Difficulty Gastro Questions Flashcards
What are the two main locations where dysphagia can occur in?
Cricopharyngeal sphincter
Distal oesophagus
What are the two main types of regurgitation?
Functional
Mechanical
What is the difference between reflux and regurgitation?
Regurgitation is return of oesophageal contents whereas reflux is passive return of gastroduodenal contents
What is the physiological cause of achlasia?
Due to loss of ganglion cells in Aurebach’s myenteric plexus which innervate the LOS wall leading to a decrease in activity of the NCNA neurones.
What are the two main pathological causes for the diagnosis of a functional oesophageal disorder?
Abnormal oesophageal contractions
Failure of protective mechanisms for reflux
What is a Heller’s Myotomy?
A continuous myotomy performed for 6 cm on the oesophagus & 3 cm onto the stomach
What is a Dor Fundipulation?
Procedure where anterior fundus folded over oesophagus and sutured to right side of myotomy
How does sclerodoma lead to GERD?
Sclerodoma is autoimmune condition which leads to atrophy of smooth muscle in the oesophagus.
Peristalsis in the distal portions of the oesophagus ceases over time, leading to decrease in resting pressure in the LOS.
Low pressure leads to acid reflux and development of GERD over time.
Malignant causes of oesophageal perforation often have a poor prognosis. Give 4 examples of some malignant causes
Advanced cancers
Radiotherapy
Dilatation
Stenting
List 6 factors that can increase pressure within the LOS to inhibit acid reflux.
High intra-abdominal pressure
Acetylcholine (eggs, meats, fish)
Hormones
Histamine
Protein rich food
alpha-adrenergic agonists (hypertension)
List 6 factors that can deceasae pressure within the LOS to promote acid reflux.
Smoking
Fat
Hormone
Beta-adrenergic agonists (asthma, bradycardia)
Chocolate
Acid gastric juice
Give 6 examples of causes for failures in defensive mechanisms against reflux.
Low saliva prodiction (Sleep + Xerostomia (dry mouth)
Decreased buffering capacity of saliva (e.g from smoking)
Abnormal peristalsis
Defective mucosal protective mechanism (e.g. alcohol)
Hiatus hernia
Decrease in sphincter pressure
Herniation formed when the stomach and the lower part of the esophagus slide up through the diaphragm
Sliding hiatus hernia
A type of herniation where part of the stomach pushes (protrudes) up through the hole in the diaphragm next to the oesophagus
Rolling hiatus hernia
Mucosal defense involves which two types of physical barriers? Give 2 examples for each type of physical barrier
Anatomical physical barriers (e.g. epthielial barriers and peristalsis)
Chemical physical barriers (e.g. enzymes and pH)
What is the role GALT plays in the active and innate immunological response? (2)
Producing lymphoid cells and antibodies
How does follicle associated epithelium (FAE) differ from normal epithelium of the intestinal tract? (3)
No goblet cells
No secretory IgA
No microvilli
Briefly explain how dendritic cells play a role in antigen sampling
Dendritic proccesses can pass through the tight junction of the epithilial cells, enabling them to sample antigens present within the lumen.
They the trnasfer the anrtigens sampled and deliver them to mesenteric lymph nodes
Explain the role of secretory IgA in the gut lumen
sIgA binds luminal antigen preventing its adhesion and consequent invasion.
List 2 parasitic causes of infectious diarrhoea (gastroenteritis)
Giardia lamblia
Entamoeba histolytica
What is the main treatment option for a patient infected with campylobacter.
Treatment not usually required (unless extremely unwell)
If so Azithromycin (macrolide) is the standard antibiotic
What is the step by step management plan for a patient who has a C.diff infection?
Isolate the patient
Stop current antibiotics
Give Metronidazole or Vancomycin
May consider Faecal Microbiota Transplantation (FMT) (98% cure rate)
What is the avergae resting pressure of the lower oesophageal sphincter
20mmHg
Give 5 examples of diseases which can lead to secondary causes of achlasia
Chagas’ Disease (parasitic infection)
Protozoa infection
Amyloid
Sarcoma (Cancer)
Eosinophilic Oesophagitis
