Gastroeneterology

mouth - mastication
tongue pushes food down the throat
epiglottis prevents choking
esophagus - peristalsis pushes food to the stomach
stomach - food is mixed up and becomes chyme
chyme - stomach content that enters the small intestine
small intestine - juices from p ancreas, liver, and intestine are mixed with chyme. water is removed and nutrients
enter the blood stream
large intestine - absorbs water, waste, becomes solid
rectum - stool leaves the body

liquids reflux to esophagus

chest pyrosis, acid reflux, food regurgitation, dysphagia, dry cough, globus sensation, laryngitis

EGD - may see esophagitis, gastritis, barrett's esophagitis, strictures, cancer, H pylori
or based on medical hx

PPIs - Omeprazole (Prilosec), Esomeprazole (Nexium)
H2 blockers - Famotidine (Pepcid)
Lifestyle modifications, weight loss, smoking cessation, diet changes

indigestion without an obvious cause

epigastric abd pain, bloating, n/v, belching, early satiety

based on symptoms
EGD - unremarkable
24 impedance study - measures how often acid enters the stomach and how long it stays
usually no abnormal reflux

H2 blockers, PPI, Carafate, Anti spasmodics, TCA

inflammation in the GI tract from mouth to anus

deeper

distal small intestine (ileum), colon

late teens-20s and 50s-70s

abd pain, diarrhea, stenosis from scar tissue, IDA, weight loss, fever, joint pain, skin rashes, perianal disease (abcess/fistula)

colonscopy, stool calprotectin, labs - ESR, CRP, Irons studies

colon cancer, obstruction, surgery, hospitalization

rarely 5-ASA, biologics, prednisone

chronic inflammation of colon and rectum

ulcerations in the colon, bloody stool, diarrhea, abd pain, rectal pain, fever, weight loss, fatigue, anorexia, nocturnal BMs, urgency

coloscopy

surgery, 5-ASA, immunomodulators, biologics

colon cancer, emergency surgery, hospitalization

extraintestinal manifestations

non inflammatory disorder that affects large intestine

abd pain at least 1x per week for 3 months
associated with change in stool, frequency, consistency
changes in defacation

SIBD - small intestinal bacterial overgrowth
lactose intolerance

abd pain, diarrhea, constipation or both
abd pain improves after BM, abd bloating

based on history, if red flags then colonoscopy

probiotics, anti-spasmodics, TCA, peppermint oil, laxatives, anti diarrheals, FODMAP diet

no risk of colon cancer!

bacteria that lives in the stomach, typically does not cause illness

peptic ulcer disease

stomach and duodenum

food and water

epigastric abd pain, anorexia, bloating, n/v

breath or stool test

antibiotics

less than 3 BMs per week

pelvic floor dysfunction, hormones, IBS, diet, IBD, Inadequate fluids

HPI, anorectal manometry, colonoscopy

fiber, fluids, laxatives, Rx therapies

watery stool that lasts beyond a week or longer

infection, IBS, IBD, medication, diet, surgery, lactose intoleance

stool studies, colonoscopy, imaging

fiber, antibiotics, FODMAP diet

cells in the colon or rectum grow out of control

abnormal growths that during screen and removed, can grow into cancers if not removed

IBD, fam hx, genetic diseases (Lynch syndrome, familial adenomatous polyposis)

tobacco, physical activity, healthy diet, limiting alcohol consumption

changes in bowel habits, abd pain, bloody stool, unintentional weight loss, diarrhea, constipation, incomplete evacuation

45-75, 76-85 individual based

every 10 years

evaluates lower 1/3 of colon, combine w/FIT, yrs vary

x ray + computers produce images or the colon, every 5 years

gFOBT
FIT
Stool DNA Test

uses chemical guaiac to detect blood in the stool, yearly

fecal immunocompromised test, uses antibodies to detect blood in stool, yearly

FIT with a test that detects altered DNA in stool, every 3 years

PUD, Gastritis/esophagitis/duodenutis, esophageal varices, angiodysplasia, malignancy, mallory-weiss tears

infection, diverticulosis, hemorrhoids, anal fissures, ischemic colitis, IBD, radiation damage

tachycardia, hypotension, rectal bleeding, hematemesis, abd pain

CT, endoscopy, colonoscopy

males - vascular diseases and diverticulosis

Upper GI bleed

altering digestive system to help you los weight

diabetes, heart disease, sleep apnea, NASH

bleeding, blood clots, infection, risk of anesthesia, lung/ breathing problem, leaky gut, nausea, vomiting, dumping syndrome, gallstones, hernia, bowel obstruction

slows down

slowly

dysphagia, gastroparesis, constipation, diverticulosis, ulcers, polyps, GERD

constipation, abdominal distention, bloating

GERD, adhesions, SIBO

IBS

colon cancer, diverticular disease, and constipation

intestinal activity

post op

missed appointments, mental health, finances, work scheduling issues, pain, transportation