GI/ LIVER Flashcards
What is GORD?
Gastro-oesophageal reflux disease–> Where acid from the stomach refluxes through the lower oesophageal sphincter, irritating the lining of the oesophagus.
What epithelium lines the oesophagus?
Squamous epithelium, making it more sensitive to the effects of stomach acid.
What epithelium does the stomach have?
Columnar epithelium, protecting it against stomach acid.
What is dyspepsia?
Indigestion–> Feeling of burning, pain or discomfort in the digestive tract
What are the symptoms of GORD?
Dyspepsia: Heart burn Acid regurgitation Retrosternal/ epigastric pain Bloating Nocturnal cough Hoarse voice
What is endoscopy used for and when might it be used in GORD?
Patients with evidence of GI bleed or other concerning features would be reffered.
Assesses for peptic ulcers and oesophageal or gastric malignancies.
What are the key red flags that would make you suspicious of cancer and therefore need a 2 week endoscopy referral?
Dysphagia Over 55 Weight loss Upper abdominal pain/ reflux Treatment resistant dyspepsia Nausea/ vomiting Low haemoglobin/ raised platelets
What lifestyle advice would be given to patients with GORD?
Reduce tea, coffee and alcohol Weight loss Avoid smoking Smaller, lighter meals Avoid heavy meals before bed Stay upright after meals
What medication can be given to manage GORD?
Acid neutralising medicine-> Gaviscon/ Rennie
Proton pump inhibitors (reduce acid secretion)–> Omeprazole/ Lansoprazole
Ranitidine
What is Ranitidine and its action?
Medicine used as an alternative to PPIs to treat GORD. H2 receptor antagonist which reduces stomach acid.
What is the surgery that can be used to treat GORD called?
Laparoscopic fundoplication–> Ties the fundus of the stomach around the lower oesophagus to lower the sphincter.
What stomach bacteria test is offered to anyone with dyspepsia and what kind of bacteria is it?
Helicobacter pylori
Gram negative aerobic bacteria
How does H. pylori avoid the acidic environment in the stomach?
Forces its way into the gastric mucosa
How does H. pylori cause damage?
Causes breaks in the mucosa, exposing the epithelial cells underneath to acid and causing gastritis, ulcers and increased risk of stomach cancer.
What does H. pylori produce to neutralise stomach acid and how does this cause damage?
Ammonia which directly damages epithelial cells.
What tests can be used to look for H. pylori?
Urea breath test
Stool antigen test
Rapid urease test
What is a rapid urease test?
Small biopsy taken of the stomach mucosa during endoscopy. Urea is added to the sample and if H. pylori is present, they produce enzymes that convert the urea to ammonia.
How is H. pylori eradicated?
Triple therapy: Proton pump inhibitor + 2 antibiotics for 7 days
What is Barretts oesophagus?
When the oesophagus epithelium changes from squamous to columnar due to constant acid reflux. (metaplasia).
Why do patients with Barrets oesophagus have to be monitored with regular endoscopy?
It is premalignant and increases the risk of adenocarcinoma development.
How can Barretts oesophagus be treated?
Proton pump inhibitors, ablation treatment during endoscopy.
Where do peptic ulcers most commonly form?
Duodenum (and stomach)
Why do ulcers form?
When there is a breakdown in the protective layer of the stomach or duodenum and an increase in stomach acid.
What makes up the protective layer of the stomach and how can it be broken down?
Mucus and bicarbonate
Can be broken down by medications (Steroids or NSAIDs) or H. Pylori