GI 5 Flashcards
What mechanisms prevent gastric reflux?
Lower oesophageal sphincter (LES):
Usually closed, transiently relaxes to allow bolus through
Stomach:
Angle of His and mucosal flap valve, as well as the postero-lateral location of the fundus all prevent acid reaching the LES and refluxing
Diaphragm:
Right crus of diaphram acts as a sling around the oesophagus serving as an ‘extrinsic’ sphincter
The failure of anti-reflux mechanisms leads to what?
Prolonged contact of gastric juices with oesophageal mucosa
Gastro-oesophageal reflux disease and associated symptoms
What are the typical clinical features of Gastro-oesophageal reflux disease (GORD)?
Dyspepsia
Worsens on lying down, bending over or drinking hot drinks
What investigations are indicated by a history that leads you to suspect GORD?
No investigations done in typical clinical presentations
Only if worrying symptoms, such as dysphagia or hiatus hernia are suspected
Endoscopic investigation in this case
What are some of the risk factors for GORD?
Pregnancy or obesity
Fat, Chocolate, Coffee or Alcohol
Large meals
Smoking
Hiatus hernia
List lifestyle management techniques to prevent/treat GORD
Lose weight
Stop smoking
Reduce consumption of chocolate, coffee, alcohol, fatty foods
Outline the types of treatment available for GORD, including their mechanism and an examples of each type
Simple antacids:
Neutralises acid with a base
E.g. Calcium carbonate
Raft antacids (alginates):
Forms a protective raft that sits on top of stomach contents and prevents reflux
E.g. Gaviscon
PPIs:
Reduction of acid secretion by oxyntic cells
E.g. Omeprazole
H2 antagonists:
Blocks H2 receptor which reduces acid secretions
E.g. Ranitidine
What is a common complication of GORD?
Continual contact of gastric juices and oesophageal mucosa can lead to metaplastic change (Barrett’s Oesophagus)
What is Gastritis?
Chronic or acute inflammation of the gastric mucosa
Differentiate acute and chronic gastritis
Chronic:
Infection with H. pylori
Inflammatory changes to mucosa leadsing to atrophy and metaplasia (possible cancer)
Acute:
NSAIDs, Alcohol, Cocaine
Exfoliation of surface cells and decreased secretion of protective mucus
What are the common symptoms of gastritis?
Commonly asymptomatic
Symptoms when they appear include:
- Dyspepia (Pain/Discomfort)*
- Nausea*
- Vomiting*
- Haematemesis*
- Melena*
Outline the complications of Gastritis
Increases risk of Peptic ulcer disease
Chronic gastritis can cause hypergastrinaemia due to increasing gastrin release from G cells, this in turn can lead to Duodenal ulceration (DU)
Chronic Antral H. Pylori gastritis can lead to Gastric cancer and mucosa associated lymphoid tissue lymphoma (MALT Lymphoma)
How is gastritis diagnosed?
Endoscopy/Biopsy
Testing for H. Pylori
Blood test (Anaemia due to GI bleed)
Stool test (Blood due to GI bleed)
What types of drugs are used to treat gastritis?
Antacids
PPIs
H2 antagonists
General theme is reduction in acid secretion for promotion of healing
Antibiotics
E.g. Clarithromycin/Amoxacillin
Treatment of H. Pylori infection
What is peptic ulcer disease?
A break in the superficial epithelial cells down to the muscularis mucosa of either stomach (GU) or duodenum (DU)
Where are peptic ulcers commonly found?
GU:
Lesser curvature and antrum
DU:
Duodenal cap
Outline the most common cause of peptic ulcer disease
Give statisitics
NSAIDs:
Inhibit prostaglandins and reduce production of unstirred layer of mucus
50% of patients with long term NSAIDs have mucosal damage
30% when endoscoped have petic ulcer(s)
5% are symptomatic
1-2% have complications such as GI bleed
What is the prevlance of the different forms of peptic ulcer disease and how do prevalence rates vary across ages and countries?
DU in 10% adult population
GU is 2-3x less common (3-5%)
Prevalence is lower among younger adults and higher in older
Developing countries have increasing prevalence of NSAID associated DU and decreasing prevalence of H. Pylori associated ulceration
What are the clinical features of Peptic ulcer disease?
Reccurent, burning epigastric pain:
Worse at night and when hungry in DU
Relieved by eating
Persistent severe pain:
Suggestive of penetrtion of ulcer into other organs
Back pain:
Suggests penetration of ulcer in posterior stomach
Nausea and vomitting:
Less common
Weight loss and anorexia:
GUs only
Sudden haematemesis:
Asymptomatic patients can suddenly present with haematemesis when a blood vessel is erroded
What are the common investigations for suspected Peptic ulcer disease?
Investigation of H. Pylori infection
In 55+ patients or those with alarming symptoms an endoscopy can be done to exclude cancer