Chapter 29: Disorders of esophagus, stomach, and small intestine

Upper GI tract

Esophagus

Stomach

Small intestine

Common Disorders of the upper GI tract

GERD

PUD

Gastroenteritis

Esophagus is a

tube like structure from the mouth to the stomach

esophagus has two

sphincters- upper and lower

Stomach has what 3 parts and 2 sphincters

Fundus, body, and pylorus

2 sphincters: Lower esophageal sphincter and pyloric

3 phases of the digestive process

Cephalic

Gastric

Intestinal

cephalic phase

vagus nerve secretes acetylcholine and the cells prepare for digestion

gastric phase

mucus (goblet cells)

HCL acid and intrinsic factor (parietal cells)

pepsinogen (chief cells)

gastrin(G-cells)

goblet cells

mucus

parietal cells

HCL acid and intrinsic factor

chief cells

pepsinogen

g cells make

gastrin

intestinal phase

duodenum reacts to chyme production moderates gastric activity through hormones and nervous system responses.

small intestine 3 parts

duodenum

jejunum

ileum

small intestine is lined with

villi: microvilli

what does microvilli do

helps with absorption of nutrients

what hormones does the small intestine secrete

cholecystokinin

secretin

cholecystokinin

bile, pancreatic enzymes

secretin

stop gastric secretion

ducts from what enters the duodenum

liver and pancreas

enterohepatic circulation

bile acids from ileum to liver

NSAIDS block

protective mucus

most accurate diagnostic for upper GI is

endoscopy

if there is an upper gastrointestinal bleed use

hemodynamic stabilization

PPI’s

decrease stomach acid

esophageal varices treatment

balloon tamponade

dysphagia means

difficulty swallowing

odynophagia means

painful swallowing

dysphagia is usually from what dysfunction

neuromuscular

structural abnormalities of the esophagus

esophageal strictures

achalasia

achalasia

esophageal motility problem

diagnosis for dysphagia

barium swallow test

esophagitis

inflammation of the esophagus

things that can cause esophagitis

irritation of mucus - stomach acid or chemicals

infection- thrush

medications- nsaids or anticholinergics

vomiting

Mallory-Weiss syndrome can cause esophagitis but what is it

a tear in the lower esophagus

esophagitis symptoms

burning in the chest or throat

dysphagia/ odynophagia

heartburn

sore throat/ white patches (from thrush)

hematemesis- with Mallory Weiss

nausea/vomiting

best diagnostic test for esophagitis

endoscopy with biopsy

treatments for esophagitis

h2 blockers

ppis

antifungals

sucralfate

GERD

problem with tone of LES

regurgitation of stomach acid into esophagus

gastroparesis

delayed stomach emptying that is a problem with GERD

what can cells do in GERD

metaplasia

esophageal cells transform to stomach like columnar cells

what is a precancerous change that can happen with GERD

Barrett’s esophagus

GERD symptoms

dysphagia

heartburn

dyspepsia

epigastric pain

regurgitation

some surgeries to treat GERD

fundoplication

endoscopic radiofrequency delivery

Upper gastrointestinal bleed

bleeding in esophagus, stomach or duodenum

some causes of upper GI bleed

PUD

esophageal varices

esophageal cancer

acute upper GI bleed

rupture, tear, or perforation causing immediate blood loss

acute upper GI bleed symptoms

hypotension

hypovolemia

hypovolemic shock may develop

chronic upper GI bleed

small tear or opening causing gradual blood loss

chronic upper GI bleed symptoms

anemia- iron deficiency

melena

occult blood in stool

symptoms of UGIB- upper GI bleed

melena

occult blood

hematemesis: bright red and coffee ground

diagnosis of UGIB

decreased HGB and HCT levels

decreased iron

BUN elevated

Endoscopy

treatment for an AGIB

hemodynamic stabilization

NG tube placement

endoscopic techniques to stop bleed

Laparoscopy

blood transfusions

treatment CGIB

PPI’s and sucralfate

Esophageal varices

engorged veins at distal end of esophagus

esophageal varices are often due to ___________ and veins may ____________

portal vein hypertension

rupture

esophageal varices symptoms

liver failure symptoms

hematemesis

melena

acute hemorrhage

main diagnosis for esophageal varices

endoscopy

treatment for esophageal varices

prevent rupture

beta blockers an ISMN

Ruptured varices require immediate surgery

esophageal cancer two types

squamous and adenocarcinoma

squamous esophageal cancer

cancer invades lining of esophagus

adenocarcinoma esophageal cancer

glandular tissue near stomach

risks for esophageal cancer

chronic alcohol use

smoking

gerd

barrett’s esophagus

barrett’s esophagus as a risk for esophageal cancer

increases risk 30-60% compared to general population

esophageal cancer symptoms

dysphagia

weight loss

change in eating pattern

hiccups

hoarse voice if tumor presses on a nerve

surgical resection treatment for esophageal cancer

esophagectomy

hiatal hernia

stomach pushes up through the opening in diaphragm

what would be a treatment for hiatal hernia

laparoscopic fundoplication

pyloric stenosis

constriction of pyloric sphincter

main symptoms of pyloric stenosis

projectile vomiting of undigested food

visible peristalsis

pyloric stenosis - what treatment is needed

surgical repair

acute gastritis/ erosive gastritis

inflammation of stomach lining

causes of acute gastritis

Medications: Aspirin, NSAID’s, corticosteroids

Infection, acute stress, bile reflux, alcohol abuse

main treatment for acute gastritis

remove causative agents

what is the most common cause of chronic gastritis

Heliobacter pylori

chronic gastritis/ nonerosive gastritis causes

irritation and erosion of stomach erosion

unlike in acute gastritis, chronic gastritis

causes atrophy of glandular stomach lining

Chronic gastritis causes decreased

intrinsic factor - needed for vitamin B12 absorption

symptoms of chronic gastritis

burning/gnawing epigastric pain

hematemesis

weight loss

nausea

anorexia

diagnosis of chronic gastritis

endoscopy with biopsy

what kind of replacement will you need for chronic gastritis

B12

PUD

inflammatory erosion of stomach or duodenum (duodenum is more common)

PUD is from what pathological changes

hypersecretion of HCL

ineffective GI mucus

ineffective GI mucus production

Poor cellular repair

some important causes of PUD

h. pylori

NSAIDS

excessive caffiene

stress

PUD genetic susceptibility

P450

symptoms of PUD

epigastric abdominal pain

• between meals

Perforation

• sudden excruciating abdominal pain radiates to back

• abdominal rigidity

• pale skin, cold sweat, hematemesis

diagnosis of PUD

h.pylori testing

endoscopy

treatment for a persistent ulcer

angiography with trans arterial embolization (TAE)

refractory cases- PUD

vagotomy

PUD gastroduodenostomy - Bilroth 1

Remove distal stomach and connect to duodenum, decrease HCl

PUD gastrojejunostomy - Bilroth 2

Removal of the lower stomach and connect to jejunum, decrease gastrin

Zollinger- Ellison syndrome

gastrin- secreting tumor

excessive HCL leading to ulcer

main symptoms of Zollinger Ellison syndrome

severe epigastric pain

GI bleeding

Vomiting

main diagnosis of Zollinger- Ellison syndrome

elevated gastrin level in blood

when would they do bariatric surgery

BMI greater than 40

Bariatric surgery sleeve gastrectomy

greater curvature of stomach removed

most common procedure in the US for bariatric surgery

RYCB for Bariatric surgery

reduce stomach size by attaching stomach to jejunum

stomach capacity 20 mL

gastric banding Bariatric surgery

inflatable band placed around upper portion of the stomach

biliopancreatic diversion for Bariatric surgery

distal end of the ileum attached to duodenum

dumping syndrome

rapid gastric emptying

common after Bariatric surgery