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Year 2 > Gastric Diseases > Flashcards

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
Q

How is reflux controlled

A

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

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26
Q

What classification do we use when doing endoscopy to gauge extent of damage

A

Los Angees classification of GORD

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27
Q

How is GORD treated

A
  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
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28
Q

What antacid is given for GORD

A

MAGNESIUM TRISILICATE MIXTURE

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29
Q

Effects of MAGNESIUM TRIPLICATE MIXTURE

A

Relieves symptoms by forming a gel or foam raft with gastric contents to reduce reflux

30
Q

Side-effect of MAGNESIUM TRIPLICATE MICTURE

A

Cause diarrhoea due to Mg

31
Q

Treatment for GORD

A
  1. Antacids
  2. Alignates
  3. PPI
  4. H2 receptor antagonist
32
Q

What alienate is given and why

A

GAVISCON (relieves symptoms)

33
Q

What PPI is given for GORD

A

LANZOPRAZOLE

34
Q

What H2 receptor antagonist is given for GORD

A

CIMETIDINE

35
Q

How does CIMETIDINE work

A

Blocks histamine receptors on parietal cells

36
Q

Surgical intervention for GORD

A
  1. Nissen fundoplication
37
Q

Aim of nissen fundoplication

A

Aims to laparoscopically increase resting LOS pressure (SEVERE GORD)

38
Q

Complications of Nissen fundoplication

A

Dysphagia and bloating

39
Q

Complication of GORD

A
  1. Peptic stricture

2. Barrett’s Oesophagus

40
Q

What is Peptic stricture pathophysiology

A
  1. Inflammation of oesophagus results form gastric acid exposure resulting in narrowing and stricture of oesophagus
41
Q

Where do peptic strictures occur

A

Patients over 60

42
Q

Clinical presentation of peptic stricture

A
  1. Presents as gradually worsening dysphagia
43
Q

How is peptic stricture treated

A

Endoscopic dilatation

Long-term PPI therapy

44
Q

What is always present in Barret’s oesophagus caused by GORD

A

Hiatus hernia

45
Q

What is the risk of having Barrett’s oesophagus

A

Risk of progression to oesophageal cancer

46
Q

What is mallory-weirs tear

A

Linear mucosal tear occurring at oesophagogastric junction and produced by a sudden increase in intra-abdominal pressure

47
Q

What usually causes mallory-weirs tears

A
  1. Bouts of coughing or retching
  2. Alcoholic ‘dry heaves’
  3. Forceful vomiting
  4. Male
  5. NSAID abuse
48
Q

Clinical features of Mallory-Weiss Tear

A
  1. VOMITING
  2. HAEMATEMESIS AFTER VOMITING
    3 .RETCHING
  3. POSTURAL HYPOTENSION
  4. DIZZINESS
49
Q

Differential diagnosis of Mallory-Weiss tear

A
  1. Gastroenteritis
  2. Peptic ulcer
  3. Cancer
  4. Oesophageal varices
50
Q

How is mallory-weirs tear diagnosed

A

Endoscopy

51
Q

How is mallory-weirs tear treated

A
  1. Minor bleeds and heal in 24 hours
  2. Haemorrhages tend to stop
  3. Surgery involves sewing the tear (not common)
52
Q

What characterises dyspepsia

A
  1. Postprandial (after-eating) fullness
  2. Early satiation
  3. Epigastric pain or burning for more than 4 weeks
53
Q

Define dyspepsia

A

Describes a number of upper abode symptoms (e.g. heart, epigastric pain or discomfort)

54
Q

What is the most common form of dyspepsia

A

Functional dyspepsia

55
Q

What causes dyspepsia

A

Peptic Ulcers

56
Q

Clinical presentation of dyspepsia

A
  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
Q

What are red flag alarm symptoms for cancer and not dyspepsia

A
  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
Q

What is melaena

A

Dark tar like black stools

59
Q

Differential diagnosis of dyspepsia

A
  1. Heartburn/Rurgitation/Cough
  2. Alarm symptoms
  3. Acute vs Chronic
60
Q

Differential diagnosis if early postprandial pain is involved

A

Gastritis, GORD or gastric carcinoma

61
Q

Differential diagnosis if postprandial pain is involved

A

Gastric ulcer

62
Q

Differential diagnosis if pain is relieved by milk

A

Gastric ulcer

63
Q

How is dyspepsia managed

A
  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
Q

Name an antidepressant given for dyspepsias

A

CITALOPRAM (reduces sensitivity of the gullet

65
Q

How many layers does the duodenum have

A

Two smooth muscle layers

outer longitudinal and inner smooth

66
Q

What structure does the duodenum connect to

A

Jejunum

67
Q

What cells are found in the upper two thirds of the stomach

A
  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
Q

What cells are found in the antral part of the stomach

A
  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
Q

Role of prostaglandins in the stomach

A

Stimulate the secretion of mucus

70
Q

Role of Brunner’s gland sin the duodenum

A

Secrete alkaline mucus

Year 2 (155 decks)

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