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Gastrointestinal > Gastritis & GORD > Flashcards

Gastritis & GORD Flashcards

1
Q

Define gastritis

A

Inflammation of the stomach mucosal lining

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2
Q

Gastritis classifications

A
  • Antral or pangastritis
  • Acute or chronic gastritis
  • Erosive or non-erosive
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3
Q

RFs for Gasritis

A

ALCOHOL
NSAIDs
HPylori
HLA-DR3 B8
Granulomas

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4
Q

Acute gastritis

A

inflammation of the gastric mucosa

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5
Q

Chronic gastritis

A

chronic inflammation of gastric mucosa → epithelial metaplasia, mucosal atrophy and gland loss. Metaplasia may also lead to dysplasia and so there is risk of cancer.

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6
Q

Aetiology of acute gastritis

A

Helicobacter pylori
Alcohol abuse
Stress
NSAIDs

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7
Q

Aetiology of chronic gastritis

A

H pylori 80%
Autoimmune gastritis

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8
Q

How does H pylori cause gastritis

A
  • Causes severe inflammatory response
  • Gastric mucus degradation and increased mucosal permeability, which is directly cytotoxic to the gastric epithelium: since H.pylori produces urease which converts urea to ammonia and CO2 which is toxic since ammonia and H+ (from HCl) form ammonium which damages gastric mucosa resulting in less mucous production.
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9
Q

What are the different types of gastritis

A

Type a -autoimmune
Type b- antral gastritis - h pylori
Reflux gastritis- bile refluxes into stomach
Erosive- due to nsaids
Stress ulceration- a result of mucosal ischaemia

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10
Q

Explain the background of autoimmune chronic gastritis

A

Parietal cell antibodies
and intrinsic factor antibodies in fundus and body of stomach → reduce vit B12 absorption in terminal ileum → pernicious anaemia

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11
Q

How doe NSAIDs like naproxen cause gastritis

A

Inhibit prostaglandins (which stimulate mucus production) via the inhibition of cyclo-oxygenase resulting in less mucus production and thus gastritis

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12
Q

Signs and symptoms of gastritis

A

Dyspepsia
Epigastric pain
Anorexia
N&V

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13
Q

Investigations for gastritis

A

Helicobacter pylori infection - Urea breath test
Biopsy
Stool antigen test - H pylori
Endoscopy
Autoimmune antibodies

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14
Q

Differential diagnoses for gastritis

A

Peptic ulcer disease (PUD)
GORD
Gastric carcinoma

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15
Q

Management of gastritis

A

H pylori eradication - triple therapy PPI and 2 antibiotics twice a day for 7 days
Stop nsaids
No alcohol

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16
Q

First line management of gastritis if H pylori positive

A

PPI+ Amoxicillin. 1g + clarithromycin 500mg

17
Q

Complications of gastritis

A

Peptic ulcers
Bleeding and anaemia
MALT lymphoma
Gastric cancer
Vitamin B12 deficiency

18
Q

What happens once you lose mucin

A

Excess acid can enter the stomach lining this can cause an ulcer

19
Q

How would you reverse the mucosal ischamaie

A

Treat with colloids

20
Q

how would you reduce acid in stomach

A

hydrogen blocker
proton pump inhibitor

21
Q

What is GORD

A

Reflux of gastric contents into the oesophagus due to lower oesophageal sphincter relaxation

22
Q

Risk factors for GORD

A

Obesity
Pregnancy
Hiatus Hernias
NSAID’S
Alcohol

23
Q

Physiology of GORD

A

O propels food into stomach via perilstalsis > at gastro-o junction LOS relaxes so food can enter stomach > after entry contracts to prevent reflux of stomach contents

If LOS relaxes or becomes loose due to drop in pressure stomach content will wash back into oesophagus

24
Q

pathophysiology in GORD

A
  • LOS pressure gets lower - reflux for longer - pathological
  • Persistent acid reflux damages the oesophageal mucosa, causing local inflammation > oedema + erosion of mucosa
  • As the epithelium is damaged, it is replaced by scar, making the walls thicker and the lumen narrower
25
Q

Signs and symptoms of GORD

A
  • Heartburn - retrosternal burning chest pain
  • Regurgitation
  • epigastric pain
  • dysphagia
26
Q

Why is GORD worse when lying down

A

easier for acid to regurgitate

27
Q

In what patients with suspected gord would you use an urgent 2 week referral

A

Dysphagia or over 55 with weight loss and one of the following

  • Upper abdo pain
  • Reflux
  • Dyspepsia
28
Q

what may endoscopy show for GORD

A
  • Oesophagitis
  • Barrets oesophagus
29
Q

Clinical investigations for GORD

A

-FBC
-24HR pH monitoring
- Upper GI Endoscopy

30
Q

Conservative management of GORD

A
  • SMOKING CESSATION
  • reduce alcohol
  • lose weight
  • eat smaller meals
31
Q

Medical management of GORD

A
  • GAVISCON
  • PPI or H2 receptor antagonists id CI

Lifestyle changes - eat better dktn smoke dietery modifications

32
Q

What is a common complication of GORD

A
  • metaplasia of stratified squamous to simple columnar epithelium
33
Q

Complications of GORD

A
  • Typical reflux syndrome
  • Reflux chest-pain syndrome
  • Barrett’s oesophagus(premalignant condition in the oesophagus due to columnar metaplasia)
  • Reflux cough syndrome
  • Reflux laryngitis syndrome: reflux goes all the way up to throat and down the larynx
  • Reflux asthma syndrom
34
Q

Last resort management of GORD

A

Surgical tightening of LOS

35
Q

What is barrets oesophagus

A

metaplasia of stratified squamous non keratinising epithelia to simple columnar

causes the oesophagus to be red and inflamed

36
Q

what does barrets oesophagus increase the likelihood of?

A

adenocarcinoma

Gastrointestinal (13 decks)

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