Upper GI Disorders

Question 1

Upper GI problems are composed of what organs? (3)

Answer 1

esophagus
stomach
BEGINNING of small intestines

Question 2

Lower GI problems are composed of what organs? (3)

Answer 2

small intestines
colon (large intestines)
rectum/anus

Question 3

What are the esophageal disorders? (2)

Answer 3

GERD (Gastroesophageal reflux disease)
Hiatal Hernia

Question 4

What are the inflammatory disorders of the stomach? (3)

Answer 4

Gastritis
Acute Gastroenteritis
PUD (peptic ulcer disease)

Question 5

Dysphagia: Definition

Answer 5

difficulty swallowing
(begins with solids and progresses to liquids)

Question 6

Dysphagia: Causes

Answer 6

1. Mechanical obstruction
   Stenosis or stricture
   Diverticula (w/in esophagus)
   Tumors
2. Neuromuscular dysfunction
   CVA
   Achalasia (LES can’t open properly
   People with trachs or that were intubated (can get better)

Question 7

GERD: Definition

Answer 7

AKA “heartburn”
Backflow of gastric acid from the stomach into the esophagus
Occurs via the lower esophageal sphincter (LES): doesn’t close properly
Highly acidic material

Question 8

GERD: Etiology

Answer 8

Anything that alters closure strength of LES
OR
increases abdominal pressure

Question 9

GERD: Etiology Examples (11)

Answer 9

fatty foods
spicy foods
tomato based foods
citrus foods
caffeine
large amounts of alcohol
cigarette smoking
sleep position
obesity
pregnancy
pharmacologic agents

Question 10

GERD: Clinical Manifestations (CM) (6)

Answer 10

heartburn (pyrosis)
dyspepsia
regurgitation
chest pain
dysphagia
pulmonary symptoms

Question 11

GERD: Mouth CM (3)

Answer 11

tooth decay
gingivitis
bad breath

Question 12

GERD: Ears CM (1)

Answer 12

earache

Question 13

GERD: Chest CM (3)

Answer 13

chronic cough
worsening asthma
recurrent pneumonias

Question 14

GERD: Throat CM (6)

Answer 14

hoarseness
chronic sore throat
throat clearing
laryngitis
lump in throat
post nasal drip

Question 15

GERD: Complications

Answer 15

ulceration
scarring
strictures
Barrett esophagus

Question 16

GERD: Barrett esophagus

Answer 16

development of abnormal metaplastic tissue- premalignant
3-fold increased risk of developing adenocarcinoma of the esophagus
over all survival only 17%

Question 17

Hiatal Hernia: Definition

Answer 17

A defect in the diaphragm that allows part of the STOMACH to pass INTO the THORAX

Question 18

Hiatal Hernia: Main Types (2)

Answer 18

1. Sliding hernia
2. Paraesophageal hernia

Question 19

Type 1: Sliding Hernia

Answer 19

usually small and often does not need treatment

Question 20

Type 2: Paraesophageal Hernia

Answer 20

part of the stomach pushes through the diaphragm and stays there

Question 21

Hiatal Hernia: Pathophysiology

Answer 21

Exact cause is unknown
Age related
Injury or other damage may weaken the diaphragm muscle
Repeatedly putting too much pressure on the muscles around the stomach (severe coughing, vomiting, constipation and straining to have a BM)

Question 22

Hiatal Hernia: Risk Factors (3)

Answer 22

age
obesity
smoking

Question 23

Hiatal Hernia: CM (5*)

Answer 23

asymptomatic
belching
dysphagia
chest or epigastric pain
*common for GERD and Hiatal Hernia to coexist

Question 24

Hiatal Hernia: Treatment

Answer 24

Mostly a conservative treatment:
Teaching: small,
frequent meals, avoid
lying down after eating
Avoid tight clothing and
abdominal supports
Weight control for
obese individuals
Antacids for the
GERD/esophagitis
symptoms
Surgery if the conservative treatments don’t work

Question 25

Gastritis: Definition

Answer 25

inflammatory condition of the stomach

Question 26

ACUTE Gastritis: Definition

Answer 26

Temporary inflammation of the stomach lining ONLY (intestines NOT affected) Generally last from 2-10 days

Question 27

ACUTE Gastritis: Etiology (3)

Answer 27

irritating substance (alcohol) drugs (NSAIDs) infectious agents

Question 28

CHRONIC Gastritis

Answer 28

Progressive disorder with chronic inflammation in the stomach Can last weeks to years

Question 29

CHRONIC Gastritis: Complications (4)

Answer 29

PUD bleeding ulcers anemia gastric cancers

Question 30

CHRONIC Gastritis: Main Etiologies (2)

Answer 30

Autoimmune: attacks parietal cells H. pylori infection

Question 31

What is H. pylori?

Answer 31

Helicobacter pylori bacterium Gram negative spiral bacteria that thrives in an ACIDIC environment When it becomes overgrown, causes destructive pattern of persistent inflammation Can cause chronic gastritis, PUD, and stomach cancer

Question 32

How is H. pylori transmitted?

Answer 32

person to person via: saliva, fecal matter, or vomit OR contaminated food or water

Question 33

Acute OR Chronic Gastritis CM (10)

Answer 33

sometimes none anorexia N/V stomach burn upset stomach postprandial discomfort (symptoms soon after you eat) intestinal gas hematemesis (blood in vomit) tarry stools anemia

Question 34

Acute Gastroenteritis: Definition

Answer 34

inflammation of stomach AND small intestine Usually lasts 1-3 days but may last as long as 10 days

Question 35

Acute Gastroenteritis: Etiology (3)

Answer 35

Viral infections: Norovirus and rotavirus Bacterial infections: E. coli, salmonella, and campylobacter Parasitic infections

Question 36

Acute Gastroenteritis: CM (4)

Answer 36

watery diarrhea (may be bloody if bacterial) abdominal pain N/V Fever, malaise

Question 37

Acute Gastroenteritis: Complication (1)

Answer 37

fluid volume deficits (worried about dehydration)

Question 38

Peptic Ulcer Disease (PUD): Definition

Answer 38

Ulcerative disorder of the upper GI tract ulcer in esophagus: esophageal ulcer ulcer in stomach: gastric ulcer ulcer in duodenum: peptic ulcer Develops when the GI tract is exposed to acid and H. pylori

Question 39

Aggressive Factors for Developing Ulcers? (5)

Answer 39

H. pylori NSAIDs Too much acid secretion Pepsin Smoking

Question 40

Defensive Factors to help GI Tract? (4)

Answer 40

Mucus Bicarbonate Increase blood Flow Prostaglandins

Question 41

PUD: Etiology (6)

Answer 41

H. pylori injury causing substances (NSAIDs, ASA, alcohol) excess secretion of acid smoking family history stress (increased gastric acid secreted with the stress response)

Question 42

Risk factors: NSAID-Induced PUD (6)

Answer 42

age higher doses of NSAIDs history of PUD use of corticosteroids and anticoags serious systemic disorders H. pylori infection

Question 43

PUD: Pathogenesis

Answer 43

Mucosa is damaged Histamine is secreted resulting in: increase in acid and pepsin secretion- causes further tissue damage vasodilation- causes edema If blood vessels are destroyed, this results in BLEEDING

Question 44

PUD: Classification

Answer 44

DUODENAL Ulcer: most common type, age- any; early adulthood Gastric/peptic ulcer: age- peak 50-70; why? increased use of NSAIDs, corticosteroids, anticoags, and more likely to have serious systemic illnesses

Question 45

PUD: CM (6)

Answer 45

sometimes none N/V anorexia weight loss bleeding burning pain- in middle of abdomen that is usually when the stomach is empty

Question 46

Gastric Ulcer: Pain characterisitcs, location, timing

Answer 46

burning, cramping, gas-like epigastrium, back *1-2 hours after eating

Question 47

Duodenal Ulcer: Pain characterisitcs, location, timing

Answer 47

burning, cramping, gas-like epigastrium, back *2-4 hours after eating

Question 48

PUD: Complications (3)

Answer 48

"HOP" H- hemorrhage O- obstruction P- perforation and peritonitis