GI disorders part 1 Flashcards
1
Q
What do parietal cells secrete?
A
HCL & intrinsic factor
2
Q
What do parietal cells act as?
A
- proton-pumps
- histamine receptors
3
Q
What is the function of parietal cells?
A
- secretes HCL: sterilizes & breaks down food (mainly PRO & CHO)
- secrete intrinsic factor: needed to absorb B12 in small intestine
- acid synthesis is controlled by proton pump: pump triggers include acetylcholine, histamine & gastrin
4
Q
What are the three types of abd pain?
A
-parietal
- visceral
- referred
5
Q
What is parietal abd pain?
A
- localized
- described as knife-like, sharp
6
Q
What is visceral abd pain?
A
- distention/inflammation of body organs
- described as colicky,crampy
7
Q
What produces abdominal pain?
A
biochemical mediators of the inflammatory response (histamine, bradykinin, serotonin) stimulate nerve endings to produce abd pain
8
Q
What are abd organs sensitive to?
A
stretching & distension
9
Q
What are disorders of the esophagus, stomach, & small intestine?
A
- dysphagia
- achalasia
- esophagitis
- GERD
- upper GI bleed
- esophageal varices
- esophageal cancer
- hiatal hernia
- pyloric stenosis
- peptic ulcer disease
- bariatric surgery
- dumping syndrome
- hernia
- gastroenteritis
- celiac disease
- short-bowel syndrome
- small bowel obstruction
- peritonitis
10
Q
What is GERD?
A
a backward movement of gastric contents into the esophagus
11
Q
How does a normal functioning GI prevent GERD?
A
a normal functioning lower esophageal sphincter maintains a zone of high pressure to prevent chyme reflux
12
Q
When does the lower esophageal sphincter relax and what can that cause?
A
the lower esophageal sphincter relaxes spontaneously 1-2 hrs after eating, which allows regurgitation into the esophagus
13
Q
What percent of the US population is affected by GERD?
A
20-40%
14
Q
What two conditions can esophageal mucosal damage lead to?
A
- erosive esophagitis
- Barrett esophagus
15
Q
What causes/ what is barrett esophagus?
A
- Repeated injury causes metaplasia
- change to columnar epithelium
- precancerous (esophageal adenocarcinoma
16
Q
May people ______________ for GERD
A
self-medicate
17
Q
How is GERD diagnosed
A
endoscopy & manometry
18
Q
What can cause GERD?
A
certain conditions, substances, foods & medications can weaken or hinder closure of the lower esophageal spincter
19
Q
What are examples of things that can cause GERD?
A
- alcohol
- acidic food
- fatty foods
- chocolate
- coffee
- nicotine
- obesity
- pregnancy
- hiatal hernia
- meds: anticholinergics, beta-agonists, CCBs, nitrates, progesterone
20
Q
What are the clinical manifestations of GERD?
A
- dysphagia
- heartburn
- regurgitation
- bitter taste
- upper abd pain within 1 hr of eating
- increase pain w/ lying or increased intra abd pressure
- can have sx with no acid
- cough, increase in asthma sx
- may seem like angina
21
Q
What are non-pharmacologic tx of GERD?
A
- Decrease dietary fats
- eat small meals
- stop smoking
- avoid lying down for 3 hrs after eating
- avoid alcohol
- weight loss
- elevate head of bed
22
Q
What are pharmacological tx of GERD?
A
- antacids
- histamine (H2) blockers
- proton pump inhibitors
- prokinetic agents
23
Q
What is celiac disease?
A
an autoimmune disorder triggered by gluten
24
Q
What are the clinical manifestations of celiac disease?
A
- abd pain
- bloating
- diarrhea
- weight loss
- steatorrhea
- weakness
- flatulus
- fatigue
25
What is used to dx celiac disease?
- H & H
- CMP
- genetic testing
- IgA
- antibody testing
26
What is the tx for celiac disease?
- Remove gluten from the diet
- vitamin replacement
- corticosteroids
27
What percent of the worlds population is affected by helicobacter pylori?
50-75%
28
who is at an increased risk for H pylori?
Hispanics and African Americans
29
How is H pylori spread?
person to person through saliva, feces, & vomit
30
What are common causes of H pylori?
- peptic ulcers
- gastritis
- gastric (stomach) cancer
31
most people with H pylori are ________________
asymptomatic
32
What kind of bacterial is H pylori?
gram-negative rods that colonize in the mucus-secreting epithelial cells of the stomach
- small, curved or spiral shaped gram-negative rods
33
What does H pylori secrete and what does that do?
- secretes urease, which converts urea to ammonia
- ammonia neutralizes acidity of stomach for bacteria to survive
34
Where does H pylori burrow into?
mucus layer
35
What does H pylori do?
produces enzymes & toxins
- impacts protection of mucosa to acidic environment
- intense inflammatory response
- creates immune response: T & B cells
36
What are sx of H pylori?
- Many are asymptomatic
- dull burning pain in the abdomen
- increase pain with an empty stomach
- N/V
- dyspepsia
- bloating
- weight loss
37
How is H pylori dx?
- urea breath test
- serologic tests
- stool antigen test
- endoscopic biopsy
38
How is an H pylori infection tx?
- antibiotics
- bismuth (antibacterial effect)
- PPI (raise the pH)
- H2 blockers
39
What is peptic ulcer disease?
inflammatory erosion in stomach (gastric ulcer) or duodenal lining (duodenal ulcer)
40
Where does peptic ulcer disease occur?
occurs in the upper portion of the GI tract
41
What is the pathophysiology of peptic ulcer disease?
- hypersecretion of HCL
- ineffective mucous production
- poor cellular repair
42
Is peptic ulcer disease chronic?
no; there are periods of exacerbation & remission
43
In what age group is peptic ulcer disease seen most?
middle aged individuals
44
What are the causes of peptic ulcer disease?
- H pylori
- chronic aspirin or NSAID use
- stress
- alcohol
45
How does H pylori cause erosion of mucosal lining?
- HCL diffuses into stomach wall & blood vessels
- creases inflammatory response causing the release of histamine & prostagandin
46
What does histamine do after being releases in the mucosal lining?
- causes vasodilation & stimulates pepsin & gastrin release
- acid secretion stimulated which attacked unprotected lining
47
What does HCL do in H pylori response?
- released by parietal cells
- irritates & destroys lining & continues to trigger inflammation
48
How does scarring and fibrosis of lining happen in H pylori?
- Fibrosis inhibits healthy cell reproduction
- decreased mucus & bicarb production to protect lining
49
Where do gastric ulcers occur?
the stomach
50
H pylori can lead to the development of
- erosion
- ulcers that can extend into the muscularis layer
51
When is pain experienced when gastric ulcers are present>
epigastric pain 1-2 hrs after eating
52
What can gastric ulcers cause?
- hematemesis or melena
- gastric carcinoma
53
What sx are commonly seen with gastric ulcers?
- heartburn
- chest discomfort
- early satiety
54
Where do duodenal ulcers occur?
occur in the duodenum
55
When is pain experienced wth duodenal ulcers?
epigastric pain 2-3 hrs after eating
56
What can duodenal ulcers cause?
melena or hematochezia
57
What may a pt with duodenal ulcers experience?
may have pain waken them during night
58
What sx may be seen with duodenal ulcers but are less common?
heartburn & chest discomfort
59
Where in the stomach do gastric ulcers occur?
tend to develop in the antral region of the stomach, adjacent to the acid-secreting mucosa of the body
60
In what age and gender are gastric ulcers common?
ages 55-65 male & female
61
What is the pathophysiology of gastric ulcers?
- primary defect is an increased mucosal permeability to hydrogen ions
- frequent H pylori
- gastric secretion is normal to less than normal
62
What is the most common type of peptic ulcer disease?
duodenal ulcer
63
What causes duodenal ulcers?
- h pylori
- smoking
- nsaids
- stress
- genetic predisposition
64
why does epigastric pain occur 2-3 hrs after eating with duodenal ulcers?
- increased gastrin levels that stay high after eating, continue to stimulate the secretion of acid
- impaired duodenal bicarb secretion
- failure of feedback where acid in the antrum inhibits the gastrin release
- rapid gastric emptying overwhelms buffering
65
What are the clinical manifestations of duodenal ulcers?
- chronic intermittent pain in epigastric area
- pain increases aout 30 min to 2 hrs after eating
- night time pain between 11-2
- spasm & acid
- relieved w/ food & antacids
66
What are the clinical manifestations of gastric ulcers?
- pain tends to increase after eating
- belching
- early satiety
- anorexia
- N/ V
- weight loss
- tends to be chronic
67
what clinical manifestations do duodenal & gastric ulcers have in common?
- Both can cause melena or hematemesis
- can lead to hemorrhage, perforation, gastric outlet obstruction
68
what are goals of PUD tx?
- promote healing
- relieve pain
- decreased acid levels
- prevent recurrence
69
What lifestyle changes should be made to tx PUD?
avoid:
- caffeine
- alcohol
- tobacco
- spicy food
- high fat food
- ASA
- NSAIDs
70
What pharmacological tx can be used for PUD?
- antibiotics
- PPIs
- H2 inhibitors
