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The Gastrointestinal System > GORD, Dyspepsia and Ulcers > Flashcards

GORD, Dyspepsia and Ulcers Flashcards

1
Q

What is GORD?

A

Gastro-oesopageal reflux disease

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2
Q

What may be the underlying cause of GORD?

A
  • Incompetent lower oesophageal sphincter
  • Poor oesophageal clearance
  • Barrir function or visceral senstivity
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3
Q

What is dysphagia?

A

Difficulty swallowing

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4
Q

What may be the main symptoms of GORD?

A
  • Dysphagia
  • Chest pain
  • Acid reflux
  • Heartburn
  • Weight loss
  • Odynophagia - pain on swallowing
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5
Q

What investigations can be done for GORD?

A

Endoscopy

Barium swallow

Nuclear studies

Biopsies

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6
Q

What treatments are available for oesophageal carcinoma?

A

Radiotherapy

Surgery - Oesophagostomy

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7
Q

What is the name of the stage before adenocarcinoma in the oesophagus?

A

Barret’s oesophagus

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8
Q

How is GORD managed? (3)

A
  1. Symptom relief
  2. Heal oesophagitits
  3. Prevent complications
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9
Q

Which lifestyle factor changes are recommended for GORD?

A
  • Smoking cessation
  • Lose weight
  • Prop up bed
  • Avoid provoking factors such as spicy or fatty foods
    *
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10
Q

Why are antacids useful in GORD?

A

They provide symptomatic relief

(they do not aid healing or further prevention)

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11
Q

Which histamine receptor will histamine antagonists block in the oesophagus?

A

H2

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12
Q

Which histamine receptor antagonist can aid healing?

A

Ranitidine

(less effective then omeprazole (a PPI))

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13
Q

What are the negative effects of ranitidine?

A

Tolerance

Poor in preventing relapse and complications

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14
Q

Which drug class is the best at reducing symptoms over a period of four weeks as well as having healing effects?

A

Proton pump inhibitors

Omeprazole is the most commonly used

(lansoprazole is also used)

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15
Q

When sould PPIs be taken so their effects are noticed?

A

Around 30 minutes before a meal

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16
Q

When would surgery be utilised for patients with GORD?

A

When PPIs fail to reduce symptoms

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17
Q

What is the main concern for patients with Barrett’s oesophagus?

A

They may go on to develop adenocarcinoma

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18
Q

What are the best ways for dysplasia in the oesophagus to be managed?

A
  • Increased surveillance and optimised PPI doseage
  • Endoscopic mucosal resection
  • Radiofrequency ablation
  • Argon beam ablation - can also be used to stop blood loss in surgery
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19
Q

Which types of hernia will most likely contribute to GORD?

A

Sliding and paraoesophageal herniae

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20
Q

What is gastroparesis?

A

Delayed emptying of stomach

(there is no physical obstruction)

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21
Q

What symptom is often present during gastroparesis?

A

Vomiting

(this is worse at the end of the day due to filling of the stomach)

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22
Q

What symptoms may be associated with gastroparesis?

A
  • Feeling of fullness
  • Nausea and vomiting
  • Weight loss
  • Upper abdominal pain
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23
Q

What can cause gastroparesis?

A

Idiopathic

Diabetes

Cannabis

Medication - opiates, anticholinergics

Systemic disease - systemic sclerosis

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24
Q

How can gastroparesis be investigated?

A

Gastric emptying study

25
Q

How can gastroparesis be managed?

A

Removal of exacerbating factors

Liquid diet

Eat little and often

Promotility agents

Gastric pacemaker

26
Q

What is achalasia?

A

Food will fill the oesophagus when consumed

27
Q

How can achalasia be treated?

A

Botox can paralyse the lower oesophageal sphincter allowing food to pass

28
Q

What is the problem and solution to using botox in order to treat achalasia?

A

Botox is associated with tolaerance as antibodies are produced against it

In order for its effectiveness to be mainatained, types must be switched frequently to avoid this tolerance

29
Q

What is dyspepsia?

A

It is not a disease, but instead a range of symptoms describing:

  • Epigastric pain or burning
  • Postpradial fullness
  • Gastric cancer
30
Q

What are the two main branches of causes for dyspepsia?

A
  1. Organic
  2. Functional
31
Q

What are some organic causes of dyspepsia?

A

Peptic ulcer disease

Drugs - NSAIDS, COX2 inhibitors

Gastric cancer

32
Q

What are some functional causes of dyspepsia?

A

Idiopathic

Associated with other functional gut disorders such as IBS

33
Q

What may be found on clinical examination for dyspepsia?

A

Epigastric tenderness

Cachexia

Mass

Evidence of gastric outflow obstruction and peritonism

34
Q

How can dyspepsi be managed?

A

A faecal antigen test is required for H. pylori - if present it can be eradicated

If H. pylori is not present, a PPI is utilised

Otherwise, the the patient is referred to hospital (>55 years) or treated for functional dyspepsia (<55 years)

35
Q

In peptic ulcer disease, when is the pain often relieved?

A

After eating

(Most peptic ulcers are duodenal)

36
Q

When pain comes on after eating, which type of ulcer is usually associated?

A

Gastric ulcer

(more acid is produced to digest food because gastrin secretion increases)

37
Q

What are the main causes of peptic ulcer disease?

A

H. pylori

NSAIDS
Gastric dysmotility or outflow obstruction

38
Q

When in life is H. pylori often acquired?

A

Nursery, or during a young age

This is due to faecal-oral spread

39
Q

As a bacterium, what are the properties of H. pylori?

A

Gram negative

Flagellated

Rod shaped, but not bacilli

Microaerophilic

40
Q

What are the three options for the consequences of H. pylori?

A

Asymptomatic

Peptic ulcer disease

Gastric cancer

41
Q

Which cells in the stomach release acid?

A

Parietal cells

42
Q

What is the function of gastrin and where does it come from?

A

Comes from G cells

Sectreted to act on parietal cells to produce more acid

43
Q

Which type of gastritis leads to duodenal ulcers and why?

A

Distal/antrum gastritis

Gastritis damages the duodenum and stomach antrium so G cells are damaged leading to increased acid production

44
Q

What is a likely outcome of a body gastritis and why?

A

Gastric cancer

Gastritis damages gastric mucosa and parietal cells, this lowers HCl sectretion meaning a lot of gastrin is produced to no effect

This can lead to gastric cancer

45
Q

Describe the pathway to a duodenal ulcer in relation to the role of the cytokines released and their role in the developing condition

A

Cytokines released

G cells release more gastrin

Somatostatin secretion is inhibited

Gastrin causes parietal proliferation and hypersecretion of acid

Duodenal tissue is damaged due to increased acid load

46
Q

When a duodenal ulcer forms, gastric mucosa will often form there due to metaplasia, what does this mean in the presence of an H. pylori infection?

A

H. pylori can now infect here

47
Q

Which drugs can cause duodenal ulcers?

A

NSAIDS

48
Q

What is a gastritis termed if it is in the body of the stomach?

A

Body gastritis

or

Atrophic gastritis

49
Q

What happens in an atrophic gastritis?

A

Inflammation induces parietl cell apoptosis and atrophy of gastric glands

This means there is a hyposecretion of acid (hypochlorhydria)

Continued damage may caus ethe development of a gstric ulcer

50
Q

How can H. pylori be diagnosed?

A

Gastric biopsy - urease test, histology, culture

Urease breath test

Faecal antigen test

Serology - IgA antibodies - often inaccurate

51
Q

What is the urease test?

A

This test works because H. pylori increase the pH of its environment

H. pylori secreted urease which can break down ammonium ions tand bicarbonate

This raises the stomach pH

This test detects the urease enzyme

52
Q

How is peptic ulcer disease treated?

A

All require anti-secretory therapy - PPI - omeprazole

All tested for H. pylori - +ve, then eradicate, -ve, then PPI

Withdraw NSAID use

Improve lifestyle

Surgery - rare

53
Q

Besides PPIs, what other option is there for anti-secretory therapy?

A

H2 receptor antagonists

54
Q

Give an example of a H2 receptor antagonist

A

Ranitidine

55
Q

H2 receptor antagonists can lead to the healing of what?

A

Duodenal ulcers

56
Q

Which is the best treatment for:

a) Gastric ulcers
b) Duodenal ulcers

A

a) Omeprazole (or another PPI)
b) Ranitidine (or other H2RA)

57
Q

What are some complications of peptic ulcer disease?

A

Anaemia

Bleeding

Perforation

Gastric outlet/duodenal obstruction

58
Q

Of the two ulcer types, gastric and duodenal, which will require a follow up after treatment?

A

Gastric

An endoscopy is performed 6-8 weeks after treatment to ensure there is no malignancy and to check healing

The Gastrointestinal System (27 decks)

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