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*4a. Gastrointestinal > GORD (R1) > Flashcards

GORD (R1) Flashcards

1
Q

Normal anatomy
- Label these parts of the stomach

A
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2
Q

Normal physiology
- What are the two types of glands in the stomach?

A

Gastric (oxyntic) glands
Pyloric glands

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3
Q

Normal physiology
- Gastric glands: what are the 4 cell types?

A
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4
Q

Normal physiology
- Gastric glands: what do each of the 4 cell types secrete?
- Where are gastric glands located?

A

In the proximal 80% of the stomach

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5
Q

Normal physiology
- Pyloric glands: what are the 3 cell types?
- Where are pyloric glands located?

A

In the distal 20% of the stomach

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6
Q

Normal physiology: parietal cells
- Importance of gastric acid?
- What are the four substances that regulate HCl secretion from parietal cells?
- cAMP and protein kinase A are metabolised by phosphodiesterase: impacts of PDE inhibitors (eg. caffeine?)

A

Gastric acid enables the stomach to be very acidic (pH=1), and converts pepsinogen (from chief cells) to pepsin –> enables protein digestion

PDE inhibitors –> more gastric acid

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7
Q

Normal physiology
- Types of epithelium in the oesophagus and stomach? Their functions?

A

Oesophagus:
- Stratified squamous epithelium
- Better equipped to resist abrasion from food boluses, but more susceptible to damage.

Stomach
- Columnar epithelium
- Highly glandular

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8
Q

Normal physiology:
- Defences against acidity in the oesophagus?

A
  • Primary peristaltic waves: when food is going down
  • Secondary peristaltic waves: contractions after swallowing
  • Saliva: helps neutralise gastric acid content within the oesophagus
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9
Q

Normal physiology:
- Defences against acidity in the stomach?

A
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10
Q

Define GORD
GORD is also known as

A

GORD: reflux of stomach contents into the oesophagus –> symptoms and/or complications
Aka. Reflux oesophagitis

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11
Q

3 reasons why reflux can occur?

A
  • Lower oesophageal sphincter relaxation (decreased resting tone, increased frequency of relaxation)
  • Increased intrabdominal pressure
  • Separation of the LOS from the diaphragm (eg. hiatal hernia)
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12
Q

Reasons for increased intraabdominal pressure?

A
  • Central obesity + pregnancy
  • Chronic cough
  • Long history of heavy lifting/strenous activity (eg. occupation)
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13
Q

Reasons for increased relaxation of the LOS?

A
  • Central obesity and pregnancy
  • Diet: acidic foods (spicy, citrus, carbonated foods), caffeine (including chocolate), fatty foods
  • Alcohol, smoking
  • NSAIDs
  • LOS tone reducing drugs: CCB’s, nitrates, beta blockers, anticholinergies, prostaglandins
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14
Q

Pathophysiology: reflux damages te oesophageal mucosa leaking to inflammation (oesophagitis)
- What kind of immune cells?
- What happens to basal cells?
- Can oesophageal ulcers form?

A
  • Neutrophils and eosinophils
  • Basal cell hyperplasia
  • Yes
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15
Q

Pathophysiology:
- Atypical symptoms?

A
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16
Q

2 complications?

A

Stricture/stenosis: due to chronic oesophagitis –> scarring
Barrett’s oesophagus –> oesophageal adenocarcinoma

17
Q

Risk factors?

A

Demographics
- Age

Medical history
- Hiatus hernia
- Obesity + pregnancy
- Medications

Family history of GORD

Social history
- Diet: acidic (carbonated drinks, spicy, citrus/tomatoes), caffeine (including chocolate), high fat food
- Alcohol + smoking

18
Q

History
- Typical symptoms?
- Atypical symptoms?
- Red flag symptoms?

A

Typical symptoms
- Heartburn (pyrosis): burning retrosternal pain
- Regurgitation: acidic taste in mouth
→ Worse after meals + lying down

Atypical symptoms
- Hoarse voice
- Chronic cough
- Sore throat

Red flag symptoms
- Progressive dysphagia/odynophagia
- Early satiety
- Haematemesis
- Weight loss

19
Q

Investigations

A
20
Q

Investigations: an additional investigation?
- It isn’t always indicated; when is it indicated?

A

Ambulatory pH monitoring
Indicated when endoscopy comes back normal, used to establish diagnosis and severity of GORD.

21
Q

Management
- Lifestyle changes?

A

GORD specific
- Avoid trigger foods: acidic foods (spicy, citrus, carbonated foods), caffeine (including chocolate), fatty foods
- Eat little and often
- Don’t eat right before bed/lying down
- Keep your head elevated during sleep.

SNAP-V
- Smoking: cessation
- Nutrition: as above
- Alcohol: limit
- Physical activity: plus diet –> weight loss

22
Q

Management
- Medications?

A
  • Proton pump inhibitor (eg. esomeprazole/Nexium)
  • Can add a H2 receptor antagonist (less effective)
  • Patients can take antacids (Mylanta, Gaviscon) for symptomatic relief.
23
Q

Management: surgeries
- When are they indicated?
- 2 examples?

A
  • Indicated when pharmacological treatment isn’t effective
  • Fundoplication: wrapping the fundus around the LOS, to make it tighter
  • Hiatus hernia repair

*4a. Gastrointestinal (7 decks)

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