106 - GORD/PUD Flashcards
What factors can cause GORD?
Decreased salivation
Delayed gastric emptying
Malfunction of oesophageal sphincter - immature, transient relaxation of decreased resting tone
Impaired oesophageal clearance
What is barrett’s oesophagus?
Reprogramming of oesophageal stem cells, from ulcerated squamous epithelium (white) to columnar epithelium
- The metaplasia can be to columnar epithelium similar to the stomachs cardia - mucous glands present, body - parietal cells present, intestinal - goblet cells in mucous glands.
What are the 3 types of dyspepsia?
Postprandial fullness
Early satiation
Epigastic pain
What can cause gastritis?
Acute - chemical injuries
Chronic - Helicobacter pylori infection, NSAID chemical dmamade, autoimmune - pernicious aneamia
What are the 2 types of H pylori infection extent - how does it effect acid production?
Pan gastritis - body and antrum - reduced acid production
Antral gastritis - increased acid production
What is pernicious anaemia?
Antibodies against parietal cells - no intrinsic factor is made - so B12 cant be absorbed - so you get anaemia
What causes Peptic Ulcer Disease?
Acid + pepsin - ulcerogenic
What are the redflag signs in peptic ulcers?
Weight loss Persistant vomiting Progressive dysphagia Haematemesis Palpable mass Jaundice
What complications are possible with a peptic ulcer?
Perforation Haemorrhage Penetration to surrounding organs Obstruction Cancer
How is blood supply distributed to the oesophagus?
upper 1/3: Inferior thyroid artery
Middle 1/3: Decending aortic branches
bottom 1/3: Left gastric artery branches
What are the 4 types of treatment in GORD/PUD?
Antacids+alginates
Mucosal defence promotos - sucralfate, misoprostol
Gastric stimulants - domperidone, metoclopramide
Reduction of acid production - PPIs (omeprazole), H2 receptor antagonists (ranitidine)
What do antacids do?
Neutralise acid - eg. sodium bicarb
What do alginates do?
Reduce irritancy of acid - eg. simeticone
What contraindication is there with misoprostol?
Women of childbearing age - induces abortion
How do H2 receptor antagonists work?
Reversibly + competitively bind to H2 receptor, blocks it, supresses gastric secretion of acid
Where are parietal cells in the stomach? What do they produce?
In body + fundus of stomach
HCL
Intrinsic factor
Where are chief cells in the stomach? What do they produce?
In the body + fundus Produce pepsinogen (converted to pepsin by HCL)
Where are G cells? What do they produce?
In bottom of gastric glands - in antrum
Secrete gastrin (which stimulates parietal cells) inhibited by somatostatin
How is the parietal cell activated to produce acid?
By histamine (H2 receptor) By Ach (M3 receptor By Gastrin (CCK2 receptor
inhibited by prostaglandin receptor
