GI Disorders

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Author:
pdorse
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162066
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GI Disorders
Updated:
2012-07-14 13:19:32
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GI
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GI Disorders
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  1. Gastroesophageal Reflux Disease GERD
    -Backflow of stomach acid into the esophagus.
  2. GERD Signs / Symptoms
    • - Pyrosis
    • - Regurgitation, bitter sour/bitter taste
    • - Tooth erosion
    • - Hoarseness
    • - Eructation
    • - Flatulence
    • - Dysphagia
    • - Odynophagia
    • - Nocturnal cough
    • - Wheezing
  3. Pyrosis
    - Heartburn: burning & pressure sub sternal and retrosternal, radiates up neck, jaw and back. Mimics angina.
  4. Postprandial state
    -Post meal: 20 min 2 hrs after meals
  5. Eructation
    - Belching
  6. Water brash
    - Reflux salivary hyper-secretion that does not taste bitter.
  7. Dysphagia
    - Difficulty swallowing
  8. Odynophagia
    - Painful swallowing
  9. 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
  10. GERD Management
    • - 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
  11.  Antacids
    -aluminum hydroxide, Mylanta
  12. H2 Receptor Antagonists
    • - cimetidine, Tagament
    • - ranitidine, Zantac
    • - famotidine, Pepcid
    • - nizatidine, Axid
  13. Proton Pump Inhibitors
    • - omeprazol, Prilosec
    • - esomeprazole, Nexium
    • - pantoprazol, Protonix
    • - rabeprazol, Aciphex
    • - lansoprazole, Prevacid
  14. Antiulcer
    - secralfate, Carafate
  15. Prokinetics (promotility agents)
    • - metoclopramide, Reglan :
    • - increases peristalsis therefore, promotes gastric emptying & reduces risk of GERD
  16. Fundoplication
    - surgery to strengthen the LES and lessen the possibility of acid reflux also done to correct hiatal hernia.
  17. 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
  18. GERD Prognosis
    • - Can cause esophageal ulcerations and hemorrhage
    • - Risk for aspiration
    • - Increased risk for Adenocarcinoma
    • - Scarring can permanently damage esophagus tissue & produce stricture
  19. Achalasia
    - Cardiospasm: an abnormal condition characterized by the inability of a muscle to relax, particularly the cardiac sphincter of the stomach.
  20. Achalasia Signs & Symptoms
    • - Dysphagia
    • - Regurgitation
  21. Dx tests for Achalasia
    • - Esophagoscopy
    • - Radiologic studies: show esophageal dilation
    • - Manometry: shows absence of primary peristalsis
  22. Achalasia Management
    • - 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.
  23. Hiatal Hernia
    • - 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
  24. Hiatal Hernia Symptoms/ Complication
    • - GERD
    • - Strangulation of the herniated organ
    • - Infarction
    • - Ulceration
  25. Peptic Ulcers
    • - Ulcers of the mucous membrane or deeper structures of the GI tract
    • - Stomach & duodenum
    • - results from acid and pepsin imbalances
  26. 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.
  27. Factors contributing to Gastric Ulcers
    • - H. Pylori
    • - Type A personality
    • - Genetics
    • - NSAIDS, salicylates
    • - Tobacco
    • - Diet
  28. 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
  29. Causes of Duodenal Ulcers
    • - Excessive production or excessive relies of gastrin or increased sensitivity to gastrin.
    • - Lack of buffering ability in the duodenum.
  30. Signs & Symptoms of Peptic Ulcers
    • - 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.
  31. Peptic Ulcer Dx Tests
    • -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
  32. Drug therapy for Peptic Ulcer Disease
    • -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
  33. Sugical Interventions for Peptic Ulcer Disease
    • - Antrectomy
    • - Gastroduodenostomy: Billroth I
    • - Gastrojejunostomy: Billroth II
    • - Total gastrectomy
    • - Vagotomy
    • - Pyloroplasty
  34. Antrectomy
    - Removal of the antrum (gastric producing potion of the lower stomach)
  35. Gastro/duoden/ostomy
    • -Billroth I
    • - Anastomosis of the fundus to the duedenum
  36. Gastro/jejun/ostomy
    • - Billroth II
    • - Closure of the duodenum and anastomosis of the fundus into the jejumum (middle section of sm intestine)
  37. Total Gastrectomy
    - Removal of the entire stomach.
  38. Vagotomy
    • - 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.
  39. Pyloroplasty
    • - Surgical enlargement of the pyloric sphincter,
    • - Facilitates passage of contents from the stomach. commonly done after Vagotomy.
  40. Complications on surgery
    • -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
  41. Dumping Symdrom
    • - 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.
  42. Pernicious anemia
    • - 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.
  43. Appendicitis
    • - 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.
  44. Appendicitis signs & symptoms
    • - LRQ pain
    • - Rigid abdomen
    • - Absent or decreased bowel sounds
    • - Tenderness / rebound / McBurney's Point
    • - N/V, anorexia, fever, constipation.
  45. McBurney's Point
    - Halfway between the umbilicus and the anterior crest of the right ileum.
  46. Appendicitis Diagnostic Tests
    - WBC and differential

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