CBL2- Dyspepsia

Question 1

What happens in heartburns and GORD?

Answer 1

H- hot retro-sternal pain radiating upwards

GORD
Gatroscopy proven oesophagitis and gastric acid regurgitation into mouth.m

Question 2

What could cause dyspepsia?

Answer 2

Oesophageal, gastric, duodenal, gallbladder/biliary, pamcreatic probs.

20-40% adult probs
2-5% alll GP visits.

NHS cost: £600 pa- endoscopies + meds

Question 3

What happens in digestion?

Answer 3

Gastric acid digests food partly, then duodenum and SB. Secretion in anticipation of food.

Body and fundus: Parietal cells :HCL + intrinsic factor
Peptic cells: pepsinogen and gastric lipase + mucus
Histamines- on H2 receptors and vagus nerve (acetyl choline) also stimulate secretion.
Vagus- acts on hypothalamic cells to feel satiety when stomach- mechanical receptors distended.

Cardia + pyloric regions- secrete mucus and HCO3-
Gastrin- G cells? By antrum –> bloodstream–> parietal cells–> HCL secretion

pH2- lowest acidity- at 2am which wakes pts up- w/ heartburn.

Question 4

What drugs are used in dyspepsia?

Answer 4

1. Antacids- foam above stomach
   Gaviacon: 10mls after meals at night - NaHCO3 (bicarbonate) or gastroscote (Al(OH)3) - prone to constipation + Mg trisilicate - prone to loose motions and contains sodium bicarbonate.
2. Histamine H2 antagonsists- cimetidine, rantidine - used in Xs acidity disorders + heal gastric ulcers by reducing gastric acid secretion by parietal cells by blocking histamine H2 receptors.
   Liver metabolised so may interact with other meds.
   SE: diarrhoea, headache, rarely rash, liver probs.
   Cimetidine-> gynecomastia and erectile dysfx (ED) by blocking andogen receprots.

Question 5

What aggrevates GORD?

Answer 5

Lying down aggrevated GORD.

Question 6

Whats dyspepsia?

Answer 6

Range of UpperGI sx lasting >4 w
Heartburn
Indigestion
Upper abdo pain/ discomfort
Gastric reflux
N+V

Question 7

What happens in pancreatic digestion?

What is contained in pancreatic juice?

Answer 7

Amylase, lipase, colipase + proteases like alkaline juice secreted by pancreas (1.5L daily)
Into pancatic ducts of ampula of Vater w/ spinchters of Oddi into duodenum.

Question 8

How much L of bile a day? What does it do?

Answer 8

1-2L a day
Secreted by liver contains bile acids, to break down fats, dispose of fat end products and recycle products like bilirubin and biliverdin from haemaglobin breakdown.

Question 9

Where does the Pancreas lie?

Answer 9

L1

Question 10

What does the Small Bowel secrete?

Answer 10

Sugarases- maltase and sucrase.

Question 11

What does the Helicobacter pylori do?

Answer 11

H. Pylori- gram -ve rod shaped B assc w/ peptic ulcers, 60% gastric ulcers (GU) and 90% duodenal ulcers -DU.
Transmission- faeco oral or oral-oral.
Asymptomatic..
Major peptic ulcer disease and gastritis
RF for gastric cancer and oancreatic cancer

Question 12

GU Vs DU

Answer 12

GU- middle aged - older aged population + chemical irritation from meds like NSAIDS like ibuprofen increases risk x3 compred to nonusers. And aspirin- causes! Smoking. Crohns disease cz ulcers anywhere. ❌PAIN WORSE W/ FOOD.
Diff to differnt from cancer- biopsy at endoscopy w/ repeat checkup after 8w

DU:
Younger and ussualy male- may be FHx, aggrevated by NSAIDS, Smoking, stress, Zollinger- Ellisom syndrome. ❌❌FOOD RELIEVES IT. + NIGHT PAIN🌙✨ malignancy rare.

Z-E syndrome- 1 in million- gastrin secreting tumour of pancreas.

Question 13

What are some other dyspepsia meds?

Answer 13

Calcium antagonists
Nitrates
Theophyllines
Bisphosphates

Question 14

Cancer sx

When do you refer patients?

Answer 14

Acute GI BLEED as haematemesis or melaena - referral that day ‼️
Refer 2ww:
Dysphagia
Unintentional wt loss
Persistent vomiting
Iron def anaemia
Epigastric mass
>55Y w/ persisting dyspepsia

Question 15

What are some sx of oesophageal disorders?

Answer 15

Dysphagia- sensation of obstruction during passing of liquid or solid through the pharynx or oesophagus. Ie within 15s.
Characteristic of progression to solid foods:
Intermittent slow progression with hx of heartburn- benign pepric stricture
Relentless progression over a few weeks- malignant stricture.

Slow onset of dysphagia for solids and liquids at same time- moyility prob eg achlasia .

Odynophagia- pain during act of swolling- usually oesophagitis.
Causes: reflux, infx, chem oesophagitis due to drugs- bisphosphates or slow releasing K or assc with oesophageal stenosis.

Substantial discomfort, heartburn
Common of gastric contents reflux into oesophagus. Retrosternal burning pain that spreads to neck, across chest, and when severe hard to distinguish betwwen ischaemic heart disease.
🌟 worse lying down at night 🌙✨ when gravity promotes reflux or on bending or stooping.

Regurg- effortless reflux of oesoph contents into mouth and pharynx. ⭐️ uncommon in normal pts, common in those w/ GORD aor organic stenosis.

Question 16

What are some causes of dysphagia?

Answer 16

Neuromascular- pharyngeal dx, bulbar palsy- motor neurone disease, Myasthania gravis.

Oesophageal motility disorders
Achlasia, scleroderma, diffuse oesophageal spasm, DM, chagas disease.

Extrinsic pressure
Mediastinal glands, goitre, enlarged Left atrium

Intrinsic lesion
Foreign body, 
Stricture: benign: peptic, corrosive.
Malignant- carcinoma
Lower oesophageal ring
Oesophageal web
Pharyngeal pouch

Question 17

How would u investigate oesophageal dx?

Answer 17

Barrow swollow and meal
Oesophagoscopy
Manometry- catheter through nose to oesophagus, measures pressure genereatd from lower oesophageal sphincter and body. GOLD STANDARD TO ASSES OESOPH. MOTOR ACTIVITY.
NOT ❌ first line. Used when hx, endoscopy and barium radiology not diagnostic.
indicating peristaltic waves- up to 24hrs

pH monitoring: 24 hr ampulatory monitoring using a pH sensitive probe in LOS used to identify acid reflux episodes (pH