Gastro-oesophageal Inflammation and Peptic Ulcers Flashcards
What is Achalasia?
decreased tone of lower oesophageal sphincter:
- can be caused by impaired by smooth muscle relaxation or oesophageal obstruction
What is the Achalasia triad?
- incomplete LES relaxation
- increased LES tone
- aperistalsis of the oesophagus
What are the causes of Achalasia?
Primary:
- neuronal or ganglion cell degeneration (related to vagus n.)
- familiar causes
Secondary:
- Chagas disease (destruction of myenteric plexus)
- diabetic autonomic neuropathy
- amyloidosis
- sarcoidosis
- polio
- Downs Syndrome
- Herpes Simplex infection
What is the treatment for Achalasia?
- laparoscopic myotomy
- balloon dilation
- botox injection
What are the acute and chronic causes of oesophageal inflammation?
Acute:
- infection in immunosuppressed patients (HSV, candida, CMV and corrosives)
Chronic:
- TB
- bullous pemphigoid
- epidermolysis bullosa
- Crohn’s Disease
Non-specific:
- reflex oesophagitis
What is reflux oesophagitis and its causes?
- regurgitation of gastric contents due to incompetent gastro-oesophageal junction
- can be due to alcohol and tobacco, obesity, drugs, hiatus hernia and motility disorders
What can GORD cause?
- eopsinophils epithelial infiltration
- basal cell hyperplasia
- chronic inflammation
- severe reflux can lead to ulceration which can lead to healing by fibrosis
What is Barrett’s oesophagus?
- longstanding reflux where lower oesophagus becomes lined by columnar epithelium due to intestinal metaplasia
- premalignancy which increases risk of adenocarcinoma
What are the acute and chronic causes of gastric inflammation (gastritis)?
Acute:
- chemical injury (NSAIDS/alcohol, can alsp be H pylori associated)
Chronic:
- active chronic is H. pylori associated
- can be autoimmune
- can be due to chemical reflux
Describe the pathogenesis of H. pylori
- H.pylori produces urease which produces ammonia which neutralises pH of stomach allowing colonisation
- then causes mucosal damage which leads to inflammation and mucosal cell death
What are the symptoms of an acute H. pylori infection?
- nausea
- dyspepsia
- malaise
- halitosis
What happens in an acute H. pylori infection?
gastric mucosa is inflamed with neutrophils and inflammatory cells with marked persistent lymphocyte penetration
Describe the 2 distribution patterns seen with H. pylori associated gastritis
diffuse involvement of antrum and body:
- atrophy, fibrosis and intestinal metaplasia
- associated with gastric ulcers and cancers
antral but no body involvement:
- gastric acid secretion is increased
- associated with duodenal ulcers
What is chemical (reflux) gastritis and what is associated with it?
- irritation of the stomach caused by regurgitation of bile and alkaline duodenal secretion
- loss of epithelial cells with compensatory hyperplasia of gastric pits
- associated with defective pylorus or motility disorders
What is autoimmune chronic gastritis and what is it associated with?
- autoimmune reaction to gastric parietal cells resulting in loss of acid secretion
- decreased stomach acid and intrinsic factor
- causes vitamin B12 deficiency (pernicious anaemia)
- associated with marked gastric atrophy and intestinal metaplasia
What are peptic ulcerations?
- breach in mucosal lining of alimentary tract as a result of acid and pepsin attack
Where are the major sites of peptic ulceration?
- first part of duodenum
- junction of antrum and body mucosa in stomach
- distal oesophagus
- gastro-enerostomy stoma
What are the aetiological factors for peptic ulceration?
- hyperacidity
- H. pylori gastritis
- duodenal reflux
- NSAIDs
- smoking
- genetic factors
- Zollinger-Ellison syndrome
What are some of the complications of peptic ulcers?
- haemorrhage
- penetration of adjacent organs
- perforation
- anaemia
- obstruction
- malignancy
What are some defining features that differentiate between gastric and duodenal ulcers?
Duodenal:
- more common
- commonly blood group O
- acid levels are high or normal
Gastric:
- blood group A
- acid levels are low or normal
What are some acute causes of peptic ulcers?
- acute gastritis
- stress response
- extreme acidity
What is the pathogenesis of chronic peptic ulcers and where do they normally occur?
- patho-hyperacidity and mucosal defence defects
- most commonly occur at mucosal junctions
Describe why chronic duodenal ulcers can occur?
- increased acid production
- reduced mucosal resistance
What are the complications of ulcers?
- bleed, block or burst
- can have penetration of adjacent organs
- can have malignant changes altho rare in gastric ulcers and never in duodenal
Describe the defined structure of ulcers
- granulation tissue at base
- underlying inflammation and fibrosis
- loss of muscularis propria
