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CSI > Acid Reflux > Flashcards

Acid Reflux Flashcards

1
Q

What pain is Paul experiencing?

A

Dull pain

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2
Q

When does it normally occur?

A

After dinner

Especially if he eats late

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3
Q

How does it affect his everyday activities?

A

Stresses him- unsure about what to eat

Loses sleep

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4
Q

Describe the anatomical course of the oesophagus?

beginning

A

Neck (C6)

Continuous superiorly with the laryngeal part of the pharynx

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5
Q

Describe the anatomical course of the oesophagus?

middle

A

descends downward into the superior mediastinum

positioned between the trachea and the vertebral bodies of T1 to T4

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6
Q

Where does the oesophagus enter the abdomen?

A

Oesophageal hiatus at T10

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7
Q

What is the layers of the oesophagus?

A

Adventitia
Muscle layer
Submucosa
Mucosa

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8
Q

What is the adventitia?

A

outer layer of connective tissue

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9
Q

Where is there serosa rather than adventitia?

A

very distal and intraperitoneal portion of the oesophagus

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10
Q

What is the muscle layer?

A

external layer of longitudinal muscle and inner layer of circular muscle

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11
Q

What is the external layer composed of in each third?

A

Superior third – voluntary striated muscle
Middle third – voluntary striated and smooth muscle
Inferior third – smooth muscle

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12
Q

What is mucosa?

A

non-keratinised stratified squamous epithelium (contiguous with columnar epithelium of the stomach).

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13
Q

How is food transported through the oesophagus?

A

peristalsis

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14
Q

What is peristalsis?

A

Rhythmic contractions of the muscles, which propagates down the oesophagus

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15
Q

What can interfere with peristalsis?

A

Hardening of muscle layers can also cause dysphagia

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16
Q

What are oesophageal sphincters?

A

upper and lower oesophageal sphincters. They act to prevent the entry of air and the reflux of gastric contents respectively.

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17
Q

What is the upper o.s.?

A

anatomical, striated muscle sphincter at the junction between the pharynx and oesophagus

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18
Q

What produces the upper o.s.?

A

cricopharyngeus

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19
Q

What is the function of the upper o.s.?

A

prevent the entrance of air into the oesophagus

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20
Q

What is the lower o.s.?

A

located in the gastro-oesophageal junction

situated to the left of the T11 vertebra, and is marked by the change from oesophageal to gastric mucosa

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21
Q

What 4 phenomena form the lower o.s.?

A

The oesophagus enters the stomach at an acute angle.

The walls of the intra-abdominal section of the oesophagus are compressed when there is a positive intra-abdominal pressure.

The folds of mucosa present aid in occluding the lumen at the gastro-oesophageal junction.

The right crus of the diaphragm has a “pinch-cock” effect.

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22
Q

What are the four physiological constrictions in the lumen on the oesophagus?

A

Arch of aorta
Bronchus (left main stem)
Cricoid cartilage
Diaphragmatic hiatus

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23
Q

What is a physiological constriction?

A

Where food/foreign objects are likely to get stuck

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24
Q

What is Barrett’s oesophagus?

A

metaplasia of lower oesophageal squamous epithelium to gastric columnar epithelium

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25
Q

What causes Barrett’s?

A

hronic acid exposure as a result of a malfunctioning lower oesophageal sphincter

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26
Q

What is the most common symptom of Barrett’s?

A

long-term burning sensation of indigestion
unpleasant taste in mouth
nausea
vomiting

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27
Q

How can Barrett’s be diagnosed?

A

Endoscopy

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28
Q

What percentage of malignancies in the UK are oesophageal carcinomas?

A

2%

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29
Q

What are the clinical features of oesophageal carcinomas?

A

Dysphagia

Weight loss

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30
Q

What are the two types of oesophageal carcinomas?

A

Squamous cell carcinoma

Adenocarcinoma

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31
Q

What is squamous cell carcinoma?

A

The most common subtype of oesophagus cancer. It can occur at any level of the oesophagus

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32
Q

What is adenocarcinoma?

A

Only occurs in the inferior third of the oesophagus and is associated with Barrett’s oesophagus. It usually originates in the metaplastic epithelium of Barrett’s oesophagus

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33
Q

What are oesophageal varices?

A

abnormally dilated sub-mucosal veins (in the wall of the oesophagus) that lie within this anastomosis

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34
Q

When are oesophageal varices produced?

A

when the pressure in the portal system increases beyond normal, a state known as portal hypertension

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35
Q

When does portal hypertension most commonly occur?

A

secondary to chronic liver disease, such as cirrhosis or an obstruction in the portal vein

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36
Q

How do most patients with oesophageal varices present?

A

haematemesis (vomiting of blood)

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37
Q

Who is at high risk of developing oesophageal varices?

A

Alcoholics

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38
Q

What percentage of England’s working age population struggle to undertones health information that only contained text?

A

43%

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39
Q

Who faces the most difficulty when it comes to health literacy?

A 
Older people
BAME 
Those with low qualifications
Those without English has a first language 
Those with low job status 
Those in the poverty trap
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40
Q

What does poor understanding lead to?

A

Higher risk of emergency admission

Serious health conditions

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41
Q

What is reflux?

A

some of the acidic stomach contents come back up the oesophagus towards the mouth

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42
Q

What is heartburn?

A

a burning sensation in the chest because of the acid that’s in the stomach

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43
Q

Where is heartburn felt?

A

in the chest behind the breastbone, and it may move up towards the throat

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44
Q

What are other symptoms of acid reflux?

A

an unpleasant taste in the mouth and swallowing problems

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45
Q

What does GORD stand for?

A

Gastro-Oesophageal reflux disease

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46
Q

What are the treatments for reflux?

A

Proton pump inhibitors
4-8 week course
If it does not work a H2 blocker may be offered

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47
Q

What is the treatments for severe oesophagitis?

A

8 week PPI treatment

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48
Q

When is surgery appropriate for reflux?

A

for people who do not want to take medication long-term, or for those who have unpleasant side effects from their medication

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49
Q

What is the most common type of surgery for reflux?

A

laparoscopic fundoplication

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50
Q

What is laparoscopic fundoplication?

A

keyhole surgery technique, in which the surgeon stitches and folds the top of the stomach, just below where the oesophagus meets the stomach, to create a smaller opening

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51
Q

What is the aim of laparoscopic fundoplication?

A

reduce the amount of stomach contents re-entering the oesophagus
repait hiatus hernia
strengthen the valve at the bottom of the oesophagus

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52
Q

What other terms could be used for heartburn?

A

Acid reflux
Tummy ache
Indigestion

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53
Q

What is the single medical term that describes the category of symptoms Paul is describing?

A

Dyspepsia

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54
Q

What is dyspepsia?

A

Recurrent epicanthic pain, heartburn or symptoms of acid regurgitation, with out without bloating, nausea or vomiting

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55
Q

Would you use dyspepsia with a patient?

A

Establish good communication using familiar words

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56
Q

What additional symptoms might a patient experience if the cause of their dyspepsia was oesophageal reflux?

A

Excess salivation- water brash

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57
Q

What are the other symptoms one might get if the cause is gastroenteritis?

A

Complete later

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58
Q

What could cause dyspepsia?

A 
Coeliac disease
IBS
Upper GI malignancy
GORD
Gastritis
Pancreatitis
Medication side effects
Functional dyspepsia
Gastroenteritis 
Stress
Peptic ulcer disease
Coronary heart disease
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59
Q

What are the most likely differentials for Paul?

A 
GORD
Gastritis
Functional dyspepsia
Stress
Peptic ulcer disease
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60
Q

What is functional dyspepsia?

A

Suffers symptoms but investigations do not show causes

May have gastritis but it doesn’t correlate with the severity of symptoms

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61
Q

What can sever gastritis lead to?

A

Ulceration

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62
Q

What is the second most common endscopic finding?

A

Oesophagitis

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63
Q

What is the third most common finding?

A

Peptic ulcer disease

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64
Q

What pain is associated with biliary disease?

A

Colicky pain

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65
Q

What is colicky pain?

A

Intermittent, spastic pain when a hollow tube contracts to get rid of an obstruction

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66
Q

Why must coronary disease be considered?

A

Stress
Risk factors- smoking
Can present as dyspepsia

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67
Q

What responsibility falls upon GPs?

A

Making decisions of what is significant of not

Common symptoms can be indicative of mor serious, less common diseases

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68
Q

What is differential diagnoses?

A

The possibilities of diagnosis that can range from less to very dangerous

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69
Q

What terms is used to indicate symptoms that can indicate very serious conditions?

A

Red flag symptoms

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70
Q

Why is it important to identify red flag symptoms?

A

So patients with more serious symptoms are seen first and have the relevant investigations carried out urgently

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71
Q

What are other common presentations to the GP for which red flag features might be important?

A

Back pain

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72
Q

What can back pain be a sign of?

A

Spinal-cord compression
malignancy
infection

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73
Q

Red flags for back pain.

A

Previous cancer

bladder bowel dysfunction

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74
Q

Red flags for headaches?

A

Meningism
raised intracranial pressure
sudden and severe

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75
Q

What is the most serious differential?

A

Upper GI cancer

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76
Q

What red flag features do you think might make a doctor suspicious for Upper GI cancer?

A

Weight loss
Mass
Dysphagia

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77
Q

What is another thing to bear in mind with a red flag symptoms?

A

How long symptoms persist
E.g. vomiting over extended period is more relevant

Age

Other symptoms

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78
Q

What helps GPs decide when to refer patients?

A

Nice referral guidelines

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79
Q

What is seven further actions are most appropriate at this time? After the GP has examined Mr Miller for red flags

A 
Testing for H pylori 
FBC
LFTs
ECG
Alcohol history 
Weight 
Medication history
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80
Q

What should you ask when taking an alcohol history?

A

Units (should be 14)

Spread out

81
Q

What should be included in a medical drug history?

A

Include over-the-counter
those that affect the oesophageal sphincter
those that affect gastric mucosa

82
Q

Why test for H. Pylori?

A

Common any dyspepsia
gastritis peptic ulcer disease gastric malignancy
is highly prevalent

83
Q

Why do a FBC?

A

Anaemia

84
Q

How might Upper GI cancer result in anaemia?

A

Due to occult blood loss

Cancer cytokines can affect blood cell production

85
Q

Why would you do LFTs?

A

Biliary disease
alcohol induced changes
opportunistic

86
Q

Why is a abdominal radiograph not relevant?

A

Often used acutely

show perforation or obstruction

87
Q

When might a rectal examination be performed?

A

Upper gastrointestinal bleeding

Melaena

88
Q

What is Melaena?

A

Dark and offensive smelling faeces containing blood from the upper GI tract

89
Q

What is a OGD?

A

Oesophagogastroduodenoscopy
Invasive
Internal view

90
Q

What is the site of infection for H. Pylori?

A

Stomach

91
Q

Why is It is interesting that H pylori infects the stomach?

A

The acid in the stomach is responsible for killing pathogen is yet H pylori is found in the stomach

92
Q

Why does the acid not destroy stomach lining?

A

Alkaline protection from cells protect the stomach lining from acid

93
Q

How is H. Pylori able to survive in the stomach?

A

H pylori creates a molecule that neutralises acid

94
Q

What is the molecule that neutralises acid and is created by H pylori?

A

Urease

95
Q

What does urease do?

A

Converts urea and water to ammonia and carbon dioxide

96
Q

What does H pylori use for locomotion?

A

Flagella

97
Q

What does H pylori use for adhesion to host?

A

Lipopolysaccharides

BabA

98
Q

What does cagA do?

A

Disrupt tight junctions between cells leading to inflammation = gastritis

99
Q

What does VacA do?

A

causes the cells in the stomach lining to undergo apoptosis and die

100
Q

What is the final affect of H. Pylori toxins?

A

The lining cells are now exposed to the effects of hydrochloric acid

101
Q

What percentage of people have H pylori in their stomach?

A

50%

102
Q

How was Mr Mellors Heliobacterpylori diagnosed?

A

Stool antigen test

103
Q

What are the advantages of a carbon 13 urea breath test?

A

Non-invasive simple,Safe
High sensitivity and specificity
Can be used for diagnosis and as a test of cure

104
Q

What are the disadvantages of the carbon 13 urea breath test?

A

Requires specialist analysing equipment, samples may need sending away
If the patient is on antibiotics or PPIs the results might be falsely negative
Requires fasting conditions

105
Q

What are the advantages of a stall antigen test?

A

Non-invasive, simple, safe
High sensitivity and specificity
Can be used for diagnosis and theoretically as a test of cure

106
Q

What are the disadvantages of the stool antigen test?

A

Patience my professor of the test
Samples need refrigeration
If the patient is on antibiotics or PPIs the results might be falsely negative
Sufficient evidence is lacking for use as a test of cure

107
Q

What are the advantages of a serum serology test?

A

Cheap and widely available

May be useful for diagnosing a patient that is newly infected

108
Q

What are the disadvantages of the serum serology test?

A

IgM poorly sensitive for new infection
IgG does not tell you if infection is current as will remain positive after infection cleared
Cannot test for cure

109
Q

What are the advantages of a CLO test?

A

High sensitivity and specificity

Instantaneous results

110
Q

What are the disadvantages of a CLO test?

A

If the patient is on antibiotics or PPI is the result might be falsely negative
Invasive

111
Q

How does the human body make hydrochloric acid in the stomach?

A

Parietal cells secrete hydrochloric acid
Cells have two sides the apical side and basolateral side

Parietal cells generate hydrogen irons
Carbon dioxide diffuse into parietal cells on basolateral side
Carbonic anhydrase catalyses the creation of carbonic acid which dissociate to give hydrogen ions

A bicarbonate chloride antiporter transports bicarbonate out of parietal cell and chloride into parietal cell
Parietal cell proton pump transports hydrogen ions to apical side
Chloride channel transports chloride ions to apical side

112
Q

What receptors are involved in stimulating the process?

A

H to receptor initiate signalling cascade which transports hydrogen
A CH receptor
Gastrin receptor

113
Q

What do you PPIs do?

A

Have a week antibacterial effect
have anti urease and antia ATPase prosperities
Reduces acid production

114
Q

What are the three types of drugs used to treat gastritis?

A

Proton pump inhibitors
Antacids
H2 antagonists

115
Q

Give examples of PPIs?

A

Lansoprazole

Omeprazole

116
Q

Give examples of antacids

A

Aluminium hydroxide

Magnesium carbonate

117
Q

Give examples of H2 antagonists

A

Ranitidine

Cimetidine

118
Q

What other symptoms would be present if it is gastroenteritis causing the dyspepsia?

A

Fevers, vomiting, diarrhoea

119
Q

What did the GP give Mr Muller?

A

Omeprazole
amoxicillin
clarithromycin

120
Q

What did the GP retest Mr Muller with?

A

Carbon 13 breath test

121
Q

How long did the GP have to wait before testing Mr Muller?

A

Four weeks

122
Q

What does Mr. Muller have?

A

Treatment resistant dyspepsia

123
Q

What does nice recommend for treatment resistant dyspepsia?

A

Endoscopy

OGD

124
Q

What did Paul’s OGD find?

A

Sliding hiatus hernia present with evidence of moderate oesophagitis.
Oesophageal biopsies taken three times
Gastric mucosa macroscopically normal, random biopsy taken for CLO test.
Duodenum normal

125
Q

What was the outcome of Paul’s CLO test?

A

Negative

126
Q

What was recommended for Paul after the OGD?

A

Recommended high dose omeprazole and repeat OGD three months

127
Q

When does a hiatus hernia occur?

A

Hiatus hernia is a car when part of the abdominal viscera herniate through the oesophageal opening in the diaphragm

128
Q

What are the risk factors for hiatus hernias?

A 
Male gender
Obesity
Age
Pregnancy
Genetic predisposition
129
Q

What does a hiatus hernia occur due to?

A

Widening of the diaphragmatic hiatus
Pulling up of the stomach e.g Due to oesophageal shortening
Or pushing up of the stomach e.g. due to intra-abdominal pressure

130
Q

What occurs during a hiatus hernia?

A

Function of the lower oesophageal sphincter is compromised and the anti-reflux barrier is lost
Allow stomach contents to reflux into the oesophagus

131
Q

What are hiatus hernia is a common cause of?

A

GORD

132
Q

What are the two variants of hiatus hernia is?

A

Sliding and Rolling

133
Q

What is a sliding hiatus hernia?

A

85 to 95% of cases
GOJ moves upwards
Predominantly causes symptoms of GORD

134
Q

What is a rolling hiatus hernia?

A

5 to 15% of cases
GOJ remains in place
A portion of the stomach, bowel, pancreas or spleen herniates into the chest next to the GOJ

135
Q

What are the constituents of the refluxed material?

A

Stomach acid and indigested food

136
Q

What is the pH of the refluxed material?

A

Acidic

137
Q

Why might the PPI not work?

A

Functional dyspepsia
Non-acid reflux
Hiatus hernia

138
Q

What does gaviscon do?

A

Foamy barrier created on top of the stomach contents

139
Q

What was causing Mr Mellors presenting complaint heartburn?

A

GORD as a result of his hiatus hernia

140
Q

What is Barretts oesophagus?

A

Complication of GORD

Precondition for oesophageal cancer

141
Q

What percentage of people with GORD develop Barretts oesophagus?

A

10 percent

142
Q

What percentage of people with Barratts oesophagus develop oesophageal cancer?

A

1 to 5%

143
Q

How can the nature of tissue change a long continuous system?

A

Different tissue types along the track
Oesophagus has squamous epithelium stomach has columnar
All epithelia lined with mucus

Oesophageal configuration changes for something else

144
Q

Why does cell type change?

A

Exposure to gastric contents

145
Q

What is the phenomena when cells change from one type to another called?

A

Metaplasia

146
Q

What is the histological difference between a healthy and Barratts oesophagus?

A

more Red and velvety

147
Q

What is a precursor for intestinal metaplasia?

A

Cardiac metaplasia

148
Q

What are Barrett cells vulnerable to?

A

Architectural changes leading to dysplasia

Which can be considered low or high grade depending on the characteristics of the cells

149
Q

What can a high grade dysplasia that has not invaded neighbouring tissues be also known as?

A

Carcinoma in situ
Intraepithelial neoplasia
Stage zero cancer

150
Q

What does high grade dysplasia run the risk of?

A

Developing into invasive cancer

151
Q

How often will a patient with GORD have an OGD?

A

Every few years or more often depending on the situation

152
Q

How can invasive adeno carcinoma be treated?

A

Surgically with an oesophagectomy

153
Q

What was Mr Miller’s diagnosis of Heliobacter pylori?

A

Red herring

154
Q

What does the GP to recommend to Mr Maller?

A

How are you do is 20 mg of omprezole oral twice a day

Lifestyle changes

155
Q

What lifestyle elements should be incorporated to ease acid reflux and heartburn?

A

Eat smaller, more frequent meals
Raise one end of your bed 10 to 20 cm by putting something under your bed or mattress
Make it so your chest and head are above the level of your waist so stomach acid does not travel up towards your throat
Try to lose weight if you’re overweight
Try to find ways to relax

156
Q

What lifestyle elements should be avoided to ease heartburn and acid reflux?

A

Do you not have food or drink that triggers your symptoms
Do not eat within three or four hours before bed
Do you not wear clothes that are tight around your waist
Do not smoke
Do you not drink too much alcohol
Do not stop taking any prescribed medicine without speaking to a doctor 1st

157
Q

What lifestyle changes are especially relevant to Paul?

A

Raising his bed
Avoiding eating within 3 to 4 hours of bed
Try to lose weight
Try to find ways to relax

158
Q

How can stress exacerbate acid reflux?

A

Ulcerations of the brain gut excess

159
Q

How can smoking exacerbate acid reflux?

A

Nicotine relaxes the lower oesophageal sphincter

160
Q

How does alcohol exacerbate GORD?

A

Chronic alcohol excess is associated with GORD
Inhibition of gastric emptying
Affect the functioning of the lower oesophageal sphincter are
Contributes to gastric mucosal damage

161
Q

What are common trigger foods?

A

Spicy food
Acidic food
Coffee

162
Q

How does tight clothing exacerbate reflux?

A

Increases abdominal pressure

163
Q

What are risk factors for reflux?

A 
Overweight
Smoke
Drink to much alcohol
Eat spicy, acidic to fatty foods
Hiatus hernia
164
Q

What is a EMR?

A

Endoscopic mucosa resection

165
Q

What is the aim of an EMR?

A

remove the affected area of the oesophagus lining, without damaging the rest of the oesophagus

166
Q

How is the EMR performed?

A

surgeon removes the affected area using a thin wire called a snare
the snare is put through an endoscope into the body

167
Q

What is RFA?

A

Radiofrequency ablation

168
Q

What does RFA do?

A

Uses heat to destroy abnormal cells

169
Q

What are the side effects of RFA?

A

Mild pain
Discomfort
Generally unwell
Possible temperature

170
Q

What is a oesophagectomy?

A

surgeon removes the part of the oesophagus that contains the abnormal cells then join the stomach to the remaining part of the oesophagus

171
Q

When is someone offered a oesophagectomy?

A

you have a high-grade dysplasia

you have a high-grade dysplasia that cannot be removed using an endoscope

172
Q

What happens after a oesophagectomy?

A

ICU
Drip until they can eat or drink again
Possible NG tube
Feeding tube

173
Q

What does a NG tube do?

A

Removes digestive fluids
Helps area heal
Prevents nausea

174
Q

What are the new treatment methods for Barrett’s that are being researched?

A

Multipolar electrocoagulation

Cryotherapy

175
Q

When are antacids best given?

A

when symptoms occur or are expected, usually between meals and at bedtime

176
Q

What makes antacids suitable?

A

Aluminium- and magnesium-containing antacids

relatively insoluble in water, are long-acting if retained in the stomach

177
Q

What are potential side effects of antacids?

A

Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids may be constipating

178
Q

Why are bismuth containing antacids not recommended?

A

absorbed bismuth can be neurotoxic, causing encephalopathy; they tend to be constipating

179
Q

Why are calcium containing antacids not recommended?

A

an induce rebound acid secretion

prolonged high doses also cause hypercalcaemia and alkalosis, and can precipitate the milk-alkali syndrom

180
Q

What is simeticone?

A

added to an antacid as an antifoaming agent to relieve flatulence.
useful for the relief of hiccup in palliative care.

181
Q

What are alginates?

A

added to an antacid as an antifoaming agent to relieve flatulence. These preparations may be useful for the relief of hiccup in palliative care.

182
Q

What are potential adverse effects associated with long term PPI use?

A 
hypergastrinemia
pneumonia
 dementia
drug interactions
risk of fractures hypomagnesemia
Clostridium difficile–associated diarrhea
vitamin B12 deficiency
acute interstitial nephritis (AIN), cutaneous and systemic lupus erythematosus events
183
Q

What causes hypergastrinemia?

A

Gastric acid suppression

184
Q

What does hypergastrinemia cause?

A

hyperacidity; after discontinuing PPI therapy, patients may experience worsening GORD symptoms

parietal cells to hypertrophy and enterochromaffin-like cells (ECL) to undergo hyperplasia

Increase risk of gastric cancer

185
Q

What can be done to avoid hypergastrinemia?

A

PPIs should be slowly tapered

186
Q

How does PPI use cause pneumonia?

A

Acid suppression leads to an increase in gastric pH, allowing for the overgrowth of non-Helicobacter pylori bacteria in gastric juices, gastric mucosa, and the duodenum.2 This can potentially lead to microaspiration and lung colonization

187
Q

Why may PPIs cause fractures?

A

there may be as much as a 41% reduction in calcium absorption after 14 days of omeprazole therapy

188
Q

What are symptoms of hypomagnesemia?

A

muscle weakness and cramps, tetany, convulsions, arrhythmias, and hypotension

189
Q

Why might PPIs cause vitamin B12 deficiency?

A

atrophic gastritis and achlorhydria, promoting bacterial overgrowth that allows for the increased digestion of cobalamin

190
Q

What are the symptoms of acute interstitial nephritis?

A

nausea, vomiting, fatigue, fever, and hematuria

191
Q

Why may PPIs cause dementia?

A

PPIs may increase the production and degradation of amyloid and bind to tau

192
Q

What is DILE?

A

Drug-induced lupus erythematous

Lupus-like syndrome that usually resolves after discontinuation of the medication

193
Q

What is the most common form of DILE?

A

SCLE

Drug-induced subacute cutaneous lupus erythematous

194
Q

Who is at risk of developing SCLE?

A

Women of childbearing age, those with drug allergies or previous episodes of SCLE, photosensitive skin, exposure to ultra-violet radiation, and family history

195
Q

Give examples of drugs that interact with PPIs

A

itraconazole, ketoconazole, isoniazid, oral iron supplements, and several protease inhibitors

196
Q

What pathways can the brain and gut communicate via?

A 
neural pathway (vagus nerve and enteric nervous pathway)
Endocrine pathway
Immune pathway
197
Q

What hormones are involved in communication?

A

Cortisol
Adrenaline
both influence immune cytokines

198
Q

What can influence the composition of our GI bacteria?

A

Stress

Altered levels of glucocorticoid hormones leads to modulates immune response

199
Q

What is the modulated immune response?

A

Increased levels of proinflammaotory cytokines
Change in the levels of neuroactive molecules
Influences brain function

CSI (17 decks)

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