GORD Flashcards
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What are the risk factors of GORD
Aetiology (6)
Obesity
Smoking
Diet
medication
Hiatus hernia
pregnancy
How does a Hiatal Hernia occur?
A hiatal hernia occurs when part of the stomach protrudes through the diaphragm into the thoracic cavity, contributing to GERD.
How does obesity contribute to the development of GERD?
Obesity increases abdominal pressure, which can push stomach contents up into the esophagus, overwhelming the lower esophageal sphincter and leading to reflux.
Which mechanism is primarily responsible for the reflux of stomach contents into the esophagus in GERD?
Weakening of the lower esophageal sphincter (LES)
What is Barrets Oesophagus?
The replacement of nromal esophagel squamous cells with columnar cells
Explain the role of esophageal motility in the pathophysiology of GERD
Impaired esophageal motility can reduce the efficiency of esophageal peristalsis, which decreases the clearance of acid from the esophagus. This can contribute to prolonged exposure of the esophageal lining to acidic content, exacerbating GERD symptoms.
Which class of medication is used to neutralize stomach acid in the treatment of GERD?
c) Antacids
True or False: Proton pump inhibitors (PPIs) are considered a first-line treatment for GERD due to their ability to significantly reduce gastric acid production.
True
Provide an example of an H2-receptor antagonist and explain its mechanism of action in GERD treatment.
An example of an H2-receptor antagonist is Famotidine. H2-receptor antagonists work by blocking histamine H2 receptors in the stomach lining, which reduces the production of gastric acid and helps to alleviate GERD symptoms.
GORD red flag symptoms
Alarm (5)
Unintentional weight loss
dysphagia
Age >55
Anaemia
Hemetamesis / Malaena
Persistent dysphagia (difficulty swallowing) in a GERD patient indicates what?
esophageal cancer or severe esophageal damage, or blockage in the oesophagus
What are the potential implications of the presence of hematemesis (vomiting blood) in a patient with GERD?
Hematemesis in a patient with GERD suggests significant esophageal damage or bleeding, possibly due to esophageal ulcers. This requires immediate evaluation and treatment, including endoscopy, to identify the cause and manage any potential complications.
Which 3 chemicals stimulate the production of gastric acid by stimulation of parietal cells?
gastrin
acetylcholine
histamine
What effect does histamine have on proton pump activity?
b) Directly activates the proton pump through H₂ receptors
A patient with GERD is experiencing severe symptoms despite being on an H₂-receptor antagonist. Explain why an H₂-receptor antagonist might be less effective compared to a proton pump inhibitor (PPI) in managing this condition.
H₂-receptor antagonists work by blocking histamine H₂ receptors, which reduces acid production by inhibiting the proton pump indirectly. However, PPIs provide a more effective reduction in gastric acid production because they directly inhibit the proton pump (H⁺/K⁺-ATPase), which is the final step in acid secretion. As a result, PPIs offer a more potent and sustained decrease in acid production compared to H₂-receptor antagonists, leading to better management of GERD symptoms.