FCM GI

disorder of the tube that carries food from the mouth to the stomach (esophagus), which affects the ability of the esophagus to move food toward the stomach.

a benign epithelial tumor in which the cells form recognizable glandular structures or in which the cells are derived from glandular epithelium.

intestinal obstruction due to inhibition of bowel motility

• for cholangitis (inflammation of the bile ducts)
• jaundice, fever (with chills), abdominal pain (usually RUQ)

surgical removal of the gall bladder

painful inflammation of the gall bladder wall

presence of a gallstone in the common bile duct

condition caused by rapidly developing (acute) or long-term (chronic) interruption in the excretion of bile (a digestive fluid that helps the body process fat). The term is taken from the Greek chole, bile, and stasis, standing still.

chronic degenerative disease in which normal liver cells are damaged and are then replaced by scar tissue.

the evacuation of fecal matter from the rectum.

nausea, weakness, sweating, palpitation, syncope, often a sensation of warmth, and sometimes diarrhea, occurring after ingestion of food in patients who have undergone partial gastrectomy.

painful, difficult, or disturbed digestion, which may be accompanied by symptoms such as nausea and vomiting, heartburn, bloating, and stomach discomfort.

• any degenerative brain disease
• hepatic encephalopathy

the collection of excessive amounts of triglycerides and other fats inside liver cells.

a permanent abnormal passageway between two organs in the body or between an organ and the exterior of the body

Nerve damage of the stomach that delays or stops stomach emptying, resulting in nausea, vomiting, bloating, discomfort, and weight loss

A gram negative rod-shaped bacterium that lives in the tissues of the stomach and causes inflammation of the stomach lining

passage of bloody stools

vomiting blood

The destruction or dissolution of red blood cells, with release of hemoglobin

ultrasound waves to break up gallstones

The passage of black tarlike stools containing blood that has been acted on by the intestinal juices.

a test for gallbladder disease in which the patient is asked to inhale while the examiner's fingers are hooked under the liver border at the bottom of the rib cage. The inspiration causes the gallbladder to descend onto the fingers, producing pain if the gallbladder is inflamed. Deep inspiration can be very much limited.

any obstruction that results in failure of the contents of the intestine to progress through the lumen of the bowel. The most common cause is a mechanical blockage resulting from adhesions, impacted feces, tumor of the bowel, hernia, intussusception, volvulus, or the strictures of inflammatory bowel disease. Obstruction may also be the result of paralytic ileus. Obstruction of the small bowel may cause severe pain, vomiting of fecal matter, dehydration, and eventually a drop in blood pressure. Obstruction of the colon causes less severe pain, marked abdominal distension, and constipation. Radiographic examination may reveal the level of obstruction and its cause. Treatment includes the evacuation of intestinal contents by means of an intestinal tube. Surgical repair is sometimes necessary. Fluid balance and electrolyte balance are restored by carefully monitored IV infusion. Nonnarcotic analgesics are usually prescribed to prevent the decrease in intestinal motility that often accompanies the administration of narcotic analgesics

that present in such small quantities that it is detectible only by chemical tests or by spectroscopic or microscopic examination.

a severe sensation of burning, squeezing pain while swallowing caused by irritation of the mucosa or a muscular disorder of the esophagus, such as gastroesophageal reflux; bacterial or fungal infection; tumor; achalasia; or chemical irritation

disorder brought on by a deficiency of the nutrient called niacin or nicotinic acid, one of the B-complex vitamins.

Beriberi is a disease caused by a deficiency of thiamine (vitamin B1) that affects many systems of the body, including the muscles, heart, nerves, and digestive system. Beriberi literally means "I can't, I can't" in Singhalese, which reflects the crippling effect it has on its victims. It is common in parts of southeast Asia, where white rice is the main food. In the United States, beriberi is primarily seen in people with chronic alcoholism.

any dummy medical treatment; originally, a medicinal preparation having no specific pharmacological activity against the patient's illness or complaint given solely for the psychophysiological effects of the treatment; more recently, a dummy treatment administered to the control group in a controlled clinical trial in order that the specific and nonspecific effects of the experimental treatment can be distinguished.

severe gastroesophageal reflux with damage to the esophageal mucosa, often with erosion and ulceration, and sometimes leading to stricture, scarring, and perforation.

stricture; an abnormal narrowing or contraction of a duct or canal

dilatation and hypertrophy of the colon associated with amebic or ulcerative colitis

A type of varicose vein that develops in veins in the linings of the esophagus and upper stomach when these veins fill with blood and swell due to an increase in blood pressure in the portal veins.

• (alanine aminotransferase)
• an enzyme that catalyzes the reversible transfer of an amino group from alanine to α-ketoglutarate to form pyruvate and glutamate. Normally present in many tissues and body fluids, especially in the liver, it is released into the serum as a result of tissue injury; the serum concentration is increased particularly when there is acute damage to hepatic cells, as in viral or toxic hepatitis, infectious mononucleosis, and obstructive jaundice.

an enzyme that catalyzes the hydrolysis of starch into simpler compounds. The α-a's occur in animals and include pancreatic and salivary amylase

• (aspartate transaminase)
• an enzyme normally present in body tissues, especially in the heart and liver; it is released into the serum as the result of tissue injury, hence the concentration in the serum (SGOT) may be increased in disorders such as myocardial infarction or acute damage to hepatic cells.

• (complete blood count)
• A routine analysis performed on a sample of blood taken from the patient's vein with a needle and vacuum tube. The measurements taken in a CBC include a white blood cell count, a red blood cell count, the red cell distribution width, the hematocrit (ratio of the volume of the red blood cells to the blood volume), and the amount of hemoglobin (the blood protein that carries oxygen). CBCs are a routine blood test used for many medical reasons, not only for AIDS patients. They can help the doctor determine if a patient is in advanced stages of the disease

• (comprehensive metabolic panel)
• A battery of analytes–albumin, alk phos, AST, BUN, calcium, chloride, glucose, potassium, sodium, total protein–which are measured to establish a baseline and detect metabolic disorders

• included in acute abdominal series
• to view any free air in the abdomen

elevations of direct (conjugated) bilirubin typically result from obstruction either within the liver (intrahepatic) or a source outside the liver (e.g. gallstones or a tumor blocking the bile ducts)

elevated levels of indirect (unconjugated) bilirubin are usually caused by liver cell dysfunction (e.g. hepatitis)

erythrocyte sedimentation rate: the rate at which red blood cells settle in a vertical tube, used to detect the presence of disease

a test that utilizes an enzyme immunoassay format, with multiple monoclonal antibodies to detect Helicobacter pylori antigens

Hepatitis B serologic testing involves measurement of several hepatitis B virus (HBV)-specific antigens and antibodies. Different serologic "markers" or combinations of markers are used to identify different phases of HBV infection and to determine whether a patient has acute or chronic HBV infection, is immune to HBV as a result of prior infection or vaccination, or is susceptible to infection.

• Lactate dehydrogenase is of medical significance because it is found extensively in body tissues, such as blood cells and heart muscle.
• main use of the test for lactate dehydrogenase (LDH) is as a general indicator of the existence and severity of acute or chronic tissue damage and, sometimes, as a monitor of progressive conditions such as kidney disease, liver disease, and some cancers. It may be used as a tumor marker for testicular cancer and other germ cell tumors such as ovarian cancer to help stage, determine prognosis, and monitor treatment as well as in other cancers, including lymphoma, melanoma, and neuroblastoma.
• LDH used to be ordered to help diagnose and monitor a heart attack, but the troponin test has largely replaced LDH in this role. LDH isoenzymes may be used in differential diagnosis to help determine which organs are likely to be involved.

Liver function tests, or LFTs, include tests for bilirubin, a breakdown product of hemoglobin, and ammonia, a protein byproduct that is normally converted into urea by the liver before being excreted by the kidneys. LFTs also commonly include tests to measure levels of several enzymes, which are special proteins that help the body break down and use (metabolize) other substances. Enzymes that are often measured in LFTs include gamma-glutamyl transferase (GGT); alanine aminotransferase (ALT or SGPT); aspartate aminotransferase (AST or SGOT); and alkaline phosphatase (ALP). LFTs also may include prothrombin time (PT), a measure of how long it takes for the blood to clot.

any enzyme that catalyzes the cleavage of a fatty acid anion from a triglyceride or phospholipid.

• testing stool for culture and sensitivity
• to identify bacteria associated with enteric disease

• fecal occult blood
• screening for colon cancer

testing stool for white blood cells, which may be caused by diseases such as inflammatory bowel disease.

• to investigate the cause of chronic diarrhea and loose, fatty, foul-smelling stools (steatorrhea).
• Used along with other testing for CF

• testing stool for ova and parasites
• determine if a parasite is infecting intestinal tract
• diarrhea after travel outside US and drinking contaminated water sources

subgroup of anti-infectives that are derived from bacterial sources and are used to treat bacterial infections. Other classes of drugs, most notably the sulfonamides, may be effective antibacterials. Similarly, some antibiotics may have secondary uses, such as the use of demeclocycline (Declomycin, a tetracycline derivative) to treat the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Other antibiotics may be useful in treating protozoal infections

medicines that neutralize stomach acid

• An agent that is antagonistic to the action of parasympathetic or other cholinergic nerve fibers.
• (side effects of dry mouth/eyes)

Medications prescribed to relieve major depression. Classes of antidepressants include selective serotonin reuptake inhibitors (fluoxetine/Prozac, sertraline/Zoloft), tricyclics (amitriptyline/ Elavil), MAOIs (phenelzine/Nardil), and heterocyclics (bupropion/Wellbutrin, trazodone/Desyrel).

drugs that combat diarrhea by decreasing gastrointestinal motility; may cause sedation of the central nervous system and xerostomia.

preventing or alleviating nausea and vomiting

Preventing or relieving convulsions or spasms.

• antitumour necrosis factor (anti-TNF); anti-TNF-α agents
• cytokine antibody to TNF-α used to control inflammation and vasculitis, and effect tissue repair in rheumatological diseases (e.g. rheumatoid arthritis, ankylosing spondylitis and psoriasis); indicated for rheumatoid arthritis patients who have not responded to at least two standard disease-modifying antirheumatism drugs, including methotrexate

• A trademark for ciprofloxacin and its hydrochloride derivative.
• Anti-infective of the Fluoroquinolone class of drugs
• Inhibits bacterial DNA synthesis by inhibiting DNA gyrase in susceptible gram-negative and gram-positive organisms

Any of a family of cholesterol-lowering agents—e.g., cholestipol, cholestyramine—that bind with cholesterol-containing bile acids in the intestine and remove them in stool.

• medication or supplements to clean toxins from the colon. Fiber is the best natural way to maintain colon health.
• A bowel cleanser is used as a prep for colonoscopy.

protecting cells from noxious chemicals or other stimuli

• used for treating C. diff
• A trademark for the drug metronidazole.
• Anti-infective, antiprotozoal of the Nitroimidazole derivative class of drugs
• Disturbs DNA synthesis in susceptible bacterial organisms

an agent that blocks the action of histamine by competitive binding to the H2 receptor; used to inhibit acid secretion in the treatment of peptic ulcer.

• drugs that inhibit or prevent activity of the immune system. They are used in immunosuppressive therapy to -
• Prevent the rejection of transplanted organs and tissues (e.g., bone marrow, heart, kidney, liver)
• Treat autoimmune diseases or diseases that are most likely of autoimmune origin (e.g., rheumatoid arthritis, multiple sclerosis, myasthenia gravis, systemic lupus erythematosus, sarcoidosis, focal segmental glomerulosclerosis, Crohn's disease, Behcet's Disease, pemphigus, and ulcerative colitis).
• Treat some other non-autoimmune inflammatory diseases (e.g., long term allergic asthma control).

promote bowel movements

• Nonsteroidal anti-inflammatory drugs are medications such as aspirin and ibuprofen that decrease pain and inflammation
• Inhibit prostaglandins - risk of kidney failure and liver disease

drugs which enhance the passage of intraluminal contents of the gastrointestinal tract.

used to improve GERD symptoms for patients with slow gastric emptying. They speed digestion, which prevents acid from staying in the stomach too long. They may also be used for patients with GERD when therapy with H2 blockers or Proton Pump Inhibitors (PPIs) does not work.

molecules which are manufactured to bind to a prostaglandin receptor

are a group of drugs whose main action is a pronounced and long-lasting reduction of gastric acid production. They are the most potent inhibitors of acid secretion available. The group followed and has largely superseded another group of pharmaceuticals with similar effects, but a different mode of action, called H2-receptor antagonists. These drugs are among the most widely sold drugs in the world, and are generally considered effective. The vast majority of these drugs are benzimidazole derivatives, but promising new research indicates the imidazopyridine derivatives may be a more effective means of treatment. High dose or long-term use of PPIs carries a possible increased risk of bone fractures.

• (Selective serotonin reuptake inhibitor)
• a class of drugs that inhibit the reuptake of serotonin in the central nervous system, used to treat depression and other psychiatric disorders.

A group of drugs that includes the corticosteroids, similar to hormones produced by the adrenal glands, and used to relieve inflammation and itching.

• (tricyclic antidepressant)
• any of a class of drugs with particular tricyclic structure and potentiating catecholamine action; used for the treatment of depression.
• Also used for treatment of diffuse esophageal spasm

• (for H. pylori)
• Proton pump inhibitor (orally, twice daily)
• Clarithromycin (500 mg orally, twice daily)
• Amoxicillian (1 g orally, twice daily) (or metronidazole - 500 mg orally twice daily if penicillin allergic)

• (fecal occult blood testing)
• The fecal occult blood test (FOBT) is performed as part of the routine physical examination during the examination of the rectum. It is used to detect microscopic blood in the stool and is a screening tool for colorectal cancer.

• (also known as a lower GI (gastrointestinal) exam)
• is a test that uses x-ray examination to view the large intestine. There are two types of this test: the single-contrast technique where barium sulfate is injected into the rectum in order to gain a profile view of the large intestine; and the double-contrast (or "air contrast") technique where air is inserted into the rectum.

medical procedure where a long, flexible, tubular instrument called the colonoscope is used to view the entire inner lining of the colon (large intestine) and the rectum

• (computed tomography)
• an imaging method in which a cross-sectional image of the structures in a body plane is reconstructed by a computer program from the x-ray absorption of beams projected through the body in the image plane.

Examination of the interior of a canal or hollow organ by means of an endoscope.

• (endoscopic retrograde cholangiopancreatography)
• an endoscopic test that provides radiographic visualization of the bile and pancreatic ducts. A flexible fiberoptic duodenoscope is placed into the common bile duct. A radiopaque substance is instilled directly into the duct, and serial x-ray films are taken. It is useful in identifying partial or total obstruction of these ducts, as well as stones, benign strictures, cysts, ampullary stenosis, anatomic variations, and malignant tumors.

a diagnostic study to assess the competence of the lower esophageal sphincter. A catheter sheathed with a water-filled balloon is inserted nasally and advanced into the esophagus; a series of measurements reflecting esophageal resting pressures are taken as the catheters are moved.

• barium swallow
• A technique in which a radiocontrast "milkshake" of barium sulfate is swallowed to detect benign or malignant lesions of the pharynx, oesophagus, stomach and small intestine and evaluate the integrity of the swallowing mechanism; the progress of the barium is followed radiographically to detect filling defects—e.g., places where a normal outline of barium should be seen but is not.

• (magnetic resonance imagining)
• a method of visualizing soft tissues of the body by applying an external magnetic field that makes it possible to distinguish between hydrogen atoms in different environments.

a procedure by which a doctor inserts either a short and rigid or slightly longer and flexible fiber-optic tube into the rectum to examine the lower portion of the large intestine (or bowel).

A rapid diagnostic test used to identify Helicobacter pylori, based upon its ability to convert urea to ammonia. Formerly considered the gold standard non-invasive test for H pylori, the urea breath test is being replaced by the monoclonal stool antigen test, which is more sensitive (97%) and more specific (96%)

• Upper 1/3 striated muscle, partially under voluntary control, includes UES, contracted at rest
• Lower 1/3 smooth muscle, under involuntary control, includes LES, contracted at rest
• Middle 1/3 is mixed

regulated by vagus n.

• "Transfer" dysphagia
• Upper esophageal, pharyngeal, or UES disease
• Problem right with swallowing
• Can be caused by - Parkinson disease, stroke, multiple sclerosis, myasthenia gravis, amyotrophic lateral sclerosis

• Painful swallowing due to:
• Esophageal ulceration or inflammation
• Caustic ingestions
• Pill-induced ulceration
• Radiation injury
• Infectious esophagitis or ulcers in immunocompromised patients (e.g. CMV)
• Esophagitis due to severe GERD (unusual & also will have reflux complaints)
• Initial test = Endoscopy

• Burning sensation occurring under sternum & radiating towards mouth/throat
• Cardinal feature of GERD
• 1-2 hours after meals, heavy lifting, bending over
• Large meals & certain foods may trigger symptoms (fats, sugars, chocolates, acidic foods)
• Nocturnal heartburn (suggests erosive esophagitis)
• Frequency of symptoms not related to severity of disease

• Lump of tightness in throat unrelated to swallowing
• Feels like something caught in throat
• Swallowing may give relief

Esophagogastroduodenoscopy

• Videofluoroscopy - Often initial test, allows evaluation of swallowing mechanics
• Barium Swallow - May detect presence of aspiration, detects diverticula, masses
• Fiberoptic nasopharyngeal laryngoscopy - Allows detailed examination of oro/hypopharynx, larynx
• Esophageal manometry - Allows evaluation of UES
• EGD - Allows confirmation of findings of other tests (e.g. masses)

• Heartburn
• Acid or Food Regurgitation
• Dysphagia - If present, suspect peptic stricture, Schatzki's ring, esophageal web
• Less Common Clinical Presentations -
• Waterbrash (excess salivation due to GERD)
• Globus sensation (constant lump in throat)
• Odynophagia

• treatment for GERD
• Metoclopramide 5-10 mg QAC (before every meal) & QHS (at bedtime)
• Promote acid clearance & gastric emptying

• Precursor to esophageal adenocarcinoma
• Metaplastic change from normal esophageal squamous epithelium to intestinalized columnar epithelium
• Premalignant condition
• Chronic GERD plays a role in the development and progression of Barrett’s esophagus, however other factors are important