UPPER GI

fluoroscopic xray with contrast medium

for structural abnormalities w/ esophogeus, stomach, duodueum

UPPER GI

fluoroscopic xray of colon via contrast medium

to detetct the presense of a tumor, diverticula and polyps in LOWER GI

• magnetic resonance imagingin using radio frequencies
• - non invasive

detect hepatobilliary disease, hepatic lesions, source of GI bleed, colorectal cancer

visualize mucosal lining of esophogeus, stomach, duodoneum or stomach motility

detects inflammation, ulceration, tumor, varices, Mallory Weiss tears

metabolic alkalosis from loss of gastric HCL

dark feces containing blood

brainstem(medulla)

• -afferent pathway from ANS
• -receptors in GI, kidney, heart and uterus

• -closure of glottis
• -deep inspiration
• -contraction of diaphragm
• -closure of pylorus
• -relax stomach and LES
• -contract abdominal muscle w/ increasing intraabdominal pressure

dopamine and seratonin

histamine and acetylcholine

• Compazine
• Phenergan
• Zofran
• reglan

act in the CNS via the CTZ to block neurochemicals that trigger N/V

block dopamine receptors

• -decrease dopamine/histamine
• - decrease vertigo/CTZ stim

motion sickness, post op, chemo

drymouth, hypo, const, rash

• -block serotonin
• -decrease CTZ
• - increase gastric emptying

chemo, post op, migrane

const, diareha, HA, fatigue

• -Prokenetic(promotility)
• - enhances ACH which increases gastric motility and emptying

• dysfunctional motility of upper gut
• -N/V
• -GERD
• -HIATIAL HERN

anxiety, involuntary movements(tremors/twitches)

a Mallory Weiss tear in the upper GI

high carb/low fat

reflux of the acidic gastric contents into the esophogaus overwhelms the esophageal defense

• -no one single cause
• -mild reflux 2x/week
• -most common upper GI prob in adults
• -can cause ulcers

• -incompetent LES
• -Impaired esophageal motility- defective mucosal defense
• -delayed gastric emptying
• -small intestine reflux of bile
• -reflux of gastric content

HCL acid and pepsin reflux into the lower esophagus and cause inflamation

• heartburn
• dyspepsia
• regurgitation
• burping often

heart burn felt beneath lower sternum

pain in upper abdomen-midline

• cough, wheeze, dypena
• -hoarse, sore throat
• -lump in throat
• -chest pain that can be relived by antacid

usually based on S/S and response to therapy

• -EGD
• -Manometric
• -biposy

-measure pressure in LES, esophgeus and esophageal motility

to differenciate barrets from CA

• -esophagitis and ulcers
• esophageal structures narrow
• dysphagia
• barrets
• respiratory

• asthma
• chronic bronchitis
• pneumonia

• -weight
• -drugs/smoke/etoh
• -HOB at 30!!!
• -don't lie down for 2-3 hrs after eating
• -avoid foods that irritate or lower LES pressure

• -improve LES function
• -Decrease volume and acidity of reflux
• -increase esophageal clearance
• -protect esophageal mucosa

• antacid
• antisecretary
• cholinerginic
• prokinetic
• cytoprotective

• -Pepcid
• protonix
• bethanechol
• reglan
• Carafate
• pepto

• NEUTRALIZE HCL ACID
• take after food
• empty stomach 20-30 min
• full stomach 2-3 hrs

• -decrease secretion of HCL
• -decrease irritation of esophageal and gastric mucosa
• -H2 receptor blocker
• -PPI

• - famotidine(Pepcid)
• -decrease conversion of pepsinogen to pepsin

• -pantaprazole(Protonix)
• -more effective than H2 blockers for healing and decreased HCL secretion
• -short term

• -bethanechol(urechoine)
• -increase LES pressure
• -increase esophageal/gastric emptying

• -metoclopramide(Reglan)
• -increase gastric motility

• -Sulcrafate(Carafate), Pepto Bismol
• -protect stomach and esophageal lining

reduce reflux by inhancing integrity of LES function

• Neissen fundoplication(sutures)
• LINX(magnetic)

herniation of a portion of the stomach into the esophogeus through an opening or hiatus into diaphragm

women and older adults

• -sliding(more common)
• -rolling(can be emergent)

• more common
• -occurs when pt is supine and can go back when pt stands up
• -part of stomach goes above diaphragm

• -weaking of muscle around LES
• -increased intraabdominal pressure
• -congenital

• -asymptomatic
• -similar to GERD
• -when bent over pt has sharp pain but relived when standing

• regurgitation
• ulcer
• bleeding
• stenosis
• esophagitis
• strangulation of hernia

• barium swallow
• endoscopy

changes at the cellular level that may indicate cancer

• herniotomy
• herniorraphy
• gastroplexy
• nissen

excision of hernia sack

closure of hiatal defect

attatchment of stomach subdiaphragmatically

• inflammation of gastric mucosa as a result of breakdown in gastric mucosal barrier
• -stomach is at risk for breakdown from HCL and pepsin

• -drugs(nsaids, asprin, steroids)
• -Diet( spicy food, ETOH)
• - H. Pylori
• -Stress
• -autoimmune gastritis

loss of parietal cells which leads to low chloride, inadequate production of intrinsic factor, b12, malabsorption and pernicious anemia

• -N/V
• -epigastric tenderness
• full feeling
• bleeding

• self limiting
• few hours to a few days
• complete healing of mucosa is expected

• -same as acute
• -could be asymptomatic
• -may cause perinicous anemia when paritel cells are lost

based on S/S and hx of drug or ETOH

• -may be delayed due to non specific symptoms
• -endoscopy w biopsy
• -cbc for anemia
• -test for h pylori

• -breath test for urea
• - gold standard: biopsy to test for urease(bi product of pylori)

• PPI
• H2 receptor blockers

• -PPI and H2 receptor blocker
• -AB if H. pylori
• -cobalmin(B12) if pernicious anemia(lifelong)

erosion of GI mucosa resulting from digestive action of HCL and pepsin

• -esophageal, gastric or duodenal
• -80% are duodoneal
• -acute or chronic

• -chronic gastritis
• -h pylori
• -asprin and nsaids
• -corticosteroids
• -etoh
• -coffee

all in crease HCL except corticosteroid, which decreases mucosal renewal ad productive effects

• acute ulcers
• after major surgery, severe burns and trauma

• may be asymptomatic
• -upper epigastric pain 1-2 hours after meal
• -pain aggravated by food

• -may be asymptomatic
• -midepigastric pain 2-5 hours after meal
• -pain relived by food

• hemmorage
• perforation
• gastric outlet obstruction

• most common
• erosion of gran tissue
• ulcerate through major blood vessels

• -most lethal 
• -ulcer penetrates serosal surface and spills gastric or duodoneal contents into peritoneum= hypovolima and peritonis

small: can seal themselves when fibrin is produced

Large: immediate surgery

• -sudden and dramatic
• -severe abd pain radiating to back
• -rigid, board like abd muscles
• -shallow, rapis rr and weak rapid pulse
• -no bowel sounds
• -n/v
• -hx of previous ulcer
• -bacterial peritonisis w/in 6-12 hours if untreated

obstruction in distal stomach and duodoneum

• edema
• inflammation
• pylorospasm
• -scar tissue

• -long hx of ulcer pain
• -upper abd discomfort
• -pain worse at end of day
• -relif from belching of self induced vomit
• -projectile
• -emisi may contain food ingested hrs or days before
• -constipation from dehydration
• -buldging of stomacj in upper abdomen

• edoscopy w biopsy
• -biopsy of stomach to test for urease
• -gold standard for h pylori
• -barium contrast studies(rule out gastric obstruction)
• -cbc for anemia
• -liver enzymes for cirrhosis
• -stools for blood

disappears in 3-6 days but ulcer healing takes 3-9 weeks

• -AB
• -antisecretory
• -cytoprotecive
• -antacids-
• -antidepressants