1. Barium Swallow study: what is it
    fluoroscopic xray with contrast medium
  2. Barium Swallow study: what is it used for
    for structural abnormalities w/ esophogeus, stomach, duodueum

  3. Barium Enema study: what is it
    fluoroscopic xray of colon via contrast medium
  4. Barium Enema study: what is it used for
    to detetct the presense of a tumor, diverticula and polyps in LOWER GI
  5. MRI: what is it
    • magnetic resonance imagingin using radio frequencies
    • - non invasive
  6. MRI: what is it used for
    detect hepatobilliary disease, hepatic lesions, source of GI bleed, colorectal cancer
  7. EGD: what is it
    visualize mucosal lining of esophogeus, stomach, duodoneum or stomach motility
  8. EGD: what is it used for
    detects inflammation, ulceration, tumor, varices, Mallory Weiss tears
  9. prolonged vomiting is a risk for
    metabolic alkalosis from loss of gastric HCL
  10. melena
    dark feces containing blood
  11. vomitting center is located in the
  12. how to signals reach the brainstem, for N/V
    • -afferent pathway from ANS
    • -receptors in GI, kidney, heart and uterus
  13. describe the act ofvomitting
    • -closure of glottis
    • -deep inspiration
    • -contraction of diaphragm
    • -closure of pylorus
    • -relax stomach and LES
    • -contract abdominal muscle w/ increasing intraabdominal pressure
  14. visceral and chemoreceptor chemicals released for N/V
    dopamine and seratonin
  15. vestibular input for N/V
    histamine and acetylcholine
  16. the antiemetics
    • Compazine
    • Phenergan
    • Zofran
    • reglan
  17. how do antiemetics work
    act in the CNS via the CTZ to block neurochemicals that trigger N/V
  18. compazine
    block dopamine receptors
  19. phenergan
    • -decrease dopamine/histamine
    • - decrease vertigo/CTZ stim
  20. Phenergan uses
    motion sickness, post op, chemo
  21. phenergan side effects
    drymouth, hypo, const, rash
  22. zofran
    • -block serotonin
    • -decrease CTZ
    • - increase gastric emptying
  23. Zofran uses
    chemo, post op, migrane
  24. zofran SE
    const, diareha, HA, fatigue
  25. reglan
    • -Prokenetic(promotility)
    • - enhances ACH which increases gastric motility and emptying
  26. reglan uses
    • dysfunctional motility of upper gut
    • -N/V
    • -GERD
  27. reglan SE
    anxiety, involuntary movements(tremors/twitches)
  28. bright blood indicates
    a Mallory Weiss tear in the upper GI
  29. when N/V, what type of diet do you advanced to
    high carb/low fat
  30. what is GERD
    reflux of the acidic gastric contents into the esophogaus overwhelms the esophageal defense
  31. GERD important facts
    • -no one single cause
    • -mild reflux 2x/week
    • -most common upper GI prob in adults
    • -can cause ulcers
  32. GERD predisposing factors
    • -incompetent LES
    • -Impaired esophageal motility- defective mucosal defense
    • -delayed gastric emptying
    • -small intestine reflux of bile
    • -reflux of gastric content
  33. what happens with GERD
    HCL acid and pepsin reflux into the lower esophagus and cause inflamation
  34. GERD symptoms
    • heartburn
    • dyspepsia
    • regurgitation
    • burping often
  35. pyrosis
    heart burn felt beneath lower sternum
  36. dyspesia
    pain in upper abdomen-midline
  37. GERD S/S that might also be reported
    • cough, wheeze, dypena
    • -hoarse, sore throat
    • -lump in throat
    • -chest pain that can be relived by antacid
  38. GERD main diagnostic
    usually based on S/S and response to therapy
  39. GERD alt diagnostics
    • -EGD
    • -Manometric
    • -biposy
  40. manometric studies
    -measure pressure in LES, esophgeus and esophageal motility
  41. why do a biopsy for GERD
    to differenciate barrets from CA
  42. GERD complications
    • -esophagitis and ulcers
    • esophageal structures narrow
    • dysphagia
    • barrets
    • respiratory
  43. GERD respiratory complications
    • asthma
    • chronic bronchitis
    • pneumonia
  44. GERD interventions
    • -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
  45. GERD drug therapy goals
    • -improve LES function
    • -Decrease volume and acidity of reflux
    • -increase esophageal clearance
    • -protect esophageal mucosa
  46. drugs given for GERD and hiatial hernia
    • antacid
    • antisecretary
    • cholinerginic
    • prokinetic
    • cytoprotective
  47. drug names for GERD and hiatial hernia
    • -Pepcid
    • protonix
    • bethanechol
    • reglan
    • Carafate
    • pepto
  48. antacids
    • take after food
    • empty stomach 20-30 min
    • full stomach 2-3 hrs
  49. antisecretary: what they do and the two types
    • -decrease secretion of HCL
    • -decrease irritation of esophageal and gastric mucosa
    • -H2 receptor blocker
    • -PPI
  50. antisecretary: H2 receptor blockers
    • - famotidine(Pepcid)
    • -decrease conversion of pepsinogen to pepsin
  51. antisecretary: PPI
    • -pantaprazole(Protonix)
    • -more effective than H2 blockers for healing and decreased HCL secretion
    • -short term
  52. cholenergenic: what they do and the drug
    • -bethanechol(urechoine)
    • -increase LES pressure
    • -increase esophageal/gastric emptying
  53. Prokenetic: what they do and the drug
    • -metoclopramide(Reglan)
    • -increase gastric motility
  54. Cytoprotective: what they do and the drug
    • -Sulcrafate(Carafate), Pepto Bismol
    • -protect stomach and esophageal lining
  55. Goal for GERD
    reduce reflux by inhancing integrity of LES function
  56. GERD surgeries
    • Neissen fundoplication(sutures)
    • LINX(magnetic)
  57. wht is hiatial hernia
    herniation of a portion of the stomach into the esophogeus through an opening or hiatus into diaphragm
  58. hiatial hernia is more common in
    women and older adults
  59. two types of hiatial hernia
    • -sliding(more common)
    • -rolling(can be emergent)
  60. sliding hernia
    • more common
    • -occurs when pt is supine and can go back when pt stands up
    • -part of stomach goes above diaphragm
  61. hiatial hernia contributing factors
    • -weaking of muscle around LES
    • -increased intraabdominal pressure
    • -congenital
  62. hiatial hernia S/S
    • -asymptomatic
    • -similar to GERD
    • -when bent over pt has sharp pain but relived when standing
  63. GERD and Hiatial Hernia complications
    • regurgitation
    • ulcer
    • bleeding
    • stenosis
    • esophagitis
    • strangulation of hernia
  64. diagnostic studies for Hernia
    • barium swallow
    • endoscopy
  65. chronic esophageal concerns
    changes at the cellular level that may indicate cancer
  66. hiatial hernia surgeries
    • herniotomy
    • herniorraphy
    • gastroplexy
    • nissen
  67. herniotomy
    excision of hernia sack
  68. herniorrhaphy
    closure of hiatal defect
  69. gastroplexy
    attatchment of stomach subdiaphragmatically
  70. gastritis: what is it
    • inflammation of gastric mucosa as a result of breakdown in gastric mucosal barrier
    • -stomach is at risk for breakdown from HCL and pepsin
  71. gastritis causes-
    • -drugs(nsaids, asprin, steroids)
    • -Diet( spicy food, ETOH)
    • - H. Pylori
    • -Stress
    • -autoimmune gastritis
  72. autoimmune gastritis
    loss of parietal cells which leads to low chloride, inadequate production of intrinsic factor, b12, malabsorption and pernicious anemia
  73. acute gastritis S/S
    • -N/V
    • -epigastric tenderness
    • full feeling
    • bleeding
  74. acute gastritis duration
    • self limiting
    • few hours to a few days
    • complete healing of mucosa is expected
  75. chronic gastritis S/S
    • -same as acute
    • -could be asymptomatic
    • -may cause perinicous anemia when paritel cells are lost
  76. acute gastritis diagnostics
    based on S/S and hx of drug or ETOH
  77. chronic gastritis diagnostics
    • -may be delayed due to non specific symptoms
    • -endoscopy w biopsy
    • -cbc for anemia
    • -test for h pylori
  78. the h. pylori test
    • -breath test for urea
    • - gold standard: biopsy to test for urease(bi product of pylori)
  79. acute gastritis drug therapy
    • PPI
    • H2 receptor blockers
  80. chronic gastritis drug therapy
    • -PPI and H2 receptor blocker
    • -AB if H. pylori
    • -cobalmin(B12) if pernicious anemia(lifelong)
  81. PUD: what is it
    erosion of GI mucosa resulting from digestive action of HCL and pepsin
  82. PUD types
    • -esophageal, gastric or duodenal
    • -80% are duodoneal
    • -acute or chronic
  83. things that destroy our mucosal barrier
    • -chronic gastritis
    • -h pylori
    • -asprin and nsaids
    • -corticosteroids
    • -etoh
    • -coffee

    all in crease HCL except corticosteroid, which decreases mucosal renewal ad productive effects
  84. stress related mucosal disease
    • acute ulcers
    • after major surgery, severe burns and trauma
  85. gastric PUD S/S
    • may be asymptomatic
    • -upper epigastric pain 1-2 hours after meal
    • -pain aggravated by food
  86. duodoneal PUD S/S
    • -may be asymptomatic
    • -midepigastric pain 2-5 hours after meal
    • -pain relived by food
  87. three major PUD complications
    • hemmorage
    • perforation
    • gastric outlet obstruction
  88. hemmorage
    • most common
    • erosion of gran tissue
    • ulcerate through major blood vessels
  89. perforation
    • -most lethalĀ 
    • -ulcer penetrates serosal surface and spills gastric or duodoneal contents into peritoneum= hypovolima and peritonis
  90. perforation: small vs large
    small: can seal themselves when fibrin is produced

    Large: immediate surgery
  91. perforation S/S
    • -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
  92. gatric outlet obstruction: what is it
    obstruction in distal stomach and duodoneum
  93. gatric outlet obstruction is a result of
    • edema
    • inflammation
    • pylorospasm
    • -scar tissue
  94. gatric outlet obstruction: S/S
    • -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
  95. PUD diagnostics
    • 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
  96. PUD pain
    disappears in 3-6 days but ulcer healing takes 3-9 weeks
  97. PUD drug therapy
    • -AB
    • -antisecretory
    • -cytoprotecive
    • -antacids-
    • -antidepressants
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