Stomach fluid is secreted after ingestion of food. This fluid can total ____ L/day, can have a pH as low as __ and derives its acidity from _____ ____.

What are the two functions of this gastic secretion?

2.4L/day

pH as low as 1

hydrochloric acid

2 funct: breakdown of food and to kill bacteria

1. What enzyme is responsible for protein digestion in the stomach?

2. _____ ______, also secreted by the gastric mucosa, combines with ____ so that the vitamin can be absorbed in the ileum.

3. In the absence of it, what condition results?

1. Pepsin

2. Intrinsic Factor, B₁₂

3. Pernicious anemia

1. trypsin: digests protein

2. amylase: digests starch

3. lipase: digests fats

liver;gallbladder

ingested fats

Normal bowel sounds range from __ to __ per minute.

Hypoactive bowel occur ___ or ___ per minute

Hyperactive bowel sounds occur ___ to ___ in less than 30secs.

norm: 5 to 35

Hypoactive: 1 or 2

Hyperactive 5 to 6 per  <30 secs.

serum albumin, globulin

Complete Metabolic Panel (CMP)

Complete blood count (CBC)

BUN, Creatinine

• lab tests
• stool samples (fecal occult blood test)
• breath tests
• Abdominal ultrasound
• Imaging (x-ray, CT scan, MRI, PET scan)
• upper/lower GI series
• endoscopy

Hydrogen breath test- evaluates carbohydrate absorption, and diagnoisis bacterial overgrowth

Urea breath test- detects the presence of Helicobacter pylori which causes peptic ulcer disease.

Upper GI tract study

1.What is the contrast that is typically used?

2. What does the study look for?

1. barium sulfate

2. anatomic or functional disorders of organs or sphincters

diagnoisis of ulcers, carices, tumors, reginoal enteritis, and malabsorption syndromes, obstructions, ileitis, and diverticula

Lower gastrointestinal tract study involves rectal installation of _____.

the enema can be used to detect the presence of:

barium enema

polyps, tumors, other lesions of lg intestine and demonstrate any anatomic abnormalities or malfunctioning of the bowel.

What are CT (computed tomography) studies useful for?

Is a contrast agent necessary?

provides cross-sectional images of abdominal organs and structures

detects appendictitis, diverticulities, regional enteritis, and ulcerative colitis

evaluates abdomen for diseases of the liver, spleen, kidney, pancreas, and pelvic organs and structural abnormalities of the ab wall.

The study can be done with or without the use of contrast

Fibroscopy/ Esophagogastroduodenoscopy

1. Allows visualization of:

2. used when what is suspected?

3. Also evaluates?

1. esophagus, gastric, and duodenal mucosa through an endoscope

2. esophageal, gastric, or duodenal disorders or inflammatory, neoplastic, or infectious processes are suspected

3. esophageal and gastric motility and to collect secretions and tissue specimens for analysis

Fiberoptic colonoscopy

1. allows visualization of:

2. used as a diagnostic and screening aid for:

1. anus, rectum, sigmoid, transcending and ascending colon

2. cancer screening, polyps, evaluate diarrhea of unknown cause, occult bleeding, or anemia

What diagostic assessment confirms the diagnosis of Achalasia?

How?

Sliding (type I): the upper stomach and gastroesoophageal junction are displaced upward and slide in and out of the thorax

Paraesophageal hernia (type II,III, IV) all or part of the stomach pushes through the diaphragm next to the gastroesophageal junction

sliding hernia: heartburn, regurgitation, and dysphagia (at least 50% of pt. are asymptomatic)

Paraesophageal hernia: usually feels a sense of fullness or chest pain after eating or no symptoms.

frequent, small feeings that can pass easily through esophagus.

Don't recline for 1 hr after eating

surgery in about 15% of patients

What are the clinical manifestations of Esophageal diverticulum?

What diagnostic tests are done?

difficulty swallowing, fullness in neck, belching, regurgitation of undigested food, and gurgling noises after eating.

a barium swallow

Antacids: maalox, tums(calcium)

H₂ Antagonists: (ZAPT) zantac, axid, pepcid, tagamet

PPI- nexium, prevacid, prilosec, protonix

benighn or malignant ulcers of the stomach or by H. pylori

pernicious anemia

dietary factors such as caffeine

use of NSAIDS

smoking/alcohol consumption

acute: ab discomfort, headache, lassitude, nausea, anorexia, vomiting, hiccupping

chronic: anorexia, heartburn after eating, belching, sour taste in mouth, nausea/vomiting

instructing to refrain from alcohol and food until symptoms subside

IV fluids if needed

gastric resection or gastrojejunostomy

modified diet, rest, avoiding alchol and nsaids

What are the two types of peptic ulcers?

What is the main cause of a peptic ulcer?

gastric or duodenal

h. pylori

duodenal:

hypersecretion of stomach acid

age:30-60; weight gain; vomiting uncommon; melena more common than hematamesis;

Pain - 2-3h after meal, right upper epigastric, non burning, relieved by eating, pain wakens during sleep

gastric:

normal to hyposecretion of stomach acid

age:50+; weight loss; vomiting common, hematamesis more common than melena;

Pain- 1/2hr - 1hr after meal, mid epigastric, not relieved by eating, rarely during night

physcial exam-pain, epigastric tenderness, ab distention

barium study showing an ulcer

endoscopy

h. pylori testing: serologic testing, stool antigen test, and urea breath test

histologic examinatino of tissue specimen fr biopsy

combination of antibiotics, PPI, and bismuth salts

stress reduction/rest, smoking cessation, dietary modification, surgical mgmt (