Upper GI Problems

Question 1

4 layers of GI tract

Answer 1

mucosa, submucosa, muscularis, serosa

Question 2

Enteric nervous system

Answer 2

can work independently of CNS, regulates motility and secretion along entire GI tract (parasympathetic vs sympathetic)

Question 3

Peritoneum

Answer 3

membrane that lines the abdominal cavity

Question 4

peritoneal cavity

Answer 4

potential space between the 2 layers

Question 5

omentum

Answer 5

fatty sheet that covers the organs

Question 6

Controls ingestion and propulsion of food

Answer 6

appetite center in hypothalamus and hormone ghrelin

Question 7

gastric secretions

Answer 7

chief cells secrete pepsinogen in the stomach

parietal cells secrete HCL acid in the stomach

Question 8

intrinsic factor

Answer 8

helps us process and absorb vit B12

Question 9

Effects of aging on GI system

Answer 9

xerostomia
decreased appetite
decreased taste
decreased HCL
constipation
smaller liver size
gallbladder disease
low food intake

Question 10

GERD

Answer 10

gastroesophageal reflux disease
(not a disease but a syndrome)
a symptom of mucosal damage in the esophagus

Question 11

causes of GERD

Answer 11

NO ONE SINGLE CAUSE
something happens that lowers the defense systems of the esophagus or the esophagus is overwhelmed by reflux of acidic gastric contents
- HCL acid and pepsin causes inflammation

Question 12

predisposing factors of GERD

Answer 12

• Incompetent lower esophageal sphincter (LES)
• decreased LES pressure
• increased intraabdominal pressure
• hiatal hernia

Question 13

PUD (peptic ulcer disease)

Answer 13

group of upper GI disorders
degrees of erosion on the gut wall
caused by imbalance between mucous and aggressive factors

Question 14

defensive factors against ulcers

Answer 14

mucus- forms barrier
bicarb- neutralizes acid
blood flow- poor blood flow to gut (makes it harder to make mucus and bicarb)
prostaglandins- stimulate the secretion of mucus + bicarb

Question 15

first most common cause of ulc

Answer 15

H.pylori

Question 16

second most common cause of ulcers

Answer 16

NSAID use

Question 17

GERD lifestyle modifications

Answer 17

avoiding triggers
maintain appropriate weight
smoking cessation
stress management
small meals
avoid late meals

Question 18

Proton pump inhibitors

Answer 18

promote esophageal healing
prescription and OTC
Side effect :headaches
*don’t stop GERD but help symptoms

Question 19

How do proton pump inhibitors work?

Answer 19

irreversible inhibition of the H+, K+ and ATPase proton pump
Take with food
(this drug blocks the pump)

Question 20

Consequences of long term use of proton pump inhibitors

Answer 20

• long term or high doses may increase the risk of fractures
• Risk of C. diff because the stomach acid can’t kill bacteria
• they may decrease calcium absorption

Question 21

Histamine-2 receptor blockers

Answer 21

decrease HCL acid
reduce symptoms and promote esophageal healing
no side effects

Question 22

How do Histamine-2 blockers work?

Answer 22

Blocks H2 receptors on parietal cells (parietal cells produce gastric acid)
take this drug with food

Question 23

4 categories of Antacids

Answer 23

1. Aluminum hydroxide
2. Magnesium hydroxide
3. Calcium carbonate
4. Sodium bicarbonate

Question 24

Which OTC should be used with caution in a patient with osteoporosis?

Answer 24

omeprazole

Question 25

PUD Drug therapy

Answer 25

``` PPIs H2 R blockers antibiotics antacids anticholinergics cyto-protective therapy ```

Question 26

Antibiotic therapy for PUD

Answer 26

eradicates H.pylori | combination therapy with a proton-pump inhibitor

Question 27

Clarithromycin

Answer 27

antibiotics | suppressed growth of H.pylori by inhibiting protein synthesis

Question 28

Cimetidine

Answer 28

blocks H2 receptors | Oral

Question 29

Cimetidine side effects

Answer 29

uncommon binds to androgen receptors causing estrogen side effects in very rare cases elevates gastric pH and may increase pneumonia Confusion in elderly

Question 30

Omeprazole

Answer 30

``` first available PPI inhibits gastric secretion short half-life used for short-term therapy take before first meal of the day ```

Question 31

Omeprazole teaching

Answer 31

used in the hospital as an ulcer prophylaxis | dont use long term

Question 32

prilosec

Answer 32

Omeprazole | Proton Pump Inhibitor

Question 33

Adverse effects of prilosec

Answer 33

``` uncommon in short term use headache Gi effects pneumonia fractures C.diff ```

Question 34

Antacids in PUD

Answer 34

``` adjunct therapy increase gastric pH interact unfavorably with a lot of drugs can effect absorption of drugs health care provider should know what meds are being taken ```

Question 35

Aluminum hydroxide antacids

Answer 35

``` relatively low acid neutralizing long duration used in combination with magnesium or hydroxide has tons of sodium causes constipation interacts with antibiotics ```

Question 36

Magnesium hydroxide antacids

Answer 36

``` rapid acting an antacid of choice cause diarrhea combination with aluminum used as a laxative use with caution in patients with renal failure ```

Question 37

Calcium carbonate antacids

Answer 37

``` rapid acting High acid neutralizing long duration causes constipation belching and flatulence ```

Question 38

Sodium bicarbonate antacids

Answer 38

used for acidosis | not appropriate for use of PUD

Question 39

Sucralfate in PUD

Answer 39

creates protective barrier for up to 6 hours

Question 40

Anticholinergics in PUD

Answer 40

Lowers HCL | lowers gastric motility

Question 41

what are the 4 defensive factors against PUD

Answer 41

mucus- protective barrier bicarb- neutralizes stomach acid blood flow- low blood flow causes vulnerability prostaglandins- make mucus and bicarb

Question 42

common causes of ulcers

Answer 42

1. H. pylori 2. NSAID use 3. stress-related