Upper GI

Question 1

Hydrochloric acid, secreted by ____ cells, is stimulated by….

Keeps stomach pH:

Increased production from…

Answer 1

Parietal cells
Stimulated by food, caffeine, chocolate, alcohol

pH 1-4

Large fatty meals, emotional/physical stress

Question 2

What is the brain’s vomiting center?
How does it work?

Answer 2

Medulla

Receives stimuli from body to initate vomit reflex

Question 3

What is the CTZ? How does it work?

Answer 3

Chemoreceptor trigger zone
-in brainstem
-responds to drugs, toxins, and motion to initiate vomiting

Stimulates PNS and SNS

Question 4

GERD is a ___ syndrome involving backflow of gastric/duodenal contents into the esophagus

Leads to…

Answer 4

Chronic

Irritation and inflammation of esophagus

Question 5

Explain the two types of hiatal hernias

Answer 5

Portion of stomach protrudes through diaphragm into esophagus

Sliding: most common, stomach can slide back and forth

Rolling: more dangerous, can strangulate, next to esophagus

Question 6

How is GERD diagnosed?

Answer 6

Upper endoscopy w/ biopsy

Question 7

What is Barret Esophagus?

Answer 7

GERD causes metaplasia (pre-canceous cellular changes) leading to an increased risk of cancer

Question 8

What are the two most common/potent treatments of GERD?

Answer 8

Proton Pump Inhibitors

H2 Blockers

Question 9

Explain eosinophilic esophagitis

Answer 9

Allergy-related, assorted triggers

Infiltration of eosinophils leads to swelling

Symptoms: similar to GERD and food impaction in esophagus

Question 10

What is the most common cause of esophageal strictures?

Answer 10

GERD

Question 11

Explain gastritis

Answer 11

Inflammation of stomach
Acute or chornic
-infection, alcohol, irritating foods, meds (NSAIDS,steroids)

Question 12

What are the two types of peptic ulcers?

What is the most common cause of both? Second most common?

Answer 12

Gastric, Duodenal

H. Pylori
NSAIDS

Question 13

What is the most common site of gastric ulcers?

Age?
Gender?
Pain is ___ w/ eating
Pain characteristics?
First symptoms may be?

Answer 13

Antrum of stomach

50-60
female
WORSE
Burning, gaseous, bloating
Perforation

Question 14

Duodenal ulcers
-age prevalence?
-increased risk of?
-pain ____ by eating

Answer 14

35-45
GI bleed
Relieved by eating

Question 15

Early satiety is associated with ___ ulcers

Answer 15

Duodenal

Question 16

What is the gold standard for diagnosis H. pylori?

Answer 16

Endoscopy w/ biopsy

Question 17

Weight gain vs. weight loss: peptic uclers?

Answer 17

Gastric: weight loss- don’t want to eat

Duodenal: weight gain: want to eat to relieve pain

Question 18

How do antacids work?

What do they NOT do?

Answer 18

-Neutralize acid
-Promotes
mucus/bicarb./prostaglandins

DO NOT: decrease acid production

Question 19

What adverse effects are associated w/ the following antacids:

Aluminum
Magnesium
Calcium

Answer 19

Aluminum: constipation
Magnesium: diarrhea
Calcium: constipation, kidney stones

Question 20

Which antacid is safe for a patient w/ renal failure?

Answer 20

Aluminum salts

Question 21

OTC antacids may cause…

Answer 21

Masking of more serious problems

Question 22

How do antacids affect quinolones?

Answer 22

Reduce absorption by 50%

take 2 hours before/after

Question 23

How do H2 Antagonists work?

Answer 23

Block H2 receptor of parietal cells, reducing H+ secretion

Raises pH of stomach

Suppressed acid secretion in stomach

Question 24

What are H2 blockers used for?

Answer 24

GERD, peptic ulcer disease, erosive esophagitis

Question 25

How are H2 blockers typically tolerated?

Answer 25

Well- few AEs

Question 26

How do Proton Pump Inhibitors work?

Answer 26

Prevent H+ movement from parietal cell into stomach, stopping 90%+ of secretion over 24 hours= achlorhydria ALL gastric acid is temp. blocked

Question 27

What is the example med of PPIs?

Answer 27

Pantoprazole

Question 28

What are some AEs of PPIs?

Answer 28

Increased C. diff risk Osteoporosis/fractures Pneumonia Mg depletion Dementia, lupus

Question 29

What 2 drugs do PPIs increase the levels of?

Answer 29

Diazepam Phenytoin

Question 30

Which acid-controlling drug is a mucosal protectant than forms a protective coating in the stomach? When should it be taken?

Answer 30

Sucralfate -1 hour before eating

Question 31

Which acid-controlling drug decreases ulcers in pts taking NSAIDS?

Answer 31

Misoprostol

Question 32

Which acid-controlling drug decreases gas and may be taken alongside antacids?

Answer 32

Simethicone

Question 33

How do prokinetic drugs work?

Answer 33

Increase LES pressure, improve gastric emptying Lots of neuro side AES -tardive dyskinesia (abnormal face movements)

Question 34

What is the triple therapy for H. pylori? What is an optional addition for stomach soothing?

Answer 34

PPI Amoxicillin Clarithromycin Optional: bismuth

Question 35

Explain perforation

Answer 35

Medical Emergency! GI contents reach through all layers, entering the sterile peritoneal cavity. Severe upper ab. pain, shoulder referral Tender, board-like abdomen Bowel sounds absent, N/V Shock symptoms

Question 36

Explain pyloric obstruction (gastric outlet obstruction)

Answer 36

Distal stomach/duodenum become obstructed from inflammation or scarring Causes belching, projectile vomiting

Question 37

How are pyloric obstructions treated?

Answer 37

Decompression (NG suction) Surgery Fluid/lyte replacement H2 blocker or PPI

Question 38

What is the route for B12 supplementation for malabsorption?

Answer 38

IM

Question 39

Explain dumping syndrome

Answer 39

Stomach surgery complication (pyloric sphincter removal) Caused by rapid passage of food/fluids into jejunum from hypertonic intestinal contents

Question 40

How does dumping syndrome manifest?

Answer 40

Sweat, dizzy, palpitations N/V/D, abdominal pain Reactive hypoglycemia

Question 41

Explain GI bleeds/hemorrhages

Answer 41

Medical emergency -hypovolemic shock risk -sudden, severe pain -melena -occult bleeding

Question 42

Which of the following symptoms for someone with PUD is the most serious? Projectile vomiting Burning pain 2 hours post-meal Coffee-ground emesis Board-like abdomen w/ shoulder pain

Answer 42

Board-like abdomen w/ shoulder pain -Perforation- most life threatening w/out immediate intervention