GI Packet #4

Cirrhosis

Irreversible scarring and fibrosis of the liver cells

How does cirrhosis occur?

Scar tissue replaces normal tissue, inhibiting blood flow, liver cannot function normally

Early stage Sx of cirrhosis (alike Hepatitis; 6)

1. None (asymptomatic)

2. Decreased appetite

3. Weight loss

4. Nausea

5. Weakness

6. Fatigue

Later stage Sx of Cirrhosis (3)

1. Swelling of abdomen and legs

2. Small red spider veins under the skin

3.Pruritus: Itching of hands and feet secondary to bile products being deposited in the skin

Causes of Cirrhosis (4)

1. Long standing alcohol use

2. Hepatitis B & C

3. Inherited diseases

4. Prolonged exposure to toxins at any time (Ex. Medical Hx of excess Tylenol use for pain management)

Testing for Cirrhosis (5)

1. Lab evaluation -> LFTs

2. Ultrasound

3. CT scan

4. MRI

5. Liver biopsy

Definitive Dx for Cirrhosis

Liver biopsy

Goals of Cirrhosis Tx (2)

1. Prevent further damage (cirrhosis is irreversible)

2. Depends on cause (Ex. Alcoholic would go to AA)

Last resort Tx for Cirrhosis

Liver transplant

Recommendation for Pt (diet)

Nutritionally sound, high caloric, nutrient dense diet

Gastroesophageal Reflux disease

Irritation of the lower esophagus by gastric secretions that backflow into the esophagus from the stomach

Gastroesophageal Reflux disease is AKA

GERD

Cause of GERD

Weakened LES

LES

Lower esophageal sphincter (right below esophagus and above the stomach)

Why does a weakened LES cause GERD?

Does not close/tighten fully, allowing gastric secretions to backflow

Aggravating factors of GERD (6)

1. Certain foods

2. Alcohol

3. Large meals

4. Lying down soon after eating

5. Certain medications

6. Cigarette smoking

What kinds of foods irritate GERD?

Caffeine, chocolate, spicy, fatty, dairy

What kinds of medications irritate GERD?

Sedatives & calcium channel blockers

Sx of GERD (6)

1. Heartburn

2. Difficulty swallowing

3. Chest pain caused via GI

4. Cough

5. Hoarseness

6. Sore throat

Definitive Dx of GERD

Endoscopy

What does an endoscopy allow the provider to do? (3)

1. View esophagus, stomach, & duodenum

2. Can take a biopsy

3. Identify abnormalities

Tx of GERD (2)

1. Antacids

2. Prescription strength meds

What do antacids do, and what are 2 examples?

Neutralizes stomach acid, provides quick relief, no healing, only Tx Sx; Ex. Maalox or Mylanta

What are the 2 types of prescription medications Pts can be prescribed for GERD?

1. H2 receptor blockers

2. Proton pump inhibitor

What do H2 receptor blockers do and what are 2 examples?

Decrease acid production, act slower (30 minutes), longer relief, can get half strength OTC; Ex. Cimetidine or Famotidine

What do proton pump inhibitors do and what are 3 examples?

Shut down pump in acid secreting cells in the stomach; Ex. Omeprazole, Pantoprazole, or Esomeprazole

Lifestyle modifications for GERD (5)

1. Weight control

2. Small meals

3. Avoid triggers

4. Stay upright 30 minutes after eating; Use gravity by raising head while laying in bed

5. Avoid smoking, alcohol, and late night meals

Complications of GERD

Barrett's Esophagus

How does Barrett's Esophagus develop?

Develops from chronic exposure of esophagus to stomach acid that is backwashing

What happens to the cells when Barrett's Esophagus is present?

Mucosa of esophagus change from normal stratified squamous epithelium to gastric type mucus secreting columnar epithelium

Why is Barrett's Esophagus dangerous?

Can become a pre-malignant condition and can progress to cancer

What kind of carcinomas can result from Barrett's Esophagus?

Most adenocarcinomas of the esophagus start with this and cell changes

Peptic Ulcer Disease

Ulcers that develop inside the stomach, duodenum, or esophagus

Peptic ulcers are the most common cause of.....?

Upper GI bleeding

Types of peptic ulcers (3)

1. Gastric

2. Duodenal

3. Esophageal

Causes of peptic ulcers (3)

1. Bacteria

2. Chronic, regular use of NSAIDs (non-steroidal anti-inflammatory drugs)

3. Hypersecretory states

What kind of bacteria causes peptic ulcers?

Helicobacter (H.) pylori

Examples of NSAIDs

Aleve, Motrin, Aspirin

What happens during a hypersecretory state?

Pathologically, too much acid is produced

What is a condition that causes a hypersecretory state?

Zollinger-Ellison Syndrome

Sx of Peptic Ulcers (3)

1. Burning/gnawing pain (lasts minutes to hours)

2. Worse on an empty stomach

3. Dark blood in stools (starts as an upper GI bleed that has gone through the GI system)

Diagnostics for peptic ulcers (2)

1. Upper GI (swallow white liquid coating and X-ray to identify ulcer)

2. Endoscopy, possible biopsy

Tx goals of peptic ulcers (2)

1. Kill the bacteria (if H. pylori is the cause)

2. Decrease amount of acid to relieve pain and encourage healing

Medication for bacterial cause of peptic ulcers

Antibiotics and PPI: Clarithromycin + Amoxicillin + Omeprazole= 1 pack of medication with 1 co-pay