Disorders of the Esophagus, Stomach, and Small Intestine

Diagnostic Tests

• Upper endoscopy and biopsy

• Laparoscopy

• Video capsule endoscopy

• Upper GI series (barium study)

• H. pylori Test

Dysphagia

• Difficulty swallowing

• Types

  • Mechanical obstruction

  • Functional dysphagia

• Achalasia

Gastroesophageal Reflux Disease (GERD)

• Reflux of chyme through the LES

• Lower LES resting tone response

• Signs and Symptoms

  • Heartburn

  • Belching

  • Flatulence

  • Vomiting

  • Difficulty swallowing

• Treatment

  • endoscopy

  • Proton pump inhibitors (PPIs), H2 receptor blockers, antacids

  • weight loss, smoking cessation, avoid spicy food, alcohol

Esophageal Varices

• Liver with cirrhosis

• Signs and Symptoms

  • jaundice

  • nausea

  • vomiting

  • weight loss

  • dark urine

  • abdominal distension

Esophageal Cancer

• Squamous Cell carcinoma

• Adenocarcinoma

• Risks

  • chronic alcohol use

  • tobacco use

  • Chronic GERD

• S/S

  • Dysphagia

  • weight loss

  • change of eating pattern

  • risk of aspiration pneumonia

  • chest pain

Hiatal Hernia

• Protrusion of stomach through diaphragm

• Sliding hiatal hernia

  • most common

• Paraesophagel hiatal hernia

Pyloric Stenosis

• constriction of the pyloric sphincter

• adult’s vs infants

• S/S

  • Gastroparesis

  • projectile vomiting

  • firm abdomen over pylorus

Gastritis

• inflammatory disorder of the gastric mucosa

• acute gastritis

  • NSAIDs, alcohol

• Chronic Gastritis

  • occurs in elderly

  • thinning and atrophy of gastric mucosa

• Management

  • small meals

  • soft bland diet

  • avoid alcohol and NSAIDs

Peptic Ulcer Disease (PUD)

• break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum

• Superficial vs deep

• Risk factors

  • h. pylori

  • NSAIDs

  • alcohol

  • smoking

  • age

  • chronic disease

Upper GI bleed (UGIB)

• bleeding in esophagus, stomach, or duodenum

• S/S

  • hematemeis

  • melena

  • fatigue

  • lethargy

  • Acute large GI bleed

• Diagnosis

  • fecal occult blood test

  • CBC

  • endoscopy: EGD

Small Bowel Obstruction

• chronic, partial and complete obstruction

• S/S

  • abdominal distension

  • pain

    • sharp

    • cramping

    • intermittent

  • nausea

  • vomiting

  • hyperactive or absent bowel sounds

Peritonitis

• inflammation of the peritoneal membrane

• causes

  • infection

  • perforation

• S/S

  • abdominal pain

  • abdominal rigidity

  • rebound tenderness

• Diagnosis

  • abdominal x-ray

    • air or fluid in the abdominal cavity

  • paracentesis

    • neutrophil count greater than 500

    • CT scan or emergency surgical laparotomy