Upper GI System Dse/Dso are compiled orderly to make the discussion/report easily. With pictures inside to fully determine the type of the certain disease. (PART 1 ONLY; UPPER) Topics: GERD Barrett’s Esophagus Hiatal Hernia Gastritis Peptic Ulcer Disease Duodinal Ulcer Gastric Ulcer Dumping Syndrome

2. 23-26 foot long pathway that extends
from the:
Mouth
Esophagus
Stomach
Small intestines
Large intestines
Rectum
Anus

5.  GERD
 Barrett’s Esophagus
 Hiatal Hernia
 Gastritis
 Peptic Ulcer Disease
› Duodinal Ulcer
› Gastric Ulcer
 Dumping Syndrome

7.  Is a chronic digestive disease that occurs
when stomach acid or, occasionally, bile
flows back (refluxes) into your food pipe
(esophagus)
 It happens when a muscle at the end of
your esophagus does not close properly
 This allows stomach contents to leak back,
or reflux, into the esophagus and irritate
it

9.  Burning sensation in your chest, sometimes spreading
to the throat, along with a sour taste in your mouth.
 Chest pain
 Dyspepsia (Indigestion)
 Dysphagia
 Dry cough
 Hoarseness or sore throat
 Regurgitation of food or sour liquid
 Hypersalivation
 Esophagitis
 Sensation of a lump in the throat
Note: The symptoms may mimic those of a heart attack. The patient’s
history aids in obtaining an accurate diagnosis.

10.  An X-ray of your upper
digestive system
 Passing a flexible tube
down your throat
 A test to monitor the
amount of acid in your
esophagus
 A test to measure the
movement of the
esophagus
 Endoscopy or barium
swallow
 Ambulatory 12-36 hour
esophageal pH
monitoring
 Bilirubin Monitoring
(Bilitec)

12. 1. Antacids – neutralize acid
2. H2 receptor antagonist – Decreases the amount of HCl
produced by stomach by blocking action of histamine
on histamine receptors of parietal cells in the stomach
3. PPI – Decreases gastric acid secretion by slowing the
ATPase pump on the surface of the parietal cells
4. Prokinetic agents – Enhancing colonic transit by
increasing propulsive motor activity

13.  Teaching the patient to avoid actions that
decrease lower esophageal sphincter pressure or
cause esophageal irritation
 Low fat diet
 Maintain normal body weight
 Avoid caffeine, tobacco, beer, milk, and
carbonated drinks, spicy foods
 Avoid eating / drinking 2 hours before bedtime
 Avoid tight fitting clothes
 Elevate head on bed on 6-8 inches
 Avoid lying after meals

14.  Nissen Fundoplication
› Wrapping of a portion of the gastric fundus
around the sphincter area of the esophagus
 LINX System
 Adjustable Gastric Band

15.  Nissen Fundoplication
› Wrapping of a portion of the gastric fundus
around the sphincter area of the esophagus

16.  LINX System

17.  Adjustable Gastric Band

19.  A condition in which the lining of the
esophageal mucosa is filtered
 Associated with GERD
 Reflux causes changes in the lining of the
lower esophagus
 The cells that are laid to cover the
exposed area are no longer squamous in
origin
 Precursor to esophageal cancer

21.  Burning sensation in the esophagus
(Pyrosis)
 Dyspepsia (Indigestion)
 Dysphagia
 Hypersalivation
 Esophagitis

22.  Esophagogastroduodenoscopy (EGD)
 Biopsy

24.  Photodynamic therapy
› Laser thermal ablation; destroy the
metaplastic cells
 Esophagectomy
› Total resection of the esophagus with removal
of the tumor plus a wide tumor-free margin of
the esophagus and the lymph nodes in the area

26.  The opening in the diaphragm through
which the esophagus passes becomes
enlarged, and part of the upper stomach
tends to move up into the lower portion of
the thorax.

27.  Sliding
› Upper stomach and the gastroesophageal junction are
displaced upward and slide in and out of the thorax
 Paraesophageal
› All or part of the stomach pushes through the
diaphragm beside the esophagus
 Small
› Most cause no signs or symptoms
 Large
› Heartburn, Belching, Chest pain, Nausea

30.  Heartburn
 Regurgitation
 Dysphagia
 Sense of fullness or chest pain after
eating

31.  Xray studies
 Barrium swallow
 Fluoroscopy

32.  Same pharmacological management with
GERD
 Small frequent feedings
 Patient is advised not to recline for 1 hour
after eating
 Elevate head of the bed
 Surgery is indicated in about 15% of
patients

33.  Gastropexy
› Surgical fixation of the stomach
 Nissen Fundoplication

34.  Nissen Fundoplication

36.  It is the inflammation of the gastric
mucosa

37.  Acute Gastritis
› Sudden, severe inflammation of the stomach lining
 Chronic Gastritis
› Inflammation that lasts for a long time
 Erosive Gastritis
› Often does not cause significant inflammation but
can wear away the stomach lining
› Hematemesis, Black and tarry stools, Melena, A
gnawing/burning ache/pain in your upper abdomen
that may become either worse/better with eating

38.  Repeated exposure to irritating agents
(eg. Highly seasoned food)
 Overuse of aspirin & other NSAIDs
 Excessive alcohol intake
 Bile reflux
 Radiation therapy
 Ingestion of strong acid or alkili
 Bacteria (H. Pylori)

39.  Abdominal discomfort
 Headache
 Lassitude
 N/V and hiccupping
 Heartburn after eating
 Intolerance to spicy or fatty foods
 Vitamin deficiency (Vit. B12)
 Belching

40.  Achlorhydria or hypochlorhydria (Absence
or low levels of HCl)
 Can be determined by an upper GI series
(EGD)
 Endoscopy
 Tissue specimen (Biopsy)
 Blood test
 Stool test (GUAIAC Exam)
 Test for H. Pylori infection

41.  Stool test (GUAIAC Exam)

42.  Test for H. Pylori infection

43. 1. H2 blockers
2. Antibiotics (Amoxicillin, Clarithromycin)
3. PPI

44.  Gastrojejunostomy
› Anastomosis of jejunum to stomach to detour
around the pylorus

45.  Avoidance to gastric irritating agents
 Discourage caffeinated beverages
 Be alert for indicator of hemorrhagic
gastritis (hematemesis, tachycardia,
hypotension)
 Notify the physician if signs of
hemorrhagic gastritis are present

47.  Are open sores that develop on the inside
lining of your esophagus, stomach and the
upper portion of your small intestine.

48.  Gastric Ulcers
› Peptic ulcers that occur on the inside of the
stomach
 Esophageal Ulcers
› Inside the esophagus
 Duodenal Ulcers
› Affect the inside of the upper portion of
small intestine

50.  Gram-negative bacteria (H. Pylori)
 Excessive secretion of HCL in the
stomach due to ingestion of
CAFFEINATED BEVERAGES, SPICY
FOODS, SMOKING and ALCOHOL.
 Regular use of pain relievers

51.  Burning pain
› Be felt anywhere from your navel up to your
breastbone
› Be worse when your stomach is empty
› Flare at night
› Often be temporarily relieved by eating
certain foods that buffer stomach acid or by
taking an acid-reducing medication
› Disappear and then return for a few days or
weeks

52.  The vomiting of blood – which may appear
red or black
 Dark blood in stools or stools that are
black and tarry
 Nausea and vomiting
 Unexplained weight loss
 Appetite changes

55.  Zollinger-Ellison Syndrome
› Consists of severe peptic ulcers, extreme
gastric hyperacidity, and gastrin-secreting
benign or malignant tumors

56.  Pharmacologic Therapy
› H2 Blockers (Ranitidine, Cimetidine)
› Antibiotics
› PPI (Omeprazole)
› Antacid
› Cytoprotectants
 Creates a viscous substance in the presence of
gastric acid that forms a protective barrier,
binding to the surface of the ulcer, and
prevents digestion of pepsin (Mysoprostol,
Sucralfate)

57.  Vagotomy and Pyloroplasty
› Transecting nerves that stimulate acid
secretion and opening the pylorus

60.  Billroth I (Gastroduodenostomy)
› Removal of the lower portion of the antrum of
the stomach (which contains the cells that
secrete gastrin) as well as a small portion of
the duodenum and pylorus. The remaining
segment is anastomosed to the duodenum

61.  Billroth II (Gastrojejunostomy)
› Removal of lower portion (antrum) of stomach
with anastomosis to jejunum. A duodenal
stump remains and is oversewn

63.  Stress reduction and rest
 Smoking cessation
 Dietary modification
Avoidance to the food and beverages that
irritate the gastric mucosa (alcohol, coffee,
milk, spicy foods, soft drinks, tea, NSAIDs,
Aspirin)

65.  It is partially the result of rapid gastric
emptying, which prevents adequate mixing
with pancreatic and biliary secretions
 It is an unpleasant set of and GI
symptoms that sometimes occur in
patients who have had a gastric surgery or
a form of vagotomy

67.  Symptoms occurring 30 minutes after eating
 Nausea and vomiting
 Feelings of abdominal fullness and abdominal
cramping
 Diarrhea
 Palpitations and tachycardia
 Perspiration
 Weakness and dizziness
 Borborygmi sound
 Steatorrhea “fats in the stool”

68.  Lie down after meals
 Avoid sugar, salt and milk
 Take anti-spasmodic medications as prescribed
to delay gastric emptying
 Fluid intake with meals is discouraged, instead
fluids may be consumed up to 1 hour before or 1
hour after mealtime
 Meals should contain more dry items than liquid
items
 Avoid eating large amounts of carbohydrates,
and to eat 4-6 small, high protein, low-
carbohydrate meals during the day