Card Set Information
Gastroesophageal Reflux Disease GERD
-Backflow of stomach acid into the esophagus.
GERD Signs / Symptoms
- Regurgitation, bitter sour/bitter taste
- Tooth erosion
- Nocturnal cough
- Heartburn: burning & pressure sub sternal and retrosternal, radiates up neck, jaw and back. Mimics angina.
-Post meal: 20 min 2 hrs after meals
- Reflux salivary hyper-secretion that does not taste bitter.
- Difficulty swallowing
- Painful swallowing
Dx Tests for GERD
-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
H2 receptor antagonists
Proton pump inhibitors
-aluminum hydroxide, Mylanta
H2 Receptor Antagonists
- cimetidine, Tagament
- ranitidine, Zantac
- famotidine, Pepcid
- nizatidine, Axid
Proton Pump Inhibitors
- omeprazol, Prilosec
- esomeprazole, Nexium
- pantoprazol, Protonix
- rabeprazol, Aciphex
- lansoprazole, Prevacid
- secralfate, Carafate
Prokinetics (promotility agents)
- 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.
Complications of GERD
- 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.
Achalasia Signs & Symptoms
Dx tests for Achalasia
- Radiologic studies
: show esophageal dilation
: shows absence of primary peristalsis
- Drug Therapy
: to reduce pressure in the LES
- Calcium channel blockers
- Dilation with balloon similar to PCTA
: 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
Hiatal Hernia Symptoms/ Complication
- Strangulation of the herniated organ
- Ulcers of the mucous membrane or deeper structures of the GI tract
- Stomach & duodenum
- results from acid and pepsin imbalances
Four major causes of peptic ulcers
- 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.
Factors contributing to Gastric Ulcers
- H. Pylori
- Type A personality
- NSAIDS, salicylates
Physiologic stress ulcers
- 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
Causes of Duodenal Ulcers
- Excessive production or excessive relies of gastrin or increased sensitivity to gastrin.
- Lack of buffering ability in the duodenum.
Signs & Symptoms of Peptic Ulcers
- Pain that is dull, burning, boring or gnawing.
: 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
: Vomiting blood
: tarlike, fetid smelling stool w/ undigested blood
- Gastric outlet obstruction
: relieved by constant NG aspiration.
Peptic Ulcer Dx Tests
: 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
Drug therapy for Peptic Ulcer Disease
: 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.
: eradicates H.Pylori
Sugical Interventions for Peptic Ulcer Disease
: Billroth I
: Billroth II
- Total gastrectomy
- Removal of the antrum (gastric producing potion of the lower stomach)
- 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.
Complications on surgery
: up to 7 days after surgery. Indications include abdominal rigidity, abdominal pain, restlessness, elevated temp, increased pulse, decreased BP and leukocytosis.
- Dumping symdrom
- 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.
: diaphoresis, nausea, vomiting epigastrsic pain, explosive diarrhea, borborygmi.
: 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.
Appendicitis signs & symptoms
- 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.
Appendicitis Diagnostic Tests
- WBC and differential