HCR 240 - Chapter 29 Disorders of the Esophagus, Stomach, and Small Intestine PDF

Chapter 29 Disorders of Esophagus, Stomach, and Small Intestine Copyright ©2020 F.A. Davis Company Epidemiology ▪ Upper GI Tract Esophagus, stomach, small intestine ▪ Common disorders Gastroesophageal reflux disease (GERD) Peptic ulcer disease (PUD) Gastroenteritis Copyright ©2020 F.A. Davis Company...

Chapter 29 Disorders of Esophagus, Stomach, and Small Intestine Copyright ©2020 F.A. Davis Company Epidemiology ▪ Upper GI Tract Esophagus, stomach, small intestine ▪ Common disorders Gastroesophageal reflux disease (GERD) Peptic ulcer disease (PUD) Gastroenteritis Copyright ©2020 F.A. Davis Company Basic Concepts: Esophagus Esophagus ▪ Tube-like structure from mouth to stomach ▪ Sphincters Upper esophageal sphincter (UES) Lower esophageal sphincter (LES) Copyright ©2020 F.A. Davis Company Basic Concepts: Stomach Stomach ▪ Fundus, body, pylorus ▪ Two sphincters LES and pyloric Copyright ©2020 F.A. Davis Company Basic Concepts: Stomach (continued) Stomach (continued) ▪ Phases Cephalic ‒ Vagus nerve, acetylcholine Gastric ‒ HCl acid (parietal cells), pepsinogen (chief cells), gastrin (G cells), intrinsic factor (vitamin B12 absorption), mucus Intestinal ‒ Small intestine sends signals to slow stomach emptying Copyright ©2020 F.A. Davis Company Basic Concepts: Small Intestine Small Intestine ▪ Duodenum, jejunum, ileum ▪ Lined with villi ▪ Absorption of nutrients ▪ Releases hormones Cholecystokinin, secretin ▪ Ducts from liver and pancreas enter duodenum ▪ Enterohepatic circulation Bile acids from ileum to liver Copyright ©2020 F.A. Davis Company Assessment ▪ Swallowing, indigestion, eructation (belching) ▪ Nausea and vomiting ▪ Appearance of emesis ▪ Medications NSAIDs block protective mucus formation ’ ▪ Infections Candida albicans (thrush) Copyright ©2020 F.A. Davis Company Diagnosis ▪ Esophageal or GI pain may present similar to coronary event ▪ Upper endoscopy Most accurate for diagnosis ▪ Videocapsule endoscopy ▪ Barium x-rays ▪ H. pylori testing (bacteria associated with peptic ulcer disease) Copyright ©2020 F.A. Davis Company Treatment ▪ If upper gastrointestinal bleed (UGIB), use hemodynamic stabilization ▪ Lifestyle modifications ▪ Proton pump inhibitors (PPIs) ’ Decrease stomach acid ▪ Esophageal varices Balloon tamponade Copyright ©2020 F.A. Davis Company Dysphagia ▪ Difficulty swallowing Odynophagia ‒ painful swallowing Begins with solid food, progresses to liquids ▪ Usually neuromuscular dysfunction CN IX, X, XII ▪ Structural abnormalities of esophagus Esophageal strictures Achalasia: esophageal motility problem ▪ Diagnosis Copyright ©2020 F.A. Davis Company Gastroesophageal Reflux Disease (GERD) ▪ Problem with tone of LES ▪ Regurgitation of stomach acid into esophagus ▪ Gastroparesis Delayed stomach emptying also a problem ▪ Metaplasia of cells may occur Esophageal epithelial cells transform to stomach-like columnar cells ▪ Barrett’s esophagus Precancerous change Copyright ©2020 F.A. Davis Company Gastroesophageal Reflux Disease (GERD) (continued_1) ▪ Signs and symptoms Dysphagia Heartburn Epigastric pain Regurgitation Dyspepsia ‒ Acid indigestion Copyright ©2020 F.A. Davis Company Gastroesophageal Reflux Disease (GERD) (continued_2) ▪ Diagnosis Endoscopy and manometry ▪ Treatment Lifestyle changes, PPIs, antacids Laparoscopic antireflux (fundoplication) ‒ Fundus wrapped around esophagus Endoscopic radiofrequency delivery LINX® Reflux Management System ‒ Magnets Copyright ©2020 F.A. Davis Company Hiatal Hernia ▪ Stomach pushes up through opening in diaphragm ▪ May be asymptomatic ▪ Signs and symptoms Dysphagia Epigastric discomfort ▪ Diagnosis Endoscopy ▪ Treatment PPIs, histamine-2 blockers, surgery ’ Copyright ©2020 F.A. Davis Company Pyloric Stenosis ▪ Constriction pyloric sphincter Gastric propulsion of contents is compromised Can be congenital ▪ Signs and symptoms Gastroparesis Projectile vomiting Firm abdomen over pylorus ▪ Surgical repair needed Copyright ©2020 F.A. Davis Company Acute Gastritis ▪ Inflammation of stomach lining Medications ‒ Aspirin, NSAIDs, corticosteroids ’ Infection, acute stress, bile reflux, alcohol abuse ▪ Complaints of heartburn, epigastric pain ▪ Diagnosis Endoscopy ▪ Remove causative agents ▪ Treatment PPIs, histamine-2 receptor antagonists Copyright ©2020 F.A. Davis Company ’ Chronic Gastritis ▪ Helicobacter pylori (H. pylori) Causes irritation and erosion of stomach mucosa Unlike acute gastritis, causes atrophy of glandular stomach lining (atrophic gastritis) Decreased intrinsic factor (vitamin B12 absorption) ▪ Burning and gnawing epigastric pain, hematemesis, weight loss ▪ Diagnosis Endoscopy, biopsy ▪ Treatment Antibiotics for H. pylori Copyright ©2020 F.A. Davis Company Peptic Ulcer Disease (PUD) ▪ Inflammatory erosion of stomach or duodenum (duodenum more common) Hypersecretion of HCl, ineffective GI mucus production, and poor cellular repair ▪ Causes: H. pylori, NSAIDs, stress, alcohol abuse, excessive caffeine, smoking ’ NSAIDS: counteract prostaglandin signal needed for gastric mucus production ‒ Decreased mucus increases risk of ulcers ▪ Genetic susceptibility Copyright ©2020 F.A. Davis Company Peptic Ulcer Disease (PUD) (continued_1) ▪ Signs and symptoms Epigastric, abdominal pain ‒ Episodes of pain occur between meals, about 2 to 3 hours after eating Pain is intense; a burning and gnawing sensation Perforation of the stomach or intestine Copyright ©2020 F.A. Davis Company Peptic Ulcer Disease (PUD) (continued_2) ▪ Diagnosis Serology ‒ Blood sample tested for the presence of antibodies to H. pylori Rapid urease test ‒ Endoscopic diagnostic test of choice for detection of H. pylori Endoscopy Copyright ©2020 F.A. Davis Company Peptic Ulcer Disease (PUD) (continued_3) ▪ Treatment Reduce acid levels and protect gastric lining Antibiotic therapy Lifestyle changes Copyright ©2020 F.A. Davis Company Peptic Ulcer Disease (PUD) (continued_4) ▪ Treatment (continued_1) Therapeutic endoscopic treatment ‒ Used to promote hemostasis if active bleeding ‒ Include thermal coagulation therapy, hemostatic clips, fibrin sealant, or hemostatic nanopowder spray Persistent ulcer ‒ Angiography with transarterial embolization (TAE) Refractory cases ‒ Vagotomy, surgical resection with gastric drainage Copyright ©2020 F.A. Davis Company Peptic Ulcer Disease (PUD) (continued_5) ▪ Treatment (continued_2) Gastroduodenostomy (Billroth I) ‒ Remove distal stomach and connect to duodenum, decrease HCl Gastrojejunostomy (Billroth II) ‒ Removal of the lower stomach and connect to jejunum, decrease gastrin Copyright ©2020 F.A. Davis Company Hernia ▪ Intestinal protrusion through abdominal wall ▪ More common in males ▪ Types based on location Inguinal is most common Reducible ‒ Returned to normal position with manual pressure Incarceration ‒ Loop of intestine trapped between muscle fibers Strangulation ‒ Blood supply to hernia compromised by pressure Copyright ©2020 F.A. Davis Company Hernia (continued) ▪ Symptoms and severity depend on location and extent ▪ Diagnosis Patient history and physical examination ▪ Herniorrhaphy Hernia repair Copyright ©2020 F.A. Davis Company Gastroenteritis ▪ Irritation of lining of stomach, small or large intestine by pathogen or toxin ▪ Infectious microorganisms Norovirus, rotavirus, Shigella, E. coli, Giardia ▪ Can be transmitted person to person, wateror foodborne ▪ Increased fluid shift into lumen of intestine, resulting in diarrhea ▪ Damage of villi by pathogen or toxins Copyright ©2020 F.A. Davis Company Gastroenteritis Diarrhea ▪ Osmotic Decreased absorption increases osmotic load in lumen, attracting water ▪ Inflammatory Mucosal lining inflamed, unable to absorb fluid or nutrients ▪ Secretory Organism stimulates intestinal secretions ▪ Motility Copyright ©2020 F.A. Davis Company Gastroenteritis (continued) ▪ Nausea, vomiting, diarrhea ▪ Borborygmi: hyperactive bowels ▪ Electrolytes lost ▪ Condition usually persists 48 to 72 hours ▪ IV fluid replacement may be needed ▪ Diagnosis Identify causative agent Copyright ©2020 F.A. Davis Company Celiac Disease ▪ AKA “sprue,” “gluten-sensitive enteropathy” ▪ Hypersensitivity reaction to gluten Gluten-derived protein (gliadin) Unknown cause; autoimmune disease ▪ Gluten ingestion results in bloating and gas ▪ Steatorrhea (loss of fat in stools) may develop ▪ Malnutrition is a concern Copyright ©2020 F.A. Davis Company Celiac Disease (continued) ▪ Diagnosis Serology ‒ Celiac panel Positive antibody titer of IgA antitissue transglutaminase (IgA TTG) Intestinal biopsy ▪ Treatment Dietary modification Copyright ©2020 F.A. Davis Company