Questions: Bros256-Week 1 Case Study: Gastroesophageal Reflux Disease The stomach acts as a major site of protein digestion, utilizing a mixture of hydrochloric acid and proteases to breakdown complex proteins into peptides that can be further digested in the small Intestine. However, the utilization of such a strong acid within the body can lead to tissue deterioration if steps are not taken by the digestive system. Within the stomach, mucosal cells can secrete an alkaline mucus that will coat the stomach mucosal lining, preventing the acid from coming into direct contact with the lining. Some conditions such as in peptic ulcers will result in patches within the stomach lining that are not protected with mucus, leading to the acid breaking down the lining. To prevent the acid from escaping the confines of the stomach, sphincters are utilized to prevent the flow of acid up through the esophagus (lower esophageal sphincter) and down to the duodenum (pyloric sphincter). Gastroesophageal reflux disease (GERD) occurs when stomach acid is regurgitated into the esophagus and can lead to a burning sensation in the chest, a sour taste in the back of the throat, sore throat, nausea, and bloating. Some of the conditions that can increase the prevalence of GERD include the consumption of excessive amounts of caffeine, alcohol, chocolate, or spicy foods; pregnancy; delayed stomach emptying; and birth defects such as esophageal atresia (narrowing) and hernias. Common treatments include a change in lifestyle and diet, antacids, histamine H2-receptor antagonist medications, and proton pump inhibitors (PPIs). Antacids work by neutralizing the stomach acid and inhibiting the proteases. Histamine H-receptor antagonists work by preventing the inflammatory responses within the stomach, leading to less production of stomach acid. Proton pump inhibitors act on the proton pumps found in stomach acid producing cells and preventing the pushing of hydrogen ions into the lumen of the stomach, preventing stomach acid from being produced. Background: Siobhan Smith, a 45-year-old instructor, has come to the clinic to discuss frequent "heartburn and vomiting" for the past 3 months. She has no issues with swallowing, food getting stuck, or respiratory issues. There is no abdominal pain. She has tried over-the counter antacids with only a little relief. Desired Outcomes: 1. Determine if Siobhan's sensations of "heartburn" are, in fact, gastroesophageal reflux disease (GERD). 2. Educate Siobhan on the potential causes of GERD. 3. Identify appropriate recommendations based on the findings of a GI endoscopy. Findings: Siobhan's upper GI endoscopy found inflammation within the esophageal and pharyngeal mucosa. No abnormal findings were found within the stomach of intestines. A further esophageal pH test determined that excess acid was built up within the esophagus. Questions: 1. What is the anatomical structure that malfunctions in individuals with GERD? 2. Explain how stomach acid can affect mucus membranes that are not adequately protected.

Bros256-Week 1 Case Study: Gastroesophageal Reflux Disease The stomach acts as a major site of protein digestion, utilizing a mixture of hydrochloric acid and proteases to breakdown complex proteins into peptides that can be further digested in the small Intestine. However, the utilization of such a strong acid within the body can lead to tissue deterioration if steps are not taken by the digestive system. Within the stomach, mucosal cells can secrete an alkaline mucus that will coat the stomach mucosal lining, preventing the acid from coming into direct contact with the lining. Some conditions such as in peptic ulcers will result in patches within the stomach lining that are not protected with mucus, leading to the acid breaking down the lining. To prevent the acid from escaping the confines of the stomach, sphincters are utilized to prevent the flow of acid up through the esophagus (lower esophageal sphincter) and down to the duodenum (pyloric sphincter). Gastroesophageal reflux disease (GERD) occurs when stomach acid is regurgitated into the esophagus and can lead to a burning sensation in the chest, a sour taste in the back of the throat, sore throat, nausea, and bloating. Some of the conditions that can increase the prevalence of GERD include the consumption of excessive amounts of caffeine, alcohol, chocolate, or spicy foods; pregnancy; delayed stomach emptying; and birth defects such as esophageal atresia (narrowing) and hernias. Common treatments include a change in lifestyle and diet, antacids, histamine H2-receptor antagonist medications, and proton pump inhibitors (PPIs). Antacids work by neutralizing the stomach acid and inhibiting the proteases. Histamine H-receptor antagonists work by preventing the inflammatory responses within the stomach, leading to less production of stomach acid. Proton pump inhibitors act on the proton pumps found in stomach acid producing cells and preventing the pushing of hydrogen ions into the lumen of the stomach, preventing stomach acid from being produced. Background: Siobhan Smith, a 45-year-old instructor, has come to the clinic to discuss frequent "heartburn and vomiting" for the past 3 months. She has no issues with swallowing, food getting stuck, or respiratory issues. There is no abdominal pain. She has tried over-the counter antacids with only a little relief. Desired Outcomes: 1. Determine if Siobhan's sensations of "heartburn" are, in fact, gastroesophageal reflux disease (GERD). 2. Educate Siobhan on the potential causes of GERD. 3. Identify appropriate recommendations based on the findings of a GI endoscopy. Findings: Siobhan's upper GI endoscopy found inflammation within the esophageal and pharyngeal mucosa. No abnormal findings were found within the stomach of intestines. A further esophageal pH test determined that excess acid was built up within the esophagus. Questions: 1. What is the anatomical structure that malfunctions in individuals with GERD? 2. Explain how stomach acid can affect mucus membranes that are not adequately protected.
Transcript text: Bros256-Week 1 Case Study: Gastroesophageal Reflux Disease The stomach acts as a major site of protein digestion, utilizing a mixture of hydrochloric acid and proteases to breakdown complex proteins into peptides that can be further digested in the small Intestine. However, the utilization of such a strong acid within the body can lead to tissue deterioration if steps are not taken by the digestive system. Within the stomach, mucosal cells can secrete an alkaline mucus that will coat the stomach mucosal lining, preventing the acid from coming into direct contact with the lining. Some conditions such as in peptic ulcers will result in patches within the stomach lining that are not protected with mucus, leading to the acid breaking down the lining. To prevent the acid from escaping the confines of the stomach, sphincters are utilized to prevent the flow of acid up through the esophagus (lower esophageal sphincter) and down to the duodenum (pyloric sphincter). Gastroesophageal reflux disease (GERD) occurs when stomach acid is regurgitated into the esophagus and can lead to a burning sensation in the chest, a sour taste in the back of the throat, sore throat, nausea, and bloating. Some of the conditions that can increase the prevalence of GERD include the consumption of excessive amounts of caffeine, alcohol, chocolate, or spicy foods; pregnancy; delayed stomach emptying; and birth defects such as esophageal atresia (narrowing) and hernias. Common treatments include a change in lifestyle and diet, antacids, histamine H2-receptor antagonist medications, and proton pump inhibitors (PPIs). Antacids work by neutralizing the stomach acid and inhibiting the proteases. Histamine H-receptor antagonists work by preventing the inflammatory responses within the stomach, leading to less production of stomach acid. Proton pump inhibitors act on the proton pumps found in stomach acid producing cells and preventing the pushing of hydrogen ions into the lumen of the stomach, preventing stomach acid from being produced. Background: Siobhan Smith, a 45-year-old instructor, has come to the clinic to discuss frequent "heartburn and vomiting" for the past 3 months. She has no issues with swallowing, food getting stuck, or respiratory issues. There is no abdominal pain. She has tried over-the counter antacids with only a little relief. Desired Outcomes: 1. Determine if Siobhan's sensations of "heartburn" are, in fact, gastroesophageal reflux disease (GERD). 2. Educate Siobhan on the potential causes of GERD. 3. Identify appropriate recommendations based on the findings of a GI endoscopy. Findings: Siobhan's upper GI endoscopy found inflammation within the esophageal and pharyngeal mucosa. No abnormal findings were found within the stomach of intestines. A further esophageal pH test determined that excess acid was built up within the esophagus. Questions: 1. What is the anatomical structure that malfunctions in individuals with GERD? 2. Explain how stomach acid can affect mucus membranes that are not adequately protected.
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  1. What is the anatomical structure that malfunctions in individuals with GERD?

The answer is the lower esophageal sphincter (LES).

Explanation: The lower esophageal sphincter (LES) is a ring of muscle located at the junction between the esophagus and the stomach. Its primary function is to act as a barrier to prevent the backflow (reflux) of stomach contents, including acid, into the esophagus. In individuals with GERD, the LES malfunctions by either relaxing inappropriately or weakening, which allows stomach acid to escape into the esophagus, leading to the symptoms associated with GERD.

  1. Explain how stomach acid can affect mucus membranes that are not adequately protected.

Stomach acid, primarily composed of hydrochloric acid (HCl), is highly corrosive and can cause significant damage to tissues that are not adequately protected. The stomach lining is protected by a thick layer of alkaline mucus that neutralizes the acid and prevents it from coming into direct contact with the stomach's epithelial cells. However, if this protective mucus layer is compromised or absent, the acid can erode the tissue, leading to inflammation, ulceration, and damage to the mucosal lining. In the esophagus, which lacks the same protective mucus layer as the stomach, exposure to stomach acid can result in inflammation (esophagitis), pain, and the characteristic burning sensation known as heartburn. Over time, repeated exposure can lead to more severe complications such as esophageal ulcers, strictures, or Barrett's esophagus.

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