Week 5 - Gastrointestinal

Question 1

Gastroesophageal Reflux Disease (GERD)

Answer 1

Occurs when stomach acid repeatedly flows back into the esophagus. This acid reflux can irritate and erode the lining of your esophagus.

Question 2

Warning signs for GERD

Answer 2

• Dysphagia (difficulty swallowing)
• Odynophagia (pain with swallowing)
• Nausea and vomiting
• Weight loss
• Malena
• Early satiety (feeling full after eating only a little food)

Question 3

Hiatal Hernia

Answer 3

occurs when the upper part of your stomach bulges through the diaphragm. Your diaphragm has a small opening (hiatus) through which your esophagus passes before connecting to your stomach.

It is often asymptomatic.

Question 4

Gastroparesis

Answer 4

delayed gastric emptying in the absence of mechanical gastric outlet obstruction

Question 5

Sliding hiatal hernia

Answer 5

The stomach intermittently slides up into the chest through a small opening in the diaphragm.

Question 6

Treatment for sliding hiatal hernia

Answer 6

• Usually conservative
• Eating small frequent meals
• Avoid recumbent position after meals
• Avoid tight clothes and abdominal supports
• Weight control if overweight

Question 7

Duodenal Ulcer

Answer 7

Causative factors cause acid and pepsin concentrations in the duodenum to penetrate the mucosal barrier and lead to ulceration.

Characteristic manifestation is chronic intermittent pain in the epigastric area.

Presence of acid in the duodenum facilitates H pylori infection

Question 8

Causes of Duodenal Ulcers

Answer 8

NSAID use
H. pylori

Question 9

Symptoms of duodenal ulcers

Answer 9

Chronic intermittent epigastric pain.

Pain begins 30 min – 2 hours after eating when stomach is empty

Pain can occur in the middle of the night and disappear by morning

Pain often relieved by antacids and ingestion of food

Question 10

Evaluation for duodenal ulcers

Answer 10

1. Endoscopy
2. Check gastrin levels in the blood
3. H pylori detection through urea breath test

Question 11

Management of duodenal ulcers

Answer 11

a. Relieving the cause and effects of hyperacidity and prevention of complications
b. Antacids – neutralize stomach acid, elevate pH, inactivate pepsin, relieve pain, are cytoprotective
c. Acid reduction with PPIs
d. Ulcer coating agents
i. Bismuth
e. Anticholinergic drugs to inhibit gastric secretion, suppress gastric motility and delay gastric emptying
f. Diet therapy - foods high in Vit A and C, zinc, selenium, fiber
g. Surgical resection

Question 12

Peptic Ulcer Disease

Answer 12

A breakdown or ulceration in the protective mucosal lining of the lower esophagus, stomach or duodenum. Least likely to occur in the small intestine.

Question 13

Risk factors for peptic ulcer disease

Answer 13

1. Genetic disposition
2. H pylori infection
3. Use of aspirin and NSAIDS
4. Excessive alcohol use
5. Smoking
6. Actute pancreatitits
7. Obesity
8. COPD
9. Cirrhosis
10. Over 65
11. Low socioeconomic status

Question 14

Cause of peptic ulcer disease

Answer 14

Chronic use of NSAIDS suppresses prostaglandin production resulting in less bicarb secretion and mucin production and increase in production of HCL. This causes disruption to the mucosa causing erosion and ulceration

Question 15

Types of peptic ulcer disease

Answer 15

1. Acute
2. Chronic
3. Simple
4. Multiple
5. Superficial
6. Deep