Upper GI Flashcards
(136 cards)
1
Q
What is the muscular tube that has an average length of 25cm and moves liquids and solids from mouth to stomach
A
Esophagus
2
Q
What is the esophagus lined with?
A
Nonkeratinized stratified squamous epithelium
3
Q
What do the submucosal glands secrete and why?
A
Secrete: mucin, bicarbonate, epidermal growth factor and prostaglandin E2
Why: to protect the mucosa from gastric acid
4
Q
Muscles in the esophagus are arranged to facilitate the _ of food
A
Passage
5
Q
As food moves from mouth to _ the _ _ sphincter relaxes
A
Pharynx, upper esophageal
6
Q
When food moves into the esophagus, the _ esophageal sphincter relaxes to allow food to move into _
A
Lower, stomach
7
Q
How does the esophagus prevent tissue damage from exposure to gastric contents?
A
- lower esophageal sphincter contraction
- normal gastric motility
- esophageal mucus
-thought cellular junctions - cellular pH regulators
8
Q
What is achalasia?
A
Failure of esophageal neuron’s, resulting in:
- loss of ability to relax the lower esophageal sphincter
- inability to perform normal peristalsis
9
Q
How does GERD usually show up during pregnancy?
A
Heartburn
10
Q
Chest pain is a common symptom of GERD and investigation is important to determine if chest pain is _ or _
A
Cardiac or non cardiac
11
Q
What are the 3 components of the esophagogastric junction? And what is its function?
A
- lower esophageal sphincter
- Crural diaphragm
- anatomical flap valve
Meant to function as an anti reflux barrier
12
Q
Name the 8 possible mechanisms involved in GERD
A
- Decreased salivation
- Transient lower esophageal sphincter relaxation
- Decreased lower esophageal sphincter pressure
- Impaired esophageal acid clearance
- Increased esophageal sensitivity
- Increased intraabdominal pressure
- Delayed gastric emptying
- Acid pocket
13
Q
List the 10 clinical symptoms of GERD
A
- Dental corrosion (acid coming into mouth)
- Dysphagia
- Heartburn
- Odynophagia
- Regurgitation
- Noncardiac chest pain
- Chronic cough
- Hoarseness
- Reflux-induced laryngitis
- Asthma
14
Q
Prolonged acid exposure can result in
A
- Esophagitis
- Esophageal erosions
- Ulceration
- Scarring
- Stricture
- Dysphagia
15
Q
Acute causes of esophagitis
A
- reflux
- ingestion of a corrosive agent
- viral or bacterial infection
- radiation
- eosinophilia infiltration (isolated severe inflation of cells into esophagus)
16
Q
esophagitis severity relates to
.
.
.
.
A
- composition, frequency and volume of gastric reflux
- health of the mucosal barrier
- length of exposure of the esophagus to gastric reflux
- rate of gastric emptying
17
Q
what is barrett’s esophagus?
A
a precancerous condition which normal squamous epithelium of the esophagus is replaced with abnormal columnar-lined epithelium
(it increases the risk of esophageal adenocarnioma)
18
Q
risk factors for barretts esophagus
6
A
- prolonged history of GERD-related symptoms
- middle age
- white male
- obesity
- smoking
- family history of barrett’s or adenocarcinoma of the esophagus
19
Q
what is the most common symptom if a hiatial hernia and what can be done to reduce negative consequences?
A
most common symptom is heartburn
- weight reductions and decreasing meal size can reduce negative consequences
20
Q
what are the 4 types of hiatal hernia?
A
- sliding
- true paraesophageal hernia
- mixed paraesophageal hernia
- complex paraesophageal hernia
21
Q
what is a sliding hital hernia?
A
gastroesophageal junction is pushed above the diaphragm, causing symmetric herniation of the proximal stomach
most common
22
Q
what is true paraesophageal hernia?
A
fundus slides upward and moves above the gastroesophageal junction
23
Q
what is a mixed paraesophageal hernia?
A
combined sliding and paraesophageal hernia
24
Q
what is a complex paraesophageal hernia?
A
intrathoracic herniation of other organs, such as the colon and small bowel into the hernia sac
less common
25
patients with mixed paraesophageal hernia may present with what symptoms?
- severe chest pain
- retching
- vomiting
- hematemesis
26
what is the primary medical treatment of esophageal reflux?
supression of acid secretion
27
what should you aim to do to gastric pH during periods when reflux is most likely to occur
raise gastric pH above 4
28
the use of PPIs for GERD and esophagitis are associated with superior _ rates and decreased _
healing / relapses
29
milder reflux is managed by _ receptor antagonists and _
H2 / antacid
30
prokinetics may be used in those with _ _ _
delayed gastric emptying
31
what is nisses fundoplication?
most commonly performed antireflux surgery
- completed either laprascopicallt or "open"
- fundus or top portion of the stomach is wrapped 360 degrees around the lower esophagus and sutured in place to limit reflux
32
when is surgery (nissen fundoplication) considered?
- when medical management fails
- when medical management works but is expensive/inconvenient and/or affects quality of life
- when complications of GERD occur (such as barretts esophagus or peptic stricture)
- when there are extraesophageal manifestations (e.g. hoarseness, ashtma, cough, throat-clearing)
33
what are the dietary guidelines post-nissen fundoplication?
| 10
1. start clear fluid diet after surgery
2. advance to soft, moist solids for around 2 months
3. consume small, frequent meals
4. swallow small bites and chew thoroughly
5. drink slowly
6. avoid dry foods such as bread, steak, raw veg, raw fruit, peanut butter, anything with skin, seeds/nuts
7. avoid food that may cause discomfort
8. avoid food associated with reflux (citrus fruit, tomato, pineapple, alcohol, caffeine, chocolate, carbonated bev, peppermint/spearmint, fatty/fried foods, spicy foods, vinegary foods
9. after 2 months, start to incorporate new foods (on at a time). by 3-6 months, should be able to tolerate most foods
10. consult RD or physician if having difficult eating or if experiencing unintentional weight loss
34
what should the first step in symptom management of GERD be?
lifestyle changes
- avoidance of caffeine, peppermint/spearmint, alcohol, tobacco and stress
- initial recommendations should focus on meal size and content
35
weight reduction will reduce intragastric _
pressure
36
elevation of head of bed by _-_ inches can help those with nocturnal "attacks"
6-8 inches
37
avoid eating _-_ hours before laying down
2-3 hours
38
_ mg of ginger/day for _ weeks has been shown to help with GERD
40 mg for 4 weeks
39
explain lifestyle modifications and MNT for GERD for infants.
- feeding changes (timing - increasing frequency, volume)
- position therapy
- modification of maternal diet (if breastfed)
- formula changes (if formula fed)
- thickened feedings
40
what is an esophagectomy?
removal of the esophagus
41
when is an esophagectomy indicated and what do surgical candidates present with?
- indicated in some cases of esophageal cancer or for treatment of Barrett's esophagus with high-grade dysphagia
candidates present with:
- dysphagia
- decreased appetite
- side effects from chemo
- weight loss
42
esophagectomy requires that there be a replacement conduit in place to transport food from the _ to the _
oropharnyx to the stomach
43
nutrition assessment of a candidate for esophagectomy includes
-evaluation of treatment plans
- history of weight loss
44
the only patients likely to be screened at low nutrition risk pre-op (esophagectomy) are those who are _ and/or those who have _ esophagus with high grade _
asymptomatic / barretts / dysphagia
45
complications post-gastric pull-up include:
- increased risk of aspiration
- dysphagia
- anastomosis leak
- wound infection
- stricture at the site of anastomosis
46
_ tube may be placed at surgery to provide post-op nutrition
jejunostomy
47
post esophageal diet pattern recommendations
1. small frequent meals of tender, moist foods
2. limit fluids with meals (4oz or less/meal)
3. avoid skins, seeds, nuts, tough or dry meats, breads and rolls, peanut butter, fried and greasy foods, raw veg, cooked corn and peas, raw fruits
4. avoid items associated with heart burn
5. eat slowly and chew thoroughly
48
esophageal surgery increases the risk of _ syndrome
dumping
49
symptoms of dumping syndrome
- abdominal pain
- nausea
- diarrhea
- weakness
- dizziness
50
head and neck cancer includes malignancies of the:
- Oral cavity (lips and inside of mouth)
- Oropharynx (back portion of tongue and part of the throat behind the oral cavity)
- Larynx
- Esophagus
51
_ is a hallmark of head and neck cancer
dysphagia
52
dysphagia due to head and neck cancer occurs as a result of:
.
.
.
- mechanical obstruction
- Sensory impairment, or
- odynophagia (pain when swallowing)
53
aggressive, prophylactic _ therapy is a recent development in treatment of dysphagia in patients with head and neck cancer
swallowing
54
what does prophylactic swallowing therapy focus on?
maintaining or regaining function vs accomodating dysfunction
- empowering patients to progrss carefully with oral intake despite an imperfect swallow
55
what does the stomach do?
- accommodates and stores meals
- mixes food with gastric secretions
56
gastric volume ranges between _ ml (when empty) and _ L
50 ml / 4L
57
parietal cells of the stomach produce _-_ L of acid per day
- results in a pH of _-_
1.5-2 L of acid per day / pH of 1-2
58
_ are protected from the proteolytic actions of gastric acid and pepsin by a coating of mucus secreted by glands in the stomach wall
mucosa
59
bacterial infection of the gastric mucosa is prevented by the digestive actions of _ and _
HCl and pepsin
60
what is dyspepsia, and what are the underlying causes?
- Nonspecific, persistent upper abdominal discomfort or pain
- Underlying causes include:
- GERD
- Peptic ulcer disease
- Gastritis
- Gallbladder disease
Other pathology
61
functional gastrointestinal disorders (FGID) are now known as disorders of _ - _ interaction
gut-brain
| DGBI
62
MNT for dyspepsia
use food and symptom diary
consume smaller meals with a reduction in dietary fat
63
what is gastritis?
inflammation of the stomach
64
gastritis can be used to describe:
.
.
.
- symptoms relating to the stomach
- endoscopic appearance of the gastric mucosa
- histologic change characterized by infiltration of the epithelium with inflammatory cells
65
acute gastritis refers to rapid onset _ and _
inflammation and symptoms
66
chronic gastritis may occur over months to decades, with recurring symptoms including:
1. nausea
2. vomiting
3. malaise
4. anorexia
5. hemorrhage
6. epigastric pain
67
prolonged gastritis can result in _ and loss of stomach _ cells
atrophy / parietal cells
68
parietal cells are important as they produce _
HCl
69
loss of stomach parietal cells impacts absorption of _
B12
70
_ _ is responsible for most cases of chronic inflammation of the gastric mucosa and peptic ulcer, gastric cancer and atrophic gastritis
Helicobacter pylori
71
what is the bacteria that is somewhat resistant to the acidity of the stomach?
H.Pylori
72
what are the noninvasive methods for diagnosing H.pylori?
blood test for H.Pylori antibodies, a urea breath test, or a stool antigen test
73
risk factors of h.pylori gastritis
1. patient age at onset
2. specific strain of H.pylori
3. concentration of the organism
4. genetic factors (of the host)
5. patients overall lifestyle
6. patients overall health
74
non-H.pylori gastritis is linked to chronic use of:
- aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs)
- steroids
- alcohol
- erosive substances
- tobacco
also associated with eosinophilic gastroenteritis
. poor nutrition and general poor health can contribute to the onset and severity of symptoms and can delay healing
75
what is the treatment for non-H.Pylori gastritis?
removing the inciting agent
example. NSAID
76
why is an endoscopy the common diagnostic tool for non-H.Pylori gastritis?
- allows clinicians to view, photograph and biopsy mucosa of the upper GI tract
- involves passing a flexible tube into the esophagus that has a light and camera on the distal end
- inflammation, erosions, ulcerations, changes to blood vessels and destruction of surface cells can be identified
77
what is a capsule endoscopy?
capsule contains a mini video camera, light and radio transmitter that is swallowed and the signal transmits to a reciever
- it is less invasive than a normal endoscopy and allows for observation, recording and measurement of GI function while the patient is ambulatory
78
_ and proton pump inhibitors (PPI) are primary agents for pharmacotherapy
antibiotics
79
peptic ulcer disease occurs when....
when sores form as a result of the breakdown of the normal defense and repair system
80
typically, _ of our standard protective mechanisms must be malfunctioning for peptic ulcer to develop
more than 1
81
primary causes of peptic ulcers
- H.pylori
- gastritis
- aspirin and NSAID use
- severe illness
- use of corticosteroids
- tobacco use
| stress may increase peptic ulcer risk
82
what two regions are typically involved in peptic ulcer?
gastric & duodenal
83
why has the number of surgeries related to peptic ulcers decreased over the years?
earlier screening for H.pylori
recognition and screening for risk factors
84
"emergency symptoms" of peptic ulcers
- sharp, sudden, persistent and severe stomach pain
- black or bloody stools (melena)
- bloody vomit
- coffee-ground vomit
## Footnote
Could be signs of a serious problem, such as
Acute or chronic GI bleeding
perforation
Obstruction
85
most gastric ulcers occur along the lesser curvature
this is typically associated with
.
.
.
- widespread gastritis
- inflammatory involvement of parietal cells
- atrophy of acid and pepsin producing cells
86
duodenal ulcers are characterized by...
increased acid secretion
and
decreased bicarbonate secretion
87
most duodenal ulcers occur within the first centimeters of the duodenal _
bulb
88
gastric outlet obstruction occurs more oftan as a result of _ ulcers than of _ ulcers
duodenal / gastric
89
what is the first step in medical/surgical management of ulcers?
conduct an endoscopic evaluation
- collect biopsy to diagnose or rule out H.pylori
- provide any needed resuscitation
- control active bleeding
if H.pylori is present, treat with antibiotics and acid supression
90
stress ulcers may occur as a complication of metabolic stress related to
.
.
.
.
.
.
trauma
burns
surgery
shock
renal failure
radiation therapy
91
primary concern in stress ulceration is risk of significant _ _
GI hemorrhage
92
stress ulcers are typically shallow and cause oozing of blood from superficial _ beds
capillary
93
Stress ulcer lesions may be deeper than those of nonstress ulcers, eroding into the submucosa & increasing risk of
massive hemorrhage or perforation
94
Prevention of stress ulcer is ideal – aim to limit conditions leading to _, _ and _
hypotension, ischemia and coagulopathies
95
oral and enteral nutrition increase vascular _ and stimulate secretion and _
vascular perfusion
motility
96
check B12 in those with _ _ due to predicted issues with intrinsic factor in a gastric environment that has a higher-than normal pH
atrophic gastritis
97
_ temporarily buffers gastric secretions but also stimulates secretion of acid, gastrin and pepsin
protein
98
large doses of certain spices increase _ secretion and cause small, transient superficial erosions, inflammation of the mucosal lining and altered GI permeability or motility
acid
99
# MNT for peptic ulcer
person being treated for peptic ulcer (or gastritis) should be advised to:
.
.
.
avoid foods that exacerbate symptoms
consume a nutritionally complete diet
ensure adequate dietary fibre intake from fruits and veg
100
what is the second most common cause of cancer death worldwide?
cancer of the stomach
101
what is the 5-year survival rate for those with cancer of the stomach?
20%
102
list everything that may contribute to/bring on cancer of the stomach
**diet**
-large intake processed meats, fat, starches and simple sugars
- alcohol
- excess body weight
- intake of highly salted or pickled foods
- inadequate amounts of micronutrients
- broiling meats or roasting, grilling, baking, deep frying in bbq
- sun drying, salting, curing, pickling
**lifestyle
genetic
socioeconomic**
103
Gastric cancer is any malignant _ that arises from the region extending the between the gastroesophageal junction and the _
neoplasm
pylorus
104
what are the inital symptoms of gastric cancer?
Loss of appetite
Reduced strength
Weight loss
105
Malignant gastric neoplasms (tumor) can lead to malnutrition as a result of
Excessive blood and protein losses
Obstruction and mechanical interference
106
what is a gastrectomy?
removal of stomach
107
MNT for gastric cancer is determined based on
.
.
.
location of the cancer
symptoms they are having
Stage of disease
108
what is a roux-en-Y?
- Jejunem is pulled up and anastamosed (sutured to/sewed to) with the esophagus
- Duodenum is connected to the small bowel so that bile and pancreatic secretions can flow into the intestine
109
explain billroth 1
| gastroduodenostomy
removal of the **pylorus** (bottom of stomach and/or antrum & anastomosis of the proximal end of the duodenum to the distal end of the remnant of the stomach
110
what is billroth 2
| gastrojejunostomy
removal of the stomach antrum & anastomosis of the remnant stomach to the side of the jejunem, which creates a duodenal loop
111
when is oral intake of fluids and foods initiated after a gastric surgery?
ASAP once GI tract function returns
(Typically 24-72 hrs post-op)
112
# after gastric surgery
If pt unable to tolerate an oral diet for _ - _ days or more post-op, consider EN
5-7
113
# MNT post-op
should always understand which surgery was performed as the remaining anatomy is paramount to provide proper MNT
- should read the _ report for details
OR report
114
Pts may have difficulty returning to pre-op weight due to inadequate food intake. Related to:
Early satiety
Symptoms of dumping syndrome
Nutrient malabsorption
115
potential complications after vagotomy
Impairs motor function of stomach
116
potential complications after total gastril truncal vagotomy
Gastric stasis and poor gastric emptying
117
potential complications after total gastrectomy
Early satiety, nausea, vomiting
Weight loss
Inadequate bile acids & pancreatic enzymes available
malabsorption
Protein-energy malnutrition
Anemia
Dumping syndrome
bezoar formation
Vit. B12 deficiency
Metabolic bone disease
118
potential complications after subtotal gastrectomy with vagotomy
Early satiety
Delayed gastric emptying
Rapid emptying of hypertonic fluids
119
Potential chronic nutritional complications post-gastric surgery include
Anemia
Osteoporosis
Select vitamin & mineral deficiencies
- Prophylactic B12 supplementation (injected or oral) is recommended
120
explain dumping syndrome
- A complex GI and vasomotor response to the presence of large quantities of hypertonic foods and liquids in the proximal small intestine
121
dumping syndrome usually occurs as a result of...
surgical procedures that allow excessive amounts of liquid or solid foods to enter the small intestine in a concentrated form
122
what are the early symptoms of dumping syndrome?
| within 10-30 mins after eating
Abdominal pain
Bloating
Nausea
Vomiting
Diarrhea
Headache
flushing
Fatigue
hypotension
123
what are the late symptoms of dumping syndrome?
| 1-3 hours after eating
perspiration
Weakness
Confusion
Shakiness
Hunger
Hypoglycemia
124
late dumping is likely related to _ _
reactive hypoglycemia
125
what is the inital treatment for dumping syndrome?
dietary changes
126
MNT for dumping syndrome
Proteins and fats are better tolerated than CHO because they are digested more slowly
Limit simple CHO (e.g., sucrose, fructose, lactose)
Supplement with soluble fibre
127
what is steatorrhea?
more than 7% of dietary fat in stool
128
people with steatorrhea may benefit from _ _ diet or _ enzymes
reduced fat
pancreatic enzymes
129
MNT for dumping syndrome recommends to limit fluids to _ oz at meals
4
130
MNT for dumping syndrome recommends to drink all other fluids at least _ - _ before or after meals
30 - 40 mins
131
MNT for dumping syndrome recommends to remain reclined at least _ min after eating
30
132
why should we limit simple CHO foods and liquids for those with duming syndrome?
it increases complex CHO foods
133
MNT for dumping syndrome recommends to choose foods high in _ fibre
soluble
134
MNT for dumping syndrome recommends to include a _ - containing food at each meal
protein
135
MNT for dumping syndrome recommends to introduce _ containing foods slowly
lactose
136
what are the most common causes of delayed gastric emptying?
Viral infection
diabetes
Surgeries
