GI Disorders

-Backflow of stomach acid into the esophagus.

• - Pyrosis
• - Regurgitation, bitter sour/bitter taste
• - Tooth erosion
• - Hoarseness
• - Eructation
• - Flatulence
• - Dysphagia
• - Odynophagia
• - Nocturnal cough
• - Wheezing

- Heartburn: burning & pressure sub sternal and retrosternal, radiates up neck, jaw and back. Mimics angina.

-Post meal: 20 min 2 hrs after meals

- Belching

- Reflux salivary hyper-secretion that does not taste bitter.

- Difficulty swallowing

- Painful swallowing

• -Usually diagnosed by symptoms
• - Bernstein Test: + if pain if felt when HCL is applied to esophagus
• - Esophagogastroduodenoscopy (EGD)
• - Barium swallow (upper GI series) : identifies hiatal hernia

• - Teach Diet & lifestyle changes
• - Avoid problem foods / beverages
• - Stop smoking
• - Eat 4-6 smaller meals
• - Lose weight
• - Eliminate alcohol
• - Remain upright 1-2 hrs after meals
• - Avoid tight clothing
• - Medication therapy
•       Antacids
•       H2 receptor antagonists
•       Proton pump inhibitors
• -Fundoplication

-aluminum hydroxide, Mylanta

• - cimetidine, Tagament
• - ranitidine, Zantac
• - famotidine, Pepcid
• - nizatidine, Axid

• - omeprazol, Prilosec
• - esomeprazole, Nexium
• - pantoprazol, Protonix
• - rabeprazol, Aciphex
• - lansoprazole, Prevacid

- secralfate, Carafate

• - metoclopramide, Reglan :
• - increases peristalsis therefore, promotes gastric emptying & reduces risk of GERD

- surgery to strengthen the LES and lessen the possibility of acid reflux also done to correct hiatal hernia.

• - Barrett's esophagus: Normal squamous epithelium is replaced w/columnar epithelium, increasing risk of esophageal cancer
• - Can trigger Asthma attacks
• - Chest pain resulting in bleeding
• - Narrowing or chronic irritation of esophagus

• - Can cause esophageal ulcerations and hemorrhage
• - Risk for aspiration
• - Increased risk for Adenocarcinoma
• - Scarring can permanently damage esophagus tissue & produce stricture

- Cardiospasm: an abnormal condition characterized by the inability of a muscle to relax, particularly the cardiac sphincter of the stomach.

• - Dysphagia
• - Regurgitation

• - Esophagoscopy
• - Radiologic studies: show esophageal dilation
• - Manometry: shows absence of primary peristalsis

• - Drug Therapy: to reduce pressure in the LES
• -Anticholinergics
• - Nitrates
• - Calcium channel blockers
• - Dilation with balloon similar to PCTA
• - Cardiomyotomy: incision in the muscle layer of the esophagus allowing expansion
• - High calorie, high protein diets.

• - A protrusion of the stomach and other abdominal viscera through an opening, or hiatus in the diaphragm, results of a weakness of the diaphragm.
• - Anatomical condition not a disease
• - Treated by fundoplication

• - GERD
• - Strangulation of the herniated organ
• - Infarction
• - Ulceration

• - Ulcers of the mucous membrane or deeper structures of the GI tract
• - Stomach & duodenum
• - results from acid and pepsin imbalances

• - Excess of gastric acid (duodenal ulcers)
• - Decrease in ability of GI mucosa to protect itself fr acid & pepsin (Gastric Ulcers)
• - H. Pylori
• - NSAIDS, aspirin or corticosteroids.

• - H. Pylori
• - Type A personality
• - Genetics
• - NSAIDS, salicylates
• - Tobacco
• - Diet

• - Transient ischemia of the gastric mucosa associated with hypotension, severe injury, extensive burns and complicated surgery
• - Blood flow bypass the gastric mucosa.
• - Produces an imbalance between the destructive properties of hydrochloric acid & pepsin and protective factors of the stomach's mucosal barrier especially in the fundus portion

• - Excessive production or excessive relies of gastrin or increased sensitivity to gastrin.
• - Lack of buffering ability in the duodenum.

• - Pain that is dull, burning, boring or gnawing.
• - Dyspepsia: Nausea, eructation, distention.
• - Gastric ulcers: associated w/ food intake
• - Gastric ulcers: hemorrhage, bleeding is difficult to control, may require surgery
• - Duodenal Ulcers: pain wakes up pt from sleep
• - Duodenal Ulcers: chronic bleeding, prone to perforation can lead to bacterial peritonitis
• - Hematemesis: Vomiting blood
• - Melena: tarlike, fetid smelling stool w/ undigested blood
• - Gastric outlet obstruction: relieved by constant NG aspiration.

• -Esophagogastroduodenoscopy: specimen for biopsy or ID of H.pylori.
• - Urea Breath Test: pt drinks solution containing carbon 13-enriched urea. Finding of CO213 upon exhalation confirms H. pylori infections.
• - IgG serologic testing: Id H. Pylori
• - Occult Blood

• -Antiacids: neutralize or reduce acidity
• -Histamine (H2) receptor blockers: Decrease acid secretion by blocking histamine receptors
• -Proton Pumt Inhibitors: Inhibit secretion of gastrin by the parietal cells of the stomach.
• -Mucosal Healing agents: cytoprotetive drugs that form an ulcer-adherent complex that covers and protect ulcers from evasion of pepsin, acid and bile salts.
• -Antibiotic Therepy: eradicates H.Pylori

• - Antrectomy
• - Gastroduodenostomy: Billroth I
• - Gastrojejunostomy: Billroth II
• - Total gastrectomy
• - Vagotomy
• - Pyloroplasty

- Removal of the antrum (gastric producing potion of the lower stomach)

• -Billroth I
• - Anastomosis of the fundus to the duedenum

• - Billroth II
• - Closure of the duodenum and anastomosis of the fundus into the jejumum (middle section of sm intestine)

- Removal of the entire stomach.

• - Removal of the vagal innervation to the fundus.
• decreasing acid production of the parietal cells of the stomach (usually done with Billroth I or II)
• - Decreases gastric motility and subsequently gastic emptying.

• - Surgical enlargement of the pyloric sphincter,
• - Facilitates passage of contents from the stomach. commonly done after Vagotomy.

• -Bleeding: up to 7 days after surgery. Indications include abdominal rigidity, abdominal pain, restlessness, elevated temp, increased pulse, decreased BP and leukocytosis.
• - Dumping symdrom
• - Diarrhea
• - Reflux esophagitis
• - Nutritional deficits
• - Pernicious anemia

• - complication of peptic ulcer surgery
• - Rapid gastric emptying, causing distention of the duodenum or jejunum produced by a bolus of hypertonic food.
• signs/symptoms: diaphoresis, nausea, vomiting epigastrsic pain, explosive diarrhea, borborygmi.
• -Treatment: 6 sm meals/ day, high protein, low carb, avoice liquids during meals 1) anticholinergic agents 2) recline for 1 hr after meals.
• -symptoms are self limiting.

• - Caused by a deficiency of the intrisic factor, produced in the stomach which aids intestinal absorption of vitamin B12.
• - pt's are recommended to have blood serum B12 mesured every 1-2 years
• -and replacement therepy of vitamin B12 monthy injection or weekly vial nasal route.

• - Inflammation of the vermiform appendix
• - likely to occure in teenagers and young men 20-30
• - Appendix is in LRQ attached to the cecum
• - Becomes obstructed with stool and become infected, inflamed and can perferate.

• - LRQ pain
• - Rigid abdomen
• - Absent or decreased bowel sounds
• - Tenderness / rebound / McBurney's Point
• - N/V, anorexia, fever, constipation.

- Halfway between the umbilicus and the anterior crest of the right ileum.

- WBC and differential