gastro oesophageal reflux disease * Flashcards
what is the montreal definition of GERD
it is a chronic disease
more than two heartburn episode in a week and other symptoms and complication
developed from the reflux of stomach contents such as acid , pepsin and bile
it interferes with the PATIENTS LIFESTYLE
what are the oesophageal syndromes of gastroesophageal reflux ? and symptoms
SYNDROMES reflux esophagitis oesophageal strictures barretts esophagus oesophageal adenocarcinoma
Symptoms
regurgitation
chest pain - angina pain worst after meal and lying down
dysphagia - ‘red flag’’ symptom, potentially caused by a tumor
upper gastrointestinal bleeding - red flag
what are the extraesophageal syndrome of GERD?
syndrome reflex cough syndrome = , hoarseness, sore throat reflux pharyngitis reflux laryngitis syndrome reflux dental erosion reflux asthma syndrome
symptom
epigastric pain
reflux esophagitis in GERD is classified according to what system ?
LA (loa angeles ) ENDOSCOPIC classification system for assessment of reflux esophagitis
what are the LA endoscopic classification o reflux esophagitis ?
grade a - where there is mucosal erosion however it not more than 5mm in width and it is not between the superior margins of oesophageal mucosal folds
grade b - more than 5 mm long and does not extend between the superior margins of the mucosal folds
grade c- where it extends between the superior margin of two or more mucosal folds however effects less than 75 recent of the oesophageal circumference o
grade d - involves atleast 75 percent or more of the oesophageal circumference
what is NERD?
non erosive reflux disease
there are reflux symptoms which do not involve the abrasions of the mucosal surface of the oesophagus in endoscopy
what are the DD of GERD ?
oesophageal infections
and eosinophilic esophagitis
functional dyspepsia
irritable bowel syndrome
what stimulates the acid production in the stomach ?
PGE2 and its agonist
gastrin
acetylcholine
histamine 2
all of this activates protein kinases to active the proton pumps in the stomach
where is the chief cells located and what are their function in the stomach ?
deep in stomach lining
pepsinogen
where is the g cells located and what ia their function in the stomach ?
antrum
gastrin
where are the parietal cells located and what are their function?
fundus and cardia
produce acid and INTRINSIC FACTOR
which parasympathetic nerve stimulates acid secretion (from the partial cells) and stomach peristalsis ?
vagus nerve - ACH
what are the treatment options for GERD?
proton pump inhibitors - PRIMARY histamine 2 receptor antagonist anticholinergic drugs prostaglandin inhibitors antacids pro kinetic - promote gastric emptying
frequent and light meals avoid
lying down within 3 h after eating
weight loss
avoid meals before sleep
elevate head for bed
what are some PPI ‘s?
omeprazole
esomeprazole
lansoprazole
usually given before meals
when are injectable PPI’s given ?
in bleeding ulcer and patients in ICU
