CSI C8 Flashcards
what muscles are the sphincters made from?
cricopharyngeus
why are both sphincter closed usually
Upper: stop air in
Lower: acid reflux
Barretts’ oesophagus
endoscopy
chronic acid exposure
squamous to columnar
Oesphagea carcinomas: two types + where, two main symptoms
Squamous cell caricnoma: all down oesophagus
adenocarcinoma: inferior third (from barretts)
dyphagia and weight loss
what muscle type in upper middle lower oesophagus
voluntary
mix
striated
how to help patients understand? (4 things)
speak slow
avoid jargon
repeat
ask patient what they understand
patients who face the most difficulties:
older people
first language not english
low grade jobs
poverty
what are oesophageal varices? what causes? treatment?
veins swollen, portal system high becuse of portal hypertension, obstruction in liver portal system\alcoholics\liver problems
treatment for reflux
PPI (omeprezole)
H2 inhibitor (ranitidine)
Antacids (not for long)
tretament for oesophagitis + if it comes back + doesnt work
PPI lowets dose
8 weeks than higher dose
diffeent ppi
surgery for oesophagitis
laparscopic fundoplication - make the disscetion shorter
dyspepsia
recuurent stomach pain… heartburn, bloating
4 reasons for dyspepsia
Gastritis
GORD
Peptic ulcer disease
functional dyspepsia (don’t know why, examination doesnt prove causative problems)
why gastritis comes under functional dyspepsia?
some caess gastritis isnt the cuase or shouldnt cuase the degree of symptoms. Even if it clears dyspepsia still continues
Why can ibueprofen be bad to take on an empty stomach
NSAIDs irritate mucus lining.
5 common causes of dyspepsia
GORD
Stress
Peptic ulcer disease
Fuctional dyspepsia
Oesophagitis
5 less common causes of dyspepsia
Cancer
Coronary heart disease -> angina pain can be mistaken
Pancreaitis
IBD
gall bladder disease
red flag for dyspepsia
upper gi cancer -> dysphagia, weight loss, anaemia
NICE referrals:
urgent if: mass found (2 week)
-dyphagia (2 week OGD)
>55 and weight loss with dyspepsia/reflux/pain (2 week OGD)
non urgent: haematesis (vomiting blood)
>55 and treatemnt resistant dyspepsia, pain with low haem, platlet with anything else or vomititng with anything else
7 tests used for mr muller
-ECG (pain to see if its coronary heart disease causing ischaemia
-weight
-alcohol history (varices, 14 units a week )
-medication history (CA channel blockers, beta blockers -> relax LOS)(NSAIDS -> gastric mucosa)
-full blood count (anaemia, high platlets (cancer))
- H.pylori (prescence doesnt cause symptoms always)
- LFTs
3 ways H pylori survive
1) acid nuetralisation: local nuetralistaion: urease turns urea +water into ammonia + C02
2) motion; flagella into mucus layer
3) adhesion, LPS/BabA
4) toxins: cagA -> gastric diseases vacA-> stomach cells apoptose and die
how to detetc H pylori
-stool antigen: disadv affected by meds and needs refridgettion- antigen of h PYLORI
-CLO test: invasive - urease
- Carbon 13:disadv other meds influence and fasting needed and specialist equiment -ureaese
- serum serology: igM poorly sensitive and igG (dk if curret) - human antigen
run through HCl production
Carbonic anhydrase ->
bicrabonate exchange from cl-
h+ INTO LUMEN VIA H/K antiporter (proton pump (gastric hydrogen potassium ATPase)
Atpase for K in then K diffuses into lumen then out again^
cl- diffuses in through channels
what 3 thing stimulate hcl production
1) H2 receptors
2) gastrin rceeptors
3) acetylcholine receptors
treatment for h pylori
PPI (has anti urease activity already) + antibacterial
lessen gastric secretions
PPI + H2 *on its own PPI reduces 80%
what treatment did Mr mullen get?
omprezole and 2 antibiotics (amocilian and clarthryomycin)
What is only test to see if H pylori is cured
Carbon 13!!!! (2 weeks no PPI and 4 weeks no anitbiotics)(others maje false negative)
what is a hiatus hernia + 5 risk factors + 2 types
part of abdominal viscera slips through the diagraphm, males/age/obesity/pregnancy/genetic, sliding hiatus hernia: both bottom of esoephagus (GOJ) and portion slide into or rolling: only top of stomahc/spleen etc move alongside.
raesons for having persisitent GORD even with meds
- hiatus hernia, symptomatic non acid reflux or functional dyspepsia
Alginate meds?
react to from a gel which acts as a barrier
5 lifestyle changes
dont smoke
loose weight
raise head in bed
not a lot of alcohol
tight clothes
differnce in metaplasia, dysplasia and cancer
metaplasia: reversible
dysplasia: not
cancer: invasive, rapid growth
