GI Packet 4

Cirrhosis definition

Irreversible scarring of the liver cells

Scar tissue replaces normal tissue which makes it harder for the liver to function normally

Signs/Symptoms of Cirrhosis?

Not unlike Hep A,B,C symptoms

Can have no symptoms

May develop pruritus in feet

Later stages cirrhosis signs and symptoms

Swelling of abdomen & legs

Development of spider veins in skin

Causes of Cirrhosis?

Long outstanding alcohol use

Hep B or C

Inherited disease

Prolonged exposure to toxin

Testing for cirrhosis? Definitive Dx test?

Lab evaluation (LFTs)

Ultrasound

CT scan

MRI

Liver Biopsy - Definitive Dx

Treatment for Cirrhosis?

Will hep to prevent further damage

Depends on cause

High calorie nutrient dense diet

Definition of Gastroesophageal Reflux Disease

GERD- Irritation of the lower esophagus by gastric secretions that backflow

Causes of GERD?

Weakened lower esophageal sphincters

Risk factors for GERD?

1. Family history

2. Male

3. Caucasian

4. Over 50

5. Overweight

Aggravating factors of GERD?

-Certain foods -fatty, caffeine, chocolate

-Alcohol

-Large meals

-lying down soon after eating

-Certain medications- some sedatives, calcium channel blockers

-Cigarette smoking

Symptoms of GERD?

-Heartburn

-Chest pain - mostly at night in the supine position

-difficulty swallowing

-Cough, hoarseness, sore throat

Testing for GERD?

Endoscopy - esophagus, stomach, duodenum

What do antacids do?

neutralize stomach acid. Provide quick relief,. It treats the Sx not the cause

What are the two antacids?

Maalox and Mylanta

What do H2 receptor blockers do?

reduce gastric acid production

How do H2 receptor blockers timing work?

They don't act as fast as antacids, but do provide longer relief. 30 min to work

What are the H2 receptor Blockers?

Cimetidine (Tagamet) and Famotidine (Pepcid)

What do proton pump inhibitors do?

suppress gastric acid secretion

How long do PPIs take to work?

Takes little over 30 min to work

What are the 4 PPIs?

Omeprazole (Prilosec)

Lansoprazole (Prevacid)

Pantoprazole (Protonix)

Esomeprazole (Nexium)

What are some lifestyle and home remedies for GERD?

-Avoid acid foods

-Eat smaller meals at a time

-Avoide caffine

-Don't eat before bed

-Avoid Alcohol and tobacco/smoking

-Weight control

-Lay in bed with head raised

What is the complication that can occur with GERD?

Barrett's esophagus

What is barrets esophagus?

This occurs when the lower esophagus develops chronic exposure of the stomach acid. The mucus changes from stratified squamous epithelium to simple columnar epithelium.

Where is Barrett's esophagus located?

3cm above the lower esophageal sphincter

What can happen if barrets esophagus increase chance for?

Most adenocarcinomas of the esophagus begin with Barretts

What is peptic ulcer disease?

Ulcers that develop inside - Stomach, duodenum, esophagus. Most common cause of GI bleeding

What are the specific types of peptic ulcer disease?

Gastric Ulcer

Duodenal Ulcer

Esophageal Ulcer

Causes of Peptic Ulcer Disease

Stress

H. Pylori - Helicobacter Pylori

Regular use of NSAIDS

Hypersecretory of diseases- Zollinger Ellison syndrome

Symptoms for peptic ulcer disease?

Burning/Gnawing

Can Last minutes-Hours

Worse when the stomach is empty

Dark blood in stool-Melena

Testing?

Upper GI- Patient swallows white choky liquid then x-rays are taken

Endoscopy, Possible biopsy

Treatments for Peptic ulcer disease?

Kill the bacteria (if H. Pylori is the cause)

Decrease the amount of acid to relieve pain and encourage healing

What is the methods of treatment for Peptic Ulcer Disease?

Antibiotic therapy - Amoxicillin in combination with Clarithromycin and also with PPI- Omeprazole

What is Vonoprazan?

Potassium-competitive Acid Blocker (PCAB)

Directly Inhibits Hydrogen-Potassium ATPase proton pump

** Does not require acid for activation → ?? faster onset of action vs PPI

Recently FDA approved for H. pylori in combination with Amoxicillin and Clarithromycin

Only FDA approved as combo therapy → not single entity

?? Alternative to PPI → await clinical trials