Disorders of GI function (pptx 1)

Question 1

What are the three types of abdominal pain?

Answer 1

1) parietal
2) visceral
3) referred

Question 2

Describe parietal abdominal pain

Answer 2

Localized
2) Described as knife-like, sharp pain

Question 3

Describe visceral abdominal pain

Answer 3

Distention/ inflammation of body organs
1) Described as colicky, crampy

Question 4

How is abdominal pain produced?

Answer 4

Biochemical mediators of inflammatory response (Histamine, bradykinin, & serotonin) stimulate organic nerve endings that produce abd pain

Question 5

List 2 things abdominal organs are sensitive to

Answer 5

1) Stretching
2) Distention

Question 6

LISt 7 disorders of the esophagus

Answer 6

1) Dysphagia
2) Achalasia
3) Esophagitis
4) GERD
5) Upper GI bleed
6) Esophageal varices
7) Esophageal cancer

Question 7

List 6 disorders of the stomach

Answer 7

1) Hiatal hernia
2) Pyloric stenosis
3) Peptic ulcer disease
4) Zollinger-Ellison syndrome
5) Bariatric surgery
6) Dumping syndrome

Question 8

List 6 disorders of the SI

Answer 8

1) Hernia
2) Gastroenteritis
3) Celiac disease
4) Short-bowel syndrome
5) Small bowel obstruction
6) Peritonitis

Question 9

What GI disorder affects ~ 20-40% of US population?

Answer 9

GERD

Question 10

What is GERD?

Answer 10

A backward movement of gastric contents into esophagus

Question 11

Contrast a normal functioning lower esophageal sphincter to one seen in someone with GERD

Answer 11

Normal → maintains a zone of high pressure to prevent chyme reflux

GERD → lower esophageal sphincter relaxes spontaneously 1-2 hrs after eating, which allows regurgitate into esophagus

Question 12

Diagnosis of GERD Hint: 2

Answer 12

1) Endoscopy
2) Manometry

Question 13

List 2 results of esophageal mucosal damage associated with GERD

Answer 13

1) Erosive esophagitis
2) Barrett’s esophagus

Question 14

What is Barrett’s esophagus Hint: 3

Answer 14

1) Repeated injury causes metaplasia
2) Change to columnar epithelium
3) Precancerous (esophageal adenocarcinoma)

Question 15

Cause of GERD

Answer 15

Certain conditions, substances, foods, & meds that weaken or hinder closure of lower esophageal sphincter

Question 16

List 10 examples that cause GERD

Answer 16

1) Alcohol
2) Acidic foods
3) Fatty foods
4) Chocolate
5) Coffee
6) Nicotine
7) Obesity
8) Pregnancy
9) Hiatal hernia
10) Anticholinergics; Beta agonists; CCBs; Nitrates; Progesterone

Question 17

List 9 clinical manifestations of GERD

Answer 17

1) Dysphagia
2) Heartburn
3) Regurgitation
4) Bitter taste
5) Upper abd pain within hr of eating
6) ↑ w lying or ↑ intra-abd pressures
7) Can have Sx w no acid
8) Cough, ↑ asthma Sx
9) May seem like angina

Question 18

GERD increases risk of _____

Answer 18

Aspiration

Question 19

List 7 life style & dietary changes that can Tx GERD

Answer 19

1) ↓ dietary fats
2) Eat small meals
3) Stop smoking
4) Avoid lying down for 3 hrs after eating
5) Avoid alcohol
6) Weight loss
7) Elevate HOB

Question 20

List 4 pharmacologic Tx options for GERD

Answer 20

1) Antacids
2) Histamine (H2) blockers
3) Proton pump inhibitors (PPI)
4) Prokinetic agents

Question 21

What is celiac disease?

Answer 21

An autoimmune disorder triggered by gluten

Question 22

List 8 clinical manifestations of celiac disease

Answer 22

1) Abdominal pain
2) Bloating
3) Diarrhea
4) Weight loss
5) Steatorrhea
6) Weakness
7) Flatus
8) Fatigue

Question 23

List 5 labs to look at to help Dx celiac disease

Answer 23

1) H/H
2) CMP
3) Genetic testing
4) IgA
5) Ab testing

Question 24

List 3 Tx options for celiac disease

Answer 24

1) Remove gluten from diet
2) Vitamin replacement
3) Corticosteroids

Question 25

What GI disorders affects 50-75% of the world's population?

Answer 25

Helicobacter pylori (H. pylori)

Question 26

What ethnicities is H. pylori increased in?

Answer 26

Hispanics & African Americans

Question 27

How is H. pylori transmitted?

Answer 27

Person to person → thru saliva, feces, vomiting

Question 28

List 3 disorders H. pylori causes

Answer 28

1) Peptic ulcers 2) Gastritis 3) Gastric (stomach) cancer

Question 29

True or false: Most people Dx with H. pylori are symptomatic?

Answer 29

FALSE → most are asymptomatic

Question 30

What kind of bacteria is H. pylori?

Answer 30

Gram-negative rods that colonize in mucus-secreting epithelial cells of stomach

Question 31

Describe bacteria of H. pylori gastritis

Answer 31

Small, curved or spiral shaped gram-negative rods

Question 32

What does H. pylori gastritis secrete?

Answer 32

Urease (enzyme) → converts urea to ammonia

Question 33

How does ammonia function for bacteria to survive?

Answer 33

Ammonia neutralizes acidity of the stomach for bacteria to survive

Question 34

Where is H. pylori gastritis located?

Answer 34

Burrows into mucus layer

Question 35

List 3 things that production of enzymes & toxins in H. pylori gastritis causes

Answer 35

1) Impacts protection of mucosa to acidic environment 2) Intense inflammatory response 3) Create immune response (T & B cells)

Question 36

List 7 Sx of H. pylori

Answer 36

1) Many are asymptomatic 2) Dull burning pain in abd 3) ↑ pain w empty stomach 4) N/V 5) Dyspepsia 6) Bloating 7) Weight loss

Question 37

List 4 ways to Dx H. pylori

Answer 37

1) Urea breath test 2) Serologic tests 3) Stool Ag test 4) Endoscopic biopsy

Question 38

List 4 Tx options for H. pylori

Answer 38

1) Abx 2) Bismuth (Antibacterial effect) 3) PPI (raise the pH) 4) H2 blockers

Question 39

Where do peptic ulcers occur in GI tract?

Answer 39

Upper portion of GI tract

Question 40

What is peptic ulcer disease?

Answer 40

Inflammatory erosion in stomach (gastric ulcer) or duodenal lining (duodenal ulcer)

Question 41

Pathophysiology of peptic ulcer disease **Hint: 3**

Answer 41

1) Hypersecretion of HCL 2) Ineffective mucous production 3) Poor cellular repair

Question 42

List 2 things to note about peptic ulcer disease

Answer 42

1) Periods of exacerbations & remissions 2) Commonly seen in middle aged individuals

Question 43

List 4 causes of peptic ulcer disease

Answer 43

1) **H. pylori infection** 2) **Use of ASA or NSAIDs** 3) Stress 4) Alcohol

Question 44

Patho of H. pylori PUD: H. pylori **Hint: 3**

Answer 44

1) Secretes enzyme urease 2) Breaks down urea 3) Ammonium toxic to epithelial cells & neutralizes acid

Question 45

Patho of H. pylori PUD: Erosion of mucosal lining **Hint: 3**

Answer 45

1) HCL diffuses into stomach wall & BV 2) Creates inflammatory response 3) Release of histamine & prostaglandins

Question 46

Patho of H. pylori PUD: Histamine **Hint: 2**

Answer 46

1) Causes vasodilation & stimulates pepsin & gastrin release 2) Acid secretion stimulated which attacks unprotected lining

Question 47

Patho of H. pylori PUD: HCL **Hint: 2**

Answer 47

1) Released by parietal cell 2) Irritates & destroys lining & continues to trigger inflammation

Question 48

Patho of H. pylori PUD: Scarring & fibrosis of lining **Hint: 2**

Answer 48

1) Fibrosis inhibits healthy cell reproduction 2) Decreased mucus & bicarb production to protect lining

Question 49

Patho of H. pylori PUD: Development of... **Hint: 2**

Answer 49

1) Erosion 2) Ulcer → extends into muscularis layer

Question 50

Gastric ulcer (PUD) **Hint: 5**

Answer 50

1) Occurs in stomach 2) Epigastric pain 1-2 hrs after eating 3) Causes hematemesis or melena 4) Heartburn, chest discomfort & early satiety common 5) Can cause gastric carcinoma

Question 51

Duodenal ulcer (PUD) **Hint: 5**

Answer 51

1) Occurs in duodenum 2) Epigastric pain 2-3 hrs after eating 3) Can cause melena or hematochezia 4) Heartburn, chest discomfort less common 5) Pain may awaken pt during night

Question 52

Where in the stomach do gastric ulcers tend to develop?

Answer 52

Antral region of the stomach, adjacent to the acid-secreting mucosa of the body

Question 53

Common age to see gastric ulcers

Answer 53

Ages 55-65 male & female

Question 54

Patho of gastric ulcers **Hint: 3**

Answer 54

1) Primary defect is ↑ mucosal permeability to H+ ions 2) Frequent H. pylori 3) Gastric secretion is normal or less than normal

Question 55

What is the most common type of PUD?

Answer 55

Duodenal ulcer

Question 56

List 5 causes of duodenal ulcers

Answer 56

1) H. pylori 2) Smoking 3) NSAIDs 4) Stress 5) Genetic predisposition

Question 57

List 4 things that occur with presence of duodenal ulcers

Answer 57

1) ↑ gastrin levels that stay high after eating, continue to stim secretion of acid 2) Impaired duodenal bicarb secretion 3) Failure of feedback where acid in antrum inhibits gastrin release 4) Rapid gastric emptying overwhelms buffering

Question 58

List 6 clinical manifestations of duodenal ulcers

Answer 58

1) Chronic intermittent pain in epigastric area 2) Pain ↑ ~ 30 min to 2 hrs after eating 3) Night time pain btwn 11p-2a 4) Spasm & acid 5) Relieves w food, antacids 6) Tx H. pylori, help acids, relieve pain

Question 59

List 7 clinical manifestations of gastric ulcer

Answer 59

1) Pain tends to ↑ w eating 2) Belching 3) Early satiety 4) Anorexia 5) N/V 6) Weight loss 7) Tends to be chronic

Question 60

List 2 things both duodenal & gastric ulcers can cause

Answer 60

1) Melena 2) Hematemesis

Question 61

List 3 things both duodenal & gastric ulcers can lead to

Answer 61

1) Hemorrhage 2) Perforation 3) Gastric outlet obstruction

Question 62

List 4 goals of Tx PUD

Answer 62

1) Promote healing 2) Relieve pain 3) Decrease acid levels 4) Prevent recurrence

Question 63

List 4 Tx options for PUD

Answer 63

1) Lifestyle changes 2) Abx 3) PPI 4) H2 inhibitors

Question 64

List 3 lifestyle changes for treating PUD

Answer 64

1) Avoid caffeine, alcohol, tobacco 2) Avoid spicy, high fat foods 3) Avoid ASA or NSAIDs