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PCL 424 > GIT Diseases I - GERD > Flashcards

GIT Diseases I - GERD Flashcards

1
Q

What are the components of the GIT?

A

i. The alimentary canal, extending from the mouth to the anus (including the pharynx, oesophagus, stomach, small and large intestines)
ii. Associated glandular organs e.g. salivary glands, pancreas, gallbladder and liver, which empty their contents into the canal.

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2
Q

What are the 4 main layers that compose the walls of the GIT?

A

i. mucosa
ii. submucosa
iii. muscularis externa
iv. serosa

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3
Q

The stomach is located in the _________ of the abdomen.

A

upper left quadrant

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4
Q

What kinds of epithelia line the oesophagus and stomach?

A

Oesophagus - non-keratinized stratified squamous epithelium

Stomach - columnar epithelium

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5
Q

What are the secretions of the stomach and the cells responsible for them?

A
  1. Mucin: secreted by columnar cells found all over the stomach.
  2. Pepsinogen: secreted by the chief cells located in the fundus of the stomach.
  3. Gastric acid and intrinsic factor: secreted by the parietal cells found in the body/corpus of the stomach.
  4. Gastrin: secreted by the G cells found in the pyloric antrum.
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6
Q

Gastrin acts on the parietal cells to stimulate gastric acid production, as well as on the chief cells to stimulate pepsinogen production.

True or False?

A

True.

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7
Q

Pepsinogen is a pre-enzyme.

True or False?

A

True.
In the presence of gastric acid, it is converted to the enzyme pepsin, which facilitates the digestion of proteins.

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8
Q

__________ is a glycoprotein which is necessary for the absorption of vitamin B.

A

Intrinsic factor

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9
Q

What is GERD?

A

Gastroesophageal Reflux Disease, also called Reflux Esophagitis, is chronic digestive disorder that occurs when the amount of gastric juice that refluxes into the oesophagus from the stomach or duodenum exceeds the normal limit, causing symptoms with or without associated oesophageal mucosal injury

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10
Q

What are the endogenous mechanisms to limit reflux and minimise oesophageal mucosal irritation?

A

i. The lower esophageal spinchter (LES)
ii. Normal oesophageal motility

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11
Q

Acid reflux and heartburn greater than _____ a week indicates GERD.

A

twice a week

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12
Q

The typical symptoms of GERD include:

A

i. Heartburn
ii. Regurgitation
iii. Dysphagia

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13
Q

The atypical symptoms of GERD include:

A

i. Non-cardiac chest pain
ii. Aspiration
iii. Asthma
iv. Pneumonia
v. Voice changes
vi. Hoarseness

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14
Q

_________and _________ are considered essential tests before performing anti-reflux surgery.

A

Oesophageal manometry
pH monitoring

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15
Q

Three (3) pathophysiological mechanisms predispose an individual to reflux. They are:

A

i. Spontaneous transient relaxation of LES (functional)
ii. Low resting pressure of LES (mechanical)
iii. Transient increase in abdominal pressure (e.g. due to bending over, exercise or deep inspiration)

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16
Q

Asides the pathophysiological mechanisms, additional variables that may contribute to oesophageal damage include:

A

i. The amount of gastric acid and pepsin that refluxes with a 24-hour period.
ii. The duration of time that acid and pepsin remain in the oesophagus.
iii. The natural sensitivity of the oesophageal mucosa to damage by aggressive forces.

17
Q

Mention 3 causes of transient relaxation of LES.

A
  1. Food e.g. Alcohol, chocolate, coffee, fatty meals
  2. Medication e.g. beta agonists, CCBs, nitrates, benzodiazepines, anticholinergics.
  3. Hormones e.g progesterone, estrogen.
  4. Nicotine
18
Q

Mention 9 risk factors for GERD.

A
  1. Obesity
  2. Pregnancy
  3. Smoking/Chewing Tobacco
  4. Large food portions
  5. High-fat meals
  6. Diet including chocolate, citrus juice, onions, tomatoes, chocolate, caffeine, peppermint/spearmint
  7. Elevated progesterone and estrogen
  8. Carbonated or alcoholic drinks
  9. Medications such as NSAIDs, CCBs, Benzodiazepines, Anticholinergics, Theophylline, Codeine
  10. Lifestyle - exercise, lying down after a meal, tight clothing, bending
19
Q

Describe the 3 categories of GERD.

A
  1. Physiologic (functional) gastroesophageal reflux: No underlying predisposing conditions. Pharmacological intervention not necessary.
  2. Pathologic gastroesophageal reflux/ GERD: Patients experience complications requiring evaluation and treatment
  3. Secondary gastroesophageal reflux: Due to underlying conditions such as asthma, peptic ulcer, gastric outlet obstruction.
20
Q

What are the goals of treatment of GERD?

A

i. To control symptoms
ii. To heal oesophagitis
iii. To prevent recurrence of oesophagitis or other complications.

21
Q

Mention 5 Lifestyle modifications/non-pharmacological interventions involved in GERD treatment.

A
  1. Weight loss
  2. Dietary control: avoid alcohol, citrus, coffee, chocolate, etc.
  3. Limit food portions
  4. Elevate head of bed by 8 inches
  5. Avoid lying down within 3 hours after a meal
  6. Avoid bending or stooping
22
Q

Highlight the pharmacological therapies involved in GERD treatment.

A

i. Antacids
ii. H2 Receptor Blockers: First line treatment for mild to moderate symptoms. They bind to H2 receptors on gastric parietal cells, reducing acid secretion
iii. Proton Pump Inhibitors: Most powerful medication for GERD treatment.
iv. Prokinetic medications and reflux inhibitors: They help control reflux by strengthening the LES and speeding up gastric emptying. Used only in patients with mild symptoms.

23
Q

Four examples of H2 Receptor Blockers are:

A
  1. Cimetidine
  2. Nizatidine
  3. Ranitidine
  4. Famotidine
24
Q

Four examples of Proton Pump Inhibitors are:

A
  1. Omeprazole
  2. Esomeprazole
  3. Lansoprazole
  4. Rabeprazole
25
Q

Four examples of Prokinetic agents are:

A
  1. Domperidone
  2. Bethanechol
  3. Cisapride
  4. Metoclopramide
26
Q

Long-term use of Prokinetic agents is recommended for GERD treatment.

True or False?

A

False.

Long-term use is discouraged as these agents may produce serious and potentially fatal complications.

27
Q

When are antacids best taken for GERD treatment?

A

After each meal and at bedtime.

28
Q

Mention 4 side effects of Metoclopramide.

A

i. Muscle pain or weakness
ii. Restlessness
iii. Drowsiness
iv. Diarrhoea

29
Q

Mention 4 side effects of Domperidone.

A

i. Dry mouth
ii. Drowsiness
iii. Diarrhoea
iv. Itchy skin
v. Weakness

PCL 424 (12 decks)

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