Another name for the esophagogastric sphincter
Other names for the gastroduodenal junction
Pyloris /Terminal Antrum
What are functions of the hormone Gastrin?
Helps regulate rate of gastric emptying
Promotes Hydrochloric Acid Secretion
In what part of the body does the large intestine begin?
lower right side of abdomen
GERD is commonly found in patients with what other conditions?
Hiatal Hernia, Asthma, Obesity
What is the diagnostic tool which measures pressure in the esophagus?
Esophageal Manometry (increases during episodes of reflux)
What is an EGD?
How should a patient prepare for an EGD?
Stop taking anticoagulants prior to procedure; NPO 6-12 hours before; also hold meds EXCEPT insulin, B/P meds, seizure meds, cardiac meds.
What is the major complication of an EGD?
Perforation (take VS q 15 minutes, watching especially for any increase in temperature or pain).
How should a patient prepare for gastric analysis?
Withhold any meds which affect gastric secretion for 24-48 hours.
What is Barium Sulfate and how is it used in diagnosis?
A metallic compound which shows up on X-ray.
Assists in showing abnormalities in the esophagus and stomach.
What is a fundoplication?
Surgical suturing of the stomach around the esophagus and anchoring it below the diaphragm. (used for hiatal hernias and severe cases of GERD)
Describe Barrett's esophagus
A condition in which cells similar to your stomach's glandular cells develop in the lower esophagus.
These new cells are resistant to stomach acid, but they also have a high potential for malignancy.
Inflammation of stomach and small intestine. Caused by ingesting food / liquid contaminated by virus, bacteria, or parasites. (aka "Food Poisoning")
List some fluids containing sugars & electrolytes.
Inflammation of the mucous membranes lining the stomach - leading to "auto-digestion" (?). Can be acute or chronic.
How does treatment for acute gastritis differ from treatment for chronic gastritis?
Acute (short duration): NPO + meds to slow down peristalsis. IV fluids given if severe dehydration or N/V.
Chronic: diet therapy is of primary importance (no spicy or acidic foods or alcohol). Meds: antispasmodics, antacids, H2-antagonists (ranitidine), PPIs, and/or antibiotics.
List some types of peptic ulcers
Cushing (ICP), Curling (burns), Stress-induced, Gastric, Duodenal
What defines a peptic ulcer? What is the difference between acute and chronic types?
Loss of tissue from the lining of the digestive tract.
Acute: affects only the superficial layers of the digestive lining
Chronic: affects the muscle layer
How is a stress ulcer different from a chronic peptic ulcer?
It is more acute and more likely to produce hemorrhage. Pain is rare, and perforation occurs occasionally.
How do gastric and duodenal peptic ulcers differ?
Gastric ulcers are more likely to recur and be malignant.
Duodenal and prepyloric ulcers are associated with increased amounts or acidity of gastric juices and are 70% associated with H. pylori.
Gastric ulcers are more likely to be associated with H. pylori (90%) and are characterized by normal or low levels of HCl.
Duodenal ulcers are much more common (80%).
Gastric ulcers are more often in men, elderly; duodenal ulcers are more often in young men.
Spontaneous vomiting is more common with duodenal ulcers.
Duodenal: weight gain; Gastric: weight loss.
S&S of hypovolemic shock
√ Anxiety - agitation
√ cool clammy skin
√ decreased or no urine output
√ increase heart rate
√ decrease BP
√ rapid breathing
(can be a complication of hemorrhage from PUD)
How does PUD cause GI obstruction?
scarring and loss of musculature at the pylorus which narrows the stomach outlet
Urea Breath Test
Test used to detect presence of H. pylori in the GI tract -- the bacterium can break down radio-labeled urea into CO2, which is absorbed and excreted through exhalation.
How does H. pylori cause peptic ulcers?
H. pylori weakens the protective mucous coating of the stomach and duodenum, which allows acid to get through to the sensitive lining beneath.
Both the acid and the bacteria irritate the lining and cause a sore, or ulcer.
What meds are used for treatment of H. pylori?
Bismuth subsalicylate (Pepto Bismal): protects stomach lining.
Antibiotics: metronidazole, tetracycline, clarithromycin, amoxicillin
H2 blockers /Proton pump inhibitors
When is surgical treatment of PUD necessary?
When it does not respond to meds; when there is a complication such as hemorrhage, perforation or obstruction; or when cancer is present.
Pre-op care for gastric surgery
Liquids only the day before; NPO; NGT inserted; stomach contents removed by suction; enemas to empty colon.
Post-op care for gastric surgery
Handle NG tube carefully (to avoid injury to sutures or introduction of infectious agents).
Often on TPN or J-tube until healed.
Monitor I&O and for S&S of hemorrhage or infection
After NGT removed: give small amounts of liquid and increase as tolerated. Progress to small, frequent feedings. Three regular meals a day possible within six months.
Special post-op care for total gastrectomy
Increase fluids, protein, calories, iron rich foods
Avoid fatty foods
Take Vitamin supplements
What is a pseudocyst (pancreatic abscess)?
A sac-like structure that forms on or around the pancreas containing the purulent liquefaction of necrotic pancreatic tissue.
What is the typical pattern of onset of acute pancreatitis?
Alcoholic: 12-14 hours after ingestion of ETOH
Billiary: immediately after a large meal
Why is keeping the GI tract empty part of the treatment regimen for acute pancreatitis?
This prevents the pancreas from producing enzymes
What is Cholecystitis
Inflammation of the gallbladder
What causes Cholecystitis?
90-95% of the time from gallstones; Other causes:
Obstructive tumors, anesthesia
Severely stressful situations
Cardiac surgery, bacteria
Severe burns, or multiple trauma
Toxic chemicals, opiods, starvation
What is the typical pattern of onset of cholecystitis?
3 hours after a meat high in fat content
What is Cholelithiasis?
The presence of gallstones in the gallbladder or biliary tract.
What is Choledocholithiasis?
When stones are lodged in the bile duct.
How are gall stones formed?
An imbalance of cholesterol, bile salts, and calcium in the bile causes these substances to precipitate.
Cholesterol precipitate forms the core, then the stone grows as layers of these substances accumulate over the core.
What are the milder symptoms of chronic cholelithiasis?
√ Indigestion after fatty meals
√ Nausea after eating
√ Right upper quadrant discomfort after meals
What is the expected recovery period for gallbladder surgery (removal, or cholecyctectomy)?
Laparoscopic: Discharge home after 24 hours
Open: 2-4 day stay
6 week recovery period