect the mucosa from acid-pepsin
- a protective glycoprotein
- has a coating action
acid-peptic disease develops when…. (3)
- there is excessive acid secretion
- diminished mucosal defence
- or combo of both
what are the 2 most common locations of peptic ulcer
- stomach = gastric ulcer
- duodenom
what are the 2 most common causes of peptic ulcer?
- helicobacter pylori infection
2. NSAID use
how does helicobacter pylori lead to peptic ulcer?
- produces proteases & toxins that damage mucosal cells, and inhibit mucus production
how does NSAID use lead to peptic ulcer?
- inhibit prostaglandin, which is a prime signal that tells the cells to make mucus
what is the 4 layers of the stomach wall
- mucosa (inner)
- submucosa
- muscularis
- serosa
for erosion, acute ulcer, and chronic ulcer, which layer of the stomach does each go into?
- erosion = mucosa
- acute = mucosa & submucosa
- chonic = mucosa, submucosa, and muscularis (may go into serosa) = scarring
what % of people w peptic ulcers are infected w H. pylori and have chronic gastritis?
- 90-100%
do all people infected w H.pylori develop ulcers?
- no
up to what % of people w peptic ulcers are chronic NSAID users?
- up to 20%
what % of NSAID ulcers are asymptomatic?
- 30-50%
what are contributing factors to the developing of ulcers? are these causative? (4)
- diet
- smoking
- alcohol
- stress
not causative
what kind of diet contributes to ulcers? (3)
- spicy
- salty
- animal products
what is a rare cause of ulcers
- zollinger-ellison syndrom
what is zollinger-ellison syndrome?
- where a gastrin-secreting tumor (gastrinoma) triggers excess acid production
- can be benign or malignant
what are the 4 manifestations/complications of peptic ulcer disease
- pain
- hemorrhage (bleeding)
- obstruction
- perforation
what kind of pain is present during peptic ulcers?
- burning, gnawing, or cramp-like epigastric pain = dyspepsia
how does dyspepsia vary between a duodenal and a stomach ulcer
- duodenal = relieved by food or antiacids
- stomach = worsened after eating
how can hemorrhage manifest as?? (3)
- hematemesis
- melena
- occult blood
what is hematemesis? when does this occur?
- bloody vomit appearing as fresh, bright red blood, or “coffee grounds” appearance
- when bleeding very quickly = does not have chance to digest
what is melena? when does occur?
- black, tarry, foul smelling stools
- occur when bleeding occurs slowly, allowing the blood to be partially digested
what causes the black appearance in melena
- the presence of iron
what is occult bleeding? when does this occur?
- small amounts of blood in gastric secretions, vomit, or stools not apparent by appearance
- “hidden blood”
- occurs when bleeding is very very slow, allowing the blood to be digested
how is occult bleeding detected?
- by stool guaiac test (fecal occult blood test)
what occurs if hemorrhage is severe during peptic ulcer? (2)
- anemia
- hypovolemia
what causes obstruction during ulcer disease (3)
- edema
- scar tissue
- spasm
what does obstruction during peptic ulcer disease cause? what can this lead to?
- prevent passage of chyme from the through the pylorus into the small intestine
- severe = may be vomiting of undigested food
- mild = reflux
what causes perforation w peptic ulcer disease? what does this result in?
- when an ulcer erodes thru the GI wall
= gastric juice & air enters the peritoneum
what does perforation in peptic ulcer disease cause?
= peritonitis & potential pancreatitis
what are the 2 types of therapy/treatment for peptic ulcer disease
- drug therapy
- surgical theraoy
what are some postop complications after surgical therapy for peptic ulcer disease (3)
- dumping syndrome
- postprandial hypoglycemia
- bile reflux gastritis
what is dumping syndrome
- when you “dump what you eat”
- episodes of vomitting or diarrhea after eating
what nutritional therapy may occur after surgery (2)? why do we need this?
- B12 supplements –> need the protein intrinsic factor produced by the stomach to absorb B12
- iron supplements –> iron is not dissolved well without an acidic enviro
what nutritional therapy may occur after surgery? why do we need this?
- B12 supplements –> need the protein intrinsic factor produced by the stomach to absorb B12
- iron supplements –> iron is not dissolved well without an acidic enviro
what is gastritis
- inflammation of the stomach lining (mucosa)
what is gastritis a significant cause of?
- GI bleeding (espiecally in hospitalized patients)
what is gastritis a significant cause of?
- GI bleeding (espiecally in hospitalized patients)
what does gastritis increase the risk of
- peptic ulcers
- stomach cancer
(if it occur chronically)
list the causes of gastritis (7)
- alcoholism
- NSAIDs
- portal hypertension-induced gastropathy
- H. pylori
- crohn’s disease
- pernicuous anemia
- stress
who does stress related gastritis commonly occur in? what does this cause?
- critically ill hospitalized patients
- cause significant GI bleeding in 5-10% of these patients
list major risk factors for stress related gastritis (7)
- trauma
- burns
- hypotension
- sepsis
- coagulopathy
- hepatic or renal failure
- need for mechanical ventilation
what are the manifestations of gastritis (6)
- often asymptomatic
- dyspepsia
- nausea
- vomiting
- hematemesis
- GI bleeding
what does hematemesis and GI bleeding during gastririts cause (2)
- iron-deficiency anemia
- hypovolemia
upper GI bleeding represents a significant clinical & societal burden because…
associated:
- morbidity
- mortality
- financial implications
list the causes of upper GI bleeding (3)
- esophageal origin
- stomach origin
- duodenal origin
how prevalent is stomach cancer?
- 10th leading cause of cancer death in Canada
- one of the most common cancers world-wide
who does stomach cancer often effect?
- people between the ages 50-70
- twice as common in men than women
list 5 risk factors for the development of stomach cancer
- chronic gastritis
- H. pylori infection
- gastric polyps
- pernicious anemia
- carcinogenic factors in the diet
list examples of carcinogenic factors in the diet (5)
- nitrates
- smoked food
- high salt
- spicy foods
- alcohol
what is a carcinoma
- cancer that begins in the epithelial cells
describe the manifestations of stomach cancer (7)
- usually asymptomatic until later in its course & it becomes metastatic
- anemia
- occult blood
- NV
- hematemesis
- pyloric obstruction
- dysphagia
where does stomach cancer often metastasize to (3)
- lymph nodes
- ovaries
- liver
what symptoms occur when stomach cancer metastasizes
- symptoms similar to peptic ulcer (dyspepsia)
- weight loss
why does anemia occur as a manifestation of stomach cancer
due to:
- hemorrhage
- diminished intrinsic factor secretion
what is pernicuous anemia
- anemia due to deficiency in vitamin B12
what is the treatment for stomach cancer?
- partial gastrectomy
- resection
list 3 types of treatment for peptic ulcer
- eradication of H pylori by antibiotic therapy
- mucosal protection
- decrease gastric acid production
describe the rationale for antibiotic therapy for treatment of peptic ulcer disease
- causes resolution of gastritis & allows the ulcer to heal
- associated w lowest risk of recurrence (5% with, 80% without)
list 3 ways to provide mucosal protection in peptic ulcer therapy
agents such as sucralfate:
- coat the mucosa
- stimulate bicarb
- have antimicrobial effect
decsribe how gastric acid production can be decreased for peptic ulcer theraoy
- thru blocking the histmine receptor on mucosal cells
- inhibit the mucosal proton pump to decrease the amount of acid produced by mucosal cells
