Upper GI

Pathology

100

Diagnosed based on clincal presentation, especially in the context of ETOH or illicit drug abuse, this inflammation of the gastric mucosa may be acute or chronic. 

What is gastritis?

200

This structural problem occurs when part of the stomach protrudes upward through the diaphragm.

What is a hiatal hernia?

300

Progressive difficulty swallowing and weight loss are classic warning signs of this malignant disease.
 

What is esophageal cancer?

400

A complication of gastric bypass, this condition leads to rapid transit through the GI system. Poor nutrient absorption, changes in glucose levels/electrolytes, and frequent loose/crampig stool after eating high carb meals. 

What is dumping syndrome?

500

Bismuth Quadruple Therapy is often used to eliminate this bacteria which may increase risk of developing ulcers, gastritis, or gastric cancer. 

What is H. pylori? 

Pokemon or Pharm? Pick the med!

100

Charizard or Sucralfate? 

What is Sulcralfate? 

______________________

• Class: Mucosal protectant / antiulcer agent
• Mechanism of action: In an acidic environment, it forms a sticky protective barrier that adheres to ulcers or irritated gastric/duodenal mucosa, shielding tissue from acid, pepsin, and bile so healing can occur. It does not significantly reduce acid production.
• Use: Primarily used for duodenal ulcers, gastric irritation, gastritis, and stress-ulcer prophylaxis in some settings.
• Teaching: Take on an empty stomach,  not for rapid symptom relief, may cause constipation (increase fluid intake!)

Quick memory trick --> sucralfate = “coat the sore.”

200

Promethazine or Snorlax?

What is Promethazine?

____________________________________

• Class: First-generation antihistamine / phenothiazine antiemetic
• Mechanism of action: Blocks H1 histamine receptors and also has antidopaminergic/anticholinergic effects in the vomiting center and chemoreceptor trigger zone, which helps reduce nausea and vomiting.
• Use: Used for nausea/vomiting, motion sickness, allergy symptoms, and sedation.
• Teaching: Take exactly as prescribed. May cause significant drowsiness, rise slowly from sitting/lying positions (can cause dizziness/orthostatic hypotension). Can cause dry mouth — sip water, sugar-free gum/candy

Quick memory trick:

Promethazine --> prevents puking + makes people sleepy.

300

Omeprazole or Abra?

What is Omeprazole?

_____________________________

***MAY INCREASE RISK OF C.diff INFECTION!!!!!

• Brand name: Prilosec
• Class: Proton pump inhibitor (PPI)
• Mechanism of action: Irreversibly blocks the H+/K+ ATPase proton pump in gastric parietal cells, greatly reducing stomach acid production.
• Use: Used for GERD, peptic ulcer disease, gastritis, erosive esophagitis, and prevention/treatment of ulcers (including NSAID-related ulcers). Also used with antibiotics for H. pylori treatment.

400

Reglan or Rayquaza?

What is Metoclopramide (Reglan)? 

_______________________________

• Brand name: Reglan
• Class: Antiemetic / prokinetic agent / dopamine antagonist
• Mechanism of action: Blocks dopamine (D2) receptors in the chemoreceptor trigger zone to reduce nausea, and increases gastric motility by enhancing upper GI peristalsis and speeding gastric emptying.
• Use: Used for nausea/vomiting, diabetic gastroparesis, GERD (sometimes), and to promote gastric emptying.
• Teaching: Can cause drowsiness, diarrhea, restlessness, and extrapyramidal symptoms (EPS) such as tardive dyskinesia with long-term use. Usually avoid prolonged use unless clearly indicated. 

Quick memory trick -->

Reglan = regulates the gut and reduces nausea.

500

Gaviscon or Excadrill?

What is Gaviscon?

________________________

What it is: An over-the-counter antacid / alginate reflux treatment. This works faster.

What it does:

• Neutralizes stomach acid
• Forms a “foam raft” barrier on top of stomach contents to reduce reflux into the esophagus
• Helps with heartburn, indigestion, and GERD symptoms

Common ingredients:

• Aluminum hydroxide and/or magnesium carbonate
• Sodium alginate (varies by country/formulation)

Common side effects:

• Bloating
• Constipation or diarrhea (depends on ingredients)
• Chalky taste

Teaching tip: Often works best after meals and at bedtime when reflux is worst.

Sounds like a Pokémon move: “Gaviscon used Acid Shield!”

A&P

100

Digestion starts in this part of the anatomy.

What is the mouth?

200

This small-diameter, long tube has the primary functions of digestion and absorption. 

What is the small intestine? 

300

Vitamin K and some B vitamins are produced here. 

What is the colon?

400

This muscular ring at the junction of the esophagus and stomach normally stays closed to prevent acid from backing up, but when it weakens, GERD can occur.

What is the lower esophageal sphincter (LES)?

500

This technique of bearing down while holding one’s breath increases intra-abdominal pressure and can help promote defecation, but may be risky for some cardiac patients.

What is the Valsalva maneuver?

Assessment

100

Order of operations for assessment of the abdomen.

What is look, listen, and feel? 

200

Caused by chronic irritation, _______ is a white patch on the tongue or oral mucosa, and ________ is a velvety red patch. These are concerning for possible cancer *especially in smokers.

What are leukoplakia and erythroplakia?

300

Pain high in the epigastric area 1-2 hours after eating may suggest this, which is often associated with H. pylori infection or heavy NSAID use. 

What are peptic ulcers? 

400

Classic signs of this condition include black, tarry stools and hematemesis. 

What is UPPER GI bleed? 

(lower = frank red blood in stool (hematochezia), not tarry stool) 

500

The patient with dumping syndrome is at high risk for this, with s/s of: shakiness, hunger, sweating, confusion, and palpitations.

What is hypoglycemia?

Pathology, the Sequel

100

A Mallory-Weiss tear, or mucosal laceration at the gastroesophageal junction, would cause this. 

What is an upper GI bleed?

(hematemesis; may cause significant bleeding, often does not)

200

Late manifestations include unexplained weight loss, indigestion, early satiety, abdominal discomfort or pain, and signs and symptoms of anemia. Tobacco use is a RED FLAG RISK FACTOR.

What is stomach cancer?

300

This condition is diagnosed when a patient has at least three risk factors such as central obesity, hypertension, elevated blood glucose, high triglycerides, or low HDL, greatly increasing the risk for type 2 diabetes and cardiovascular disease.

What is Metabolic syndrome?

400

After prolonged malnutrition, a severely underweight patient is started on aggressive nutritional support and develops fluid retention, dysrhythmias, and a critically low phosphorus level. This dangerous complication is called what?

What is Refeeding syndrome?

500

Sustained vomitting may lead to this acid-base imbalance.

What is metabolic alkalosis?