Dyspepsia, GORD & GI Ulcers Flashcards
Define GOR
Gastric-oesophageal reflux:
When the acidic contents of the stomach flows back into the oesophagus
Define GORD
When symptoms of GOR affects one’s wellbeing
Symptoms occur 2+ /week
Define Dyspepsia
Group of symptoms affecting upper abdomen:
- heartburn
- upper abdominal pain
- bloating
No obvious cause eg. Ulcer
Oesophagus?
- muscular tube
- collapsed when not involved in transporting food to stomach
- thickening of circular smooth muscle - where oesophagus joins the stomach
Lower Oesophageal Sphincter
- valve - keeping stomach contents out of the oesophagus
- relaxes - during swallowing, allowing food to pass
- constricts - preventing acidic contents of stomach into oesophagus
Why might the presence of the acidic stomach content in the oesophagus be an issue?
- the acid can break down tissue in the oesophagus which can cause inflammation and ulcers
- the stomach has a mucosal lining which protects it from HCI, but the oesophagus does not
Pathophysiology of GORD
Reflux occurs when there is a loss of LOS tone
- Relaxation of the sphincter naturally occurs when the stomach expands, Allowing small amounts of acid into the oesophagus after meals
= Transient Lower Esophageal Sphincter Relaxations
When are gastric contents more likely to reflux?
- after meals
- gastric volume is increased
- gastric pressure is increased
- gastric contents are near junction
- obesity, pregnancy, tight clothes 
Causes of GORD?
- genetics (higher risk if immediate family is sufferer
- age (increased incidence with increase age)
- gender
- pregnancy
- fatty and spicy foods, mint, caffeine
- obesity
- stress
- smoking
Which medication are linked with GORD?
- antibiotics
- anticholinergics
- antidepressants
- iron/potassium supplements
- NSAIDs
- BZDs
- progesterone
- calcium channel blockers
What is Hiatus hernia?
An abnormally where the top part of the stomach squeezes into the chest, through diaphragm through the diaphragm hiatus
Increase amount of gastric juice enters oesophagus
Symptoms of Hiatus Hernia
- heartburn
- waterbrash
- regurgitation
Complications of Hiatus Hernia?
Reflux oesophagitis
- non-erosive - mucous is normal or red in colour
- erosive - mucosal damage and ulcer
Stricture
Barrett’s oesophagus
Adenocarcinoma (cancer of mucous producing cells)
Hiatus in Babies?
- doesn’t usually require investigation
- medical treatment if: gagging, chocking, pneumonia
Causes of Dyspepsia?
- reflux
- PUD
- H.pylori
What are Dyspepsias reg flags
- > 55
- abdominal bloating/pain
- GI bleeding
- difficulty swallowing
- weight loss
^ refer to GP
Non-pharmacological treatment for GORD/Dyspepsia?
- healthy eating
- smoking cessations
- avoid eating large meals before bed
- raise bedhead at night
Which class of medications are used in dyspepsia/GORD?
- Antacids
- H2 Antagonist
- PPI
Antacids MOA
Neutralises HCI, which is secreted by parietal cells
Examples of Antacids?
- magnesium salts
- aluminium hydroxide
- sodium carbonate
Antacids Interactions?
- phenytoin - decreases absorption of phenytoin, causing loss of seizure control
- quinolone - decreases absorption causing loss of antibiotic efficacy
Antacid with Simethicone?
Antifoaming agents - relieves flatulence
Antacids with alginates
Rafting agent - help viscosity of stomach content, protecting oesophagus from acid content
H2 Antagonist MOA?
Competitively blocks H2 receptors, reducing acid secretion
