Chapter 29 Esophagus Stomach and Small Intestines

What is dysphagia and what are its main causes

Difficulty swallowing

Causes include: strictures, tumors, diverticula, and cranial nerve/neuromuscular dysfunction

What signs indicate cranial nerve dysfunction in dysphagia

Unilateral facial droop, absent gag reflex, deviated tongue/uvula, regurgitation, coughing, pooling food, drooling, painful or repeated swallowing

What are major complication is associated with dysphagia

Aspiration → leading to aspiration pneumonia

What is esophagitis and what causes it

Inflammation of the esophagus.

Causes: stomach acid reflux, H. pylori, Candida, NSAIDs, vomiting, chemical ingestion

Symptoms of esophagitis

Burning pain in the throat or midsternum; can lead to obstruction

What causes esophageal varices

Portal vein hypertension → vein dilation → high rupture risk.

Main symptoms of esophageal varices

Cirrhosis sign + upper GI bleed

What are risk factors for esophageal adenocarcinoma

GERD → Barrett’s esophagus; tobacco use.

What are risk factors for squamous cell carcinoma of the esophagus

Chronic alcohol use, tobacco use, HPV

Symptoms of esophageal cancer

Dyshagia, odynophagia, eating pattern changes, weight loss; high aspiration risk

What causes GERD

Decreased LES tone + increased pressure (obesity, pregnancy, gastroparesis), reflux of gastric contents

Symptoms of GERD

Dysphagia, heartburn, epigastric pain, dry cough; worse with high-fat foods and lying flat

Complications of GERD

Esophageal ulcers, metaplasia (Barrett’s), cancer

What is hematemesis vs melena

Hematemesis = bright red or coffee-ground vomit

Melena = black, tarry stool

What are symptoms of a slow GI bleed vs acute GI bleed

Slow: iron-deficiency anemia

Acute: hypovolemic shock

What is a hiatal hernia and what causes it

Stomach herniates into diaphragm. Caused by increased intra-abdominal pressure

Symptoms of sliding vs rolling hiatal hernia

Sliding: reflux, GERD

Rolling; strangulation, acute chest pain, ulcers, gastritis

What causes acute gastritis

Erosive; NSAIDs, stress, infection, bile reflux→ breaks down muscosal barrier

What causes chronic gastritis

H. pylori destroys mucosal cells, decreases intrinsic factor → pernicious anemia

What are symptoms of both acute and chronic gastritis

Heartburn, nausea, epigastric pain

What causes peptic ulcer disease (PUD)

H. pylori, NSAIDs/aspirin; hypersecretion of HCL and impaired mucous protection

Risk factors for PUD

Genetics, smoking, alcohol, stress

PUD symptom pattern

Epigastric burning/gnawing 2-3 hours after eating; relieved by food

Symptoms of bleeding ulcer

Hematemesis, melena

Symptoms of ulcer perforation

Excruciating pain, rigid abdomen, back pain, pallor → surgical emergency

What is dumping syndrome

Rapid gastric emptying after gastrectomy → hypertonic food pulls fluid into intestines → hypovolemia.

Early vs late dumping syndrome timing

Early: 30 min after eating

Late: 2-3 hours after eating

What causes gastroenteritis

Infectious irritation (fecal-oral, food-borne, water-borne)→ fluid shift → diarrhea.

Symptoms of gastroenteritis

Diarrhea, dehydration, electrolyte imbalance, N/V, cramping

What is hernia

Protrusion of intestine through abdominal wall.

Types: inguinal, femoral

Severity: reducible, incarcerated, strangulated

Symptoms of strangulated hernia

Severe ischemic pain → surgical emergency.

What is celiac disease pathophysiology

Autoimmune reaction to gluten → villi destruction → malabsorption

Symptoms of celiac disease

Steatorrhea, weight loss, bloating, anemia, hypocalcemia, fatigue

What is short bowel syndrome

<200 cm of small intestine left; malabsorption of fluids, nutrients, electrolytes. Remaining bowel eventually adapts

What causes small bowel obstruction (SBO)

Adhesions (acute), hernias (acute), tumors/inflammation (chronic)

SBO signs and symptoms

Abdominal distension, intermittent sharp pain, hyperactive bowel sounds, vomiting, dehydration, electrolyte imbalance

Triad of peritonitis

Abdominal pain, rigidity, rebound tenderness

What causes peritonitis

Perforation → leakage of intestinal contents → bacterial infection.