Gastrointestinal Disease Flashcards
What are the main purposes of medication used to treat Upper GI disease?
- Eliminate formed acids
- antacids - Reduce acid secretion
- H2 receptor blockers
- proton pump inhibitors
What are the 3 main stomach acids?
- Acetylcholine
- Gastrin
- Histamine
What type of cell secretes stomach acid?
Parietal cell
How do H2 receptor agonists reduce acid production?
By preventing histamine activation of acid production
Why is the benefit of h2 receptor agonists limited?
Alternative pathways are still operative:
- acetylcholine
- gastrin
What are the 2 most common H2 receptor agonists?
- Cimetidine
- original H2 blocker
- many drug interactions
- not fully effective - Ranitidine
- not any more effective
- safer in clinical use
- licensed for over the counter sale
What drug alternative is much more clinically effective at inhibiting acid secretion than H2 receptor agonists?
Proton pump inhibitors
- omeprazole
- lansoprazole
- pantoprazole
Where does upper GI disease start?
Mid oesophagus
What process can be used to examine the interior of the stomach and other tissues?
Endoscopy
- can be with a tube or a capsule
What is the oesophageal disorder that causes difficulty in swallowing food?
Dysphagia
What dysmotility disorders can also lead to dysphagia?
- Fibrosis
- scleroderma
- acid related fibrosis (GORD - gastro osophageal reflux disease)
. Causes chronic irritation leading to loss of specialised tissue
What process occurs in scleroderma that leads to dysphagia?
Elastic tissue is replaced by fibrous tissue which no longer allows the oesophagus to contract and propel bolus
What neuromuscular dysfunctions can lead to dysphagia?
- Parkinson’s disease
- Diabetes mellitus
- Achalasia - nerve supply to oesophagus does not form properly
Briefly describe dysphagia
- Food sticking
- intermittent or constant - Localised well by patient
- May be ‘functional’
- May be dysmotility
- May be external compression
What are the 3 main causes of Gastro Oesophageal Reflux Disease (GORD) ?
- Defective lower oesophageal sphincter
- Impaired lower clearing
- Impaired gastric emptying
What are the effects of GORD?
- Ulceration
- Inflammation
- Metaplasia (gastric)
- Barrett’s Oesphagitis
- precancerous - adenocarcinoma
What are signs and symptoms of GORD?
- Epigastric burning
- worse lying down, bending, pregnancy - Dysphagia
- oesophagitis, stricture, dysmotility - GI bleeding
- Severe pain - mimics MI
- oesophageal muscle spasm
Briefly describe hiatus hernia
- Part of the stomach is in the thorax
- passes up through the diaphragm
- makes it easier for gastric contents t pass into the oesophagagus - Symptoms can be similar to GORD
- More common in women
- Multiple types
- hiatus hernia can move through the diaphragmatic hole together with the oesophagus
- Hiatus hernia and oesophagus can behave independently
What are the main methods (lifestyle and medicine) that are used to treat GORD?
- Lifestyle
- smoking cessation (improves sphincter)
- lose weight and avoid triggering activity (bending over) - Medication
- antacids
- H2 blockers and PPI’s (ranitidine and omeprazole
- drugs that increase GI motility and gastric emptying
