GERD and PEPTIC ULCER Flashcards
Different Parts : Upper1/3; middle1/3; lower 1/3
Muscularis
mucosae (smooth
muscle)
Submucosal
glands
Muscularis
externa
Absent in beginning; longitudinal; Inner
circular & outer Longitudinal
Absent; Absent; present
Skeletal muscle ; Skeletal & smooth muscle ; smooth muscle
Diseases of the oesophagus
Congenital- oesophageal ________, __________ fistula, vascular _____, ———,———
Diverticuli- ________
___________
atresia; tracheoesophageal; ring
webs, duplication
Achalasia
Diseases of the oesophagus
Inflammatory-_____ disease, ___________, candidiasis, ________ disease
Neoplasm- ____________ ca, ___________
Reflux; Barrett’s oesophagus
Crohn’s
Squamous cell ; Adenocarcinoma
Zenker’s diverticulum, also known as ___________ diverticulum, is a type of diverticulum that forms in the _______, specifically in the area called the __________.
It is a _____-like protrusion that develops as a result of ___________ within the pharynx during swallowing.
pharyngoesophageal
pharynx; Killian triangle
pouch; increased pressure
In achalasia, the _____________, a ring of muscle at the bottom of the esophagus, ________________ during swallowing, leading to difficulty in _______________________
lower esophageal sphincter (LES)
fails to relax properly
moving food and liquid from the esophagus into the stomach.
Oesophagitis- Causes
Lacerations-________ syndrome
Chemical- alcohol, corrosive acids
or alkalis, heavy cigarette smoking,
drugs, radiation therapy
Infection: ________ virus, ________,
Fungal(_________)
Mallory-Weiss
Herpes simplex; CMV; candida
Oesophagitis- Causes
____________ ——- disease
______ disease
_______ oesophagitis
______ oesophagitis
Pemphigoid skin
Crohn
Eosinophilic
Reflux
most common cause of Oesophagitis is ??
Reflux oesophagitis
Mallory-Weiss syndrome refers to a condition characterized by a _______ or ______ in the mucous membrane lining the ____________________.
This typically occurs as a result of severe or prolonged _______ or _________.
tear or rupture
junction of the esophagus and stomach
vomiting or retching
Pemphigoid is a group of ________ _______ diseases characterized by the formation of ______ and ______ on the skin and mucous membranes.
autoimmune blistering skin
blisters; erosions
Gastro-oesophageal Reflux Disease(GERD or GORD)
• Reflux refers to a condition in which _________ content moves _____________
• It becomes a disease when _____________ causing ____________ and patient experiences symptoms
acidic stomach; up into the oesophagus.
it occurs frequently ; irritation of the lining
GERD is defined as any symptomatic condition or histopathologic _______________________ resulting from ___________________
alteration of the oesophageal mucosa
episodes of gastro-oesophageal reflux.
Occasionally, everyone experiences
regurgitation of acidic gastric content into the lower oesophagus
T/F
T
Reflux disease
Reflux disease occurs in any of these scenarios:
When there is exposure of oesophageal mucosa to PH
<____ for more than ____% of 24hrs
When ______ causes damage or when
Patient becomes __________
4.0; 4.5
regurgitation
symptomatic
Epidemiology of GERD
Prevalence of GERD is largely unknown in Africa.
T/F
T
Epidemiology of GERD
____-_____ % -Western world
<___% in Asia this was lower
10–20
5
Mechanisms that Protect oesophageal
Mucosa against damaging effect of acid
_______ secretion from ______ glands
______ present in ________
Constant ____________________prevents reflux
Mucin; submucosal
HCO3; saliva
lower oesophageal sphincter tone
Mechanisms that Protect oesophageal
Mucosa against damaging effect of acid
_________ and __________→ neutralize acid
HCO3 and submucosal mucin
Conditions that decrease _____ or increase __________ lead to GERD
LES
abdominal pressure
Predisposing factors for GERD
Factors that decrease LES:
________
________
_______
Delayed __________
Certain foods/drinks (e.g, _____,_______)→decrease LES pressure
Drugs- ______________,
nitrates, _______ ,________
→decrease LES pressure
Pregnancy; Diabetes
Hiatus hernia; gastric emptying
coffee, alcohol
calcium channel blockers
beta-blockers, progesterone
Predisposing factors for GERD
__________
________
__________
Cigarette smoking
Connective tissue disorders, such as
_______
_______________
Obesity
Alcohol
Asthma
scleroderma
Zollinger-Ellison syndrome
Zollinger-Ellison syndrome (ZES) is a (common or rare?) condition characterized by the development of ________-secreting tumors called _______.
Rare; gastrin; gastrinomas
Zollinger-Ellison syndrome (ZES)
These tumors usually form in the _______ or the _______.
pancreas; duodenum
Pathogenesis
The mechanisms that result in GERD include:
_________ ———- of the _____ oesophagus to ________ and ______
____ reflux from duodenum may aggravate damage
Prolonged exposure; distal
acid and pepsin
Bile
Pathogenesis
In a minority of people with reflux disease, normal levels of reflux
of acid and pepsin trigger reflux-induced symptoms.”
T/F
T
Natural Course of GERD
Reflux results in damage to the
________ epithelium and accelerated __________.
The response to the reflux is two fold:
Epithelial(__________ and ——————— ) and _________________ reaction
squamous; desquamation
desquamation and basal cell hyperplasia
Chronic inflammatory
IN GERD
The microscopic changes to the
oesophageal epithelium may be present
even if oesophagus appears normal
grossly on endoscopy
T/F
T
Natural Course of GERD: Inflammatory
response
Intraepithelial infiltration by eosinophil (IEE) occurs (early or late?)
• This is later followed by
_________ and _______
– Healing follows with ______________ , leading to oesophageal ________ and _______
• Other complications
Early
neutrophils and lymphocytes
subepithelial fibrosis; stricture and
narrowing
Morphology of GERD
_________ hyperplasia,_______ , ______ of the papillae and ______ of the ______________
________________ infiltration.
Basal cell ; oedema
elongation; thinning; squamous cell layer
Inflammatory cell
Morphology of GERD
Intraepithelial eosinophils of ____/HPF highly suggestive of GERD
_________ inflammation (non-specific)
___________ inflammation (usually due to _______ or ___________)
<20; Lymphocytic; Neutrophilic
reflux or Helicobacter gastritis
Morphology of GERD
_____________ metaplasia or _________ metaplasia
Dysplasia
Goblet cell intestinal
Barrett’s