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Gastric Diseases Flashcards

1
Q

What is GORD

A

Gastro-oesophageal reflux disease

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2
Q

What characteristics define GORD

A
  1. Reflux of gastric contents is normal but when there is prolonged contact of gastric contents with mucosa this results in clinical symptoms
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3
Q

What three disease can be caused by prolonged reflux

A
  1. Oesophagi’s
  2. Stricture
  3. Barrett’s Oesophagus
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4
Q

What conditions can cause GORD

A
  1. Lower oesophageal sphincter hypotension

2. Loss of oesophageal peristaltic function

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5
Q

How do hiatus hernias result in GORD

A
  1. Sliding: Where gastro-oesophageal junction + part of the stomach slides up into the chest via the hiatus so it lies above the diaphragm
  2. Rolling: Where gastro-oesophageal junction remains in the abdomen but part of the funds of the stomach prolapses through the hiatus alongside the oesophagus
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6
Q

Other causes of GORD

A
  1. Abdo obesity
  2. Gastric acid hyper secretion
  3. Slow gastric emptying
  4. Overeating
  5. Smoking
  6. Alcohol
  7. Pregnancy (results in increased abode pressure)
  8. Fat, chocolate, coffee or alcohol ingestion
  9. Drugs
  10. Systemic sclerosis
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7
Q

Why does reflux not happen in rolling hiatus

A

Because the gastro-oesophageal junction remains intact

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8
Q

In GORD, what muscles are relaxed between swallows and which are not

A

Muscles of oesophagus are relaxed

Upper + Lower oesophageal sphincters

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9
Q

When does the LOS open

A

Relaxes when swallowing is initiated

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10
Q

What happens to the LOS in GORD

A

Some random relaxation is normal but reduced tone in GORD allows gastric acid to flow back into the oesophagus

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11
Q

When do clinical features of GORD appear

A

When anti-reflux mechanisms fail, allowing acid gastric contents to make prolonged contact with lower oesophageal mucosa

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12
Q

Difference between how the LOS and UOS work

A

LOS relaxes when swallowing is initiated

UOS is released independently of a swallow

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13
Q

What four factors contribute to GORD

A
  1. Increased mucosal sensitivity to gastric acid
  2. Reduced oesophageal clearance of acid
  3. Delayed gastric emptying
  4. Prolonged post-prandial (after-eating)
  5. Nocturnal reflex
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14
Q

How does a hiatus hernia contribute to GORD

A

Impairs anti-reflux mechanism

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15
Q

Clinical presentation of GORD

A
  1. Heartburn
  2. Belching
  3. Food/Acid brash (food, acid or bile regurgitation)
  4. Water brash (Increased salivation )
  5. Odynophagia (painful swallowing)
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16
Q

How do you tell if someone has heartburn

A
  1. Aggravates by bending, stooping or lying down which promotes acid exposure
  2. Relieved by antacids
  3. Worse with hot drinks or alcohol
  4. Seldom radiates to arms
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17
Q

Four extra-oesophageal symptoms of GORD

A
  1. Nocturnal asthma
  2. Chronic cough
  3. Laryngitis (hoarseness and throat clearing)
  4. Sinusitis
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18
Q

Differential diagnosis of GORD

A
  1. CAD
  2. Biliary colic
  3. Peptic ulcer disease
  4. Malignancy
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19
Q

How can GORD be diagnosed

A
  1. Only if alarm bell signs:
  2. Endoscopy
  3. Barium swallow
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20
Q

When is an endoscopy done for GORD

A
  1. Symptoms for more than 4 weeks
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21
Q

What are alarm bell signs of GORD

A
  1. Dysphagia
  2. Weight Loss
  3. Haematemesis
  4. Persistent vomiting
  5. GI bleeding
  6. Palpable mass
  7. Over 55
  8. Symptoms despite treatment
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22
Q

Role of Barium Swallow in GORD

A

Hiatus Hernia

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23
Q

Role of endoscopy

A

Assesses oesophagi’s and hiatal hernia

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24
Q

What two conditions have reflux

A

Barrett’s oesophagus and oesophagitis

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25
How is reflux controlled
24hr oesophageal pH monitoring is helpful in diagnosing GORD when endoscopy is normal or just prior to surgery to confirm reflux or PPIs don't work
26
What classification do we use when doing endoscopy to gauge extent of damage
Los Angees classification of GORD
27
How is GORD treated
1. Encourage weight loss 2. Smoking cessation 3. Small,regular meals 4. Avoid: Hot drinks, alcohol, citrus fruits and eating less than 3 hours before bed
28
What antacid is given for GORD
MAGNESIUM TRISILICATE MIXTURE
29
Effects of MAGNESIUM TRIPLICATE MIXTURE
Relieves symptoms by forming a gel or foam raft with gastric contents to reduce reflux
30
Side-effect of MAGNESIUM TRIPLICATE MICTURE
Cause diarrhoea due to Mg
31
Treatment for GORD
1. Antacids 2. Alignates 3. PPI 4. H2 receptor antagonist
32
What alienate is given and why
GAVISCON (relieves symptoms)
33
What PPI is given for GORD
LANZOPRAZOLE
34
What H2 receptor antagonist is given for GORD
CIMETIDINE
35
How does CIMETIDINE work
Blocks histamine receptors on parietal cells
36
Surgical intervention for GORD
1. Nissen fundoplication
37
Aim of nissen fundoplication
Aims to laparoscopically increase resting LOS pressure (SEVERE GORD)
38
Complications of Nissen fundoplication
Dysphagia and bloating
39
Complication of GORD
1. Peptic stricture | 2. Barrett's Oesophagus
40
What is Peptic stricture pathophysiology
1. Inflammation of oesophagus results form gastric acid exposure resulting in narrowing and stricture of oesophagus
41
Where do peptic strictures occur
Patients over 60
42
Clinical presentation of peptic stricture
1. Presents as gradually worsening dysphagia
43
How is peptic stricture treated
Endoscopic dilatation Long-term PPI therapy
44
What is always present in Barret's oesophagus caused by GORD
Hiatus hernia
45
What is the risk of having Barrett's oesophagus
Risk of progression to oesophageal cancer
46
What is mallory-weirs tear
Linear mucosal tear occurring at oesophagogastric junction and produced by a sudden increase in intra-abdominal pressure
47
What usually causes mallory-weirs tears
1. Bouts of coughing or retching 2. Alcoholic 'dry heaves' 3. Forceful vomiting 4. Male 5. NSAID abuse
48
Clinical features of Mallory-Weiss Tear
1. VOMITING 2. HAEMATEMESIS AFTER VOMITING 3 .RETCHING 4. POSTURAL HYPOTENSION 5. DIZZINESS
49
Differential diagnosis of Mallory-Weiss tear
1. Gastroenteritis 2. Peptic ulcer 3. Cancer 4. Oesophageal varices
50
How is mallory-weirs tear diagnosed
Endoscopy
51
How is mallory-weirs tear treated
1. Minor bleeds and heal in 24 hours 2. Haemorrhages tend to stop 3. Surgery involves sewing the tear (not common)
52
What characterises dyspepsia
1. Postprandial (after-eating) fullness 2. Early satiation 3. Epigastric pain or burning for more than 4 weeks
53
Define dyspepsia
Describes a number of upper abode symptoms (e.g. heart, epigastric pain or discomfort)
54
What is the most common form of dyspepsia
Functional dyspepsia
55
What causes dyspepsia
Peptic Ulcers
56
Clinical presentation of dyspepsia
1. Reflux when lying flat 2. Heartburn 3. Acid taste (due to reflux) 4. Bloating 5. Indigestion (feeling full and can't sleep after a heavy meal)
57
What are red flag alarm symptoms for cancer and not dyspepsia
1. Unexplained weight loss 2. Anaemia 3. Evidence of GI bleeding (malaena) 4. Dysphagia 5. Upper abdo mass 6. Persistent vomiting 7. Over 55 (increased risk)
58
What is melaena
Dark tar like black stools
59
Differential diagnosis of dyspepsia
1. Heartburn/Rurgitation/Cough 2. Alarm symptoms 3. Acute vs Chronic
60
Differential diagnosis if early postprandial pain is involved
Gastritis, GORD or gastric carcinoma
61
Differential diagnosis if postprandial pain is involved
Gastric ulcer
62
Differential diagnosis if pain is relieved by milk
Gastric ulcer
63
How is dyspepsia managed
1. Reassurance 2. Dietary review 3. Antidepressants 4. Look for helicobacter pylori using faecal antigen testing or breath test 5. Endoscopy to find a clear picture of whats going on
64
Name an antidepressant given for dyspepsias
CITALOPRAM (reduces sensitivity of the gullet
65
How many layers does the duodenum have
Two smooth muscle layers | outer longitudinal and inner smooth
66
What structure does the duodenum connect to
Jejunum
67
What cells are found in the upper two thirds of the stomach
1. Parietal cells (secrete HCL) 2. Chief cells (produce pepsinogen and initiate proteolysis - the digestion of proteins) 3. ECL cells - release histamines (stimulate acid release)
68
What cells are found in the antral part of the stomach
1. Mcuus secreting cells (secrete mucin and bicarbonate) 2. G cells (secrete gastrin = acid release) 3, D cells (secrete somatostatin that surpasses acid secretion)
69
Role of prostaglandins in the stomach
Stimulate the secretion of mucus
70
Role of Brunner's gland sin the duodenum
Secrete alkaline mucus

Year 2 (155 decks)

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