Disorders of GI function (pptx 1) Flashcards by Hannah McMahon

List 3 functions of parietal cells in the stomach

1) Secretes HCL → sterilizes & breaks down food (mainly PRO & CHO)
2) Secretes IF → needed to absorb vit. B12 in SI
3) Acid synthesis is controlled by proton pump

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Parietal cells are responsible for acid synthesis which is controlled by the proton pump… list 3 pump triggers

1) Acetylcholine
2) Histamine
3) Gastrin

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Describe parietal abdominal pain

Localized
2) Described as knife-like, sharp pain

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Describe visceral abdominal pain

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

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What is the 3rd type of abdominal pain?

Referred pain

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How is abdominal pain produced?

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

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List 2 things abdominal organs are sensitive to

1) Stretching
2) Distention

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LISt 7 disorders of the esophagus

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

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List 6 disorders of the stomach

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

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List 6 disorders of the SI

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

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

GERD

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What is GERD?

A backward movement of gastric contents into esophagus

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

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

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Diagnosis of GERD Hint: 2

1) Endoscopy
2) Manometry

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List 2 results of esophageal mucosal damage associated with GERD

1) Erosive esophagitis
2) Barrett’s esophagus

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What is Barrett’s esophagus Hint: 3

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

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Cause of GERD

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

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List 10 examples that cause GERD

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

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List 9 clinical manifestations of GERD

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

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GERD increases risk of _____

Aspiration

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List 7 life style & dietary changes that can Tx GERD

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

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List 4 pharmacologic Tx options for GERD

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

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What is celiac disease?

An autoimmune disorder triggered by gluten

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List 8 clinical manifestations of celiac disease

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

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List 5 labs to look at to help Dx celiac disease

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

List 3 Tx options for celiac disease

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

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

Helicobacter pylori (H. pylori)

What ethnicities is H. pylori increased in?

Hispanics & African Americans

How is H. pylori transmitted?

Person to person → thru saliva, feces, vomiting

List 3 disorders H. pylori causes

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

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

FALSE → most are asymptomatic

What kind of bacteria is H. pylori?

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

Describe bacteria of H. pylori gastritis

Small, curved or spiral shaped gram-negative rods

What does H. pylori gastritis secrete?

Urease (enzyme) → converts urea to ammonia

How does ammonia function for bacteria to survive?

Ammonia neutralizes acidity of the stomach for bacteria to survive

Where is H. pylori gastritis located?

Burrows into mucus layer

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

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

List 7 Sx of H. pylori

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

List 4 ways to Dx H. pylori

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

List 4 Tx options for H. pylori

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

Where do peptic ulcers occur in GI tract?

Upper portion of GI tract

What is peptic ulcer disease?

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

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

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

List 2 things to note about peptic ulcer disease

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

List 4 causes of peptic ulcer disease

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

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

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

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

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

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

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

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

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

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

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

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

1) Erosion 2) Ulcer → extends into muscularis layer

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

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

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

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

Where in the stomach do gastric ulcers tend to develop?

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

Common age to see gastric ulcers

Ages 55-65 male & female

Patho of gastric ulcers **Hint: 3**

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

What is the most common type of PUD?

Duodenal ulcer

List 5 causes of duodenal ulcers

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

List 4 things that occur with presence of duodenal ulcers

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

List 6 clinical manifestations of duodenal ulcers

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

List 7 clinical manifestations of gastric ulcer

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

List 2 things both duodenal & gastric ulcers can cause

1) Melena 2) Hematemesis

List 3 things both duodenal & gastric ulcers can lead to

1) Hemorrhage 2) Perforation 3) Gastric outlet obstruction

List 4 goals of Tx PUD

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

List 4 Tx options for PUD

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

List 3 lifestyle changes for treating PUD

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