GORD (R1) Flashcards
Normal anatomy
- Label these parts of the stomach
Normal physiology
- What are the two types of glands in the stomach?
Gastric (oxyntic) glands
Pyloric glands
Normal physiology
- Gastric glands: what are the 4 cell types?
Normal physiology
- Gastric glands: what do each of the 4 cell types secrete?
- Where are gastric glands located?
In the proximal 80% of the stomach
Normal physiology
- Pyloric glands: what are the 3 cell types?
- Where are pyloric glands located?
In the distal 20% of the stomach
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?)
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
Normal physiology
- Types of epithelium in the oesophagus and stomach? Their functions?
Oesophagus:
- Stratified squamous epithelium
- Better equipped to resist abrasion from food boluses, but more susceptible to damage.
Stomach
- Columnar epithelium
- Highly glandular
Normal physiology:
- Defences against acidity in the oesophagus?
- Primary peristaltic waves: when food is going down
- Secondary peristaltic waves: contractions after swallowing
- Saliva: helps neutralise gastric acid content within the oesophagus
Normal physiology:
- Defences against acidity in the stomach?
Define GORD
GORD is also known as
GORD: reflux of stomach contents into the oesophagus –> symptoms and/or complications
Aka. Reflux oesophagitis
3 reasons why reflux can occur?
- Lower oesophageal sphincter relaxation (decreased resting tone, increased frequency of relaxation)
- Increased intrabdominal pressure
- Separation of the LOS from the diaphragm (eg. hiatal hernia)
Reasons for increased intraabdominal pressure?
- Central obesity + pregnancy
- Chronic cough
- Long history of heavy lifting/strenous activity (eg. occupation)
Reasons for increased relaxation of the LOS?
- 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
Pathophysiology: reflux damages te oesophageal mucosa leaking to inflammation (oesophagitis)
- What kind of immune cells?
- What happens to basal cells?
- Can oesophageal ulcers form?
- Neutrophils and eosinophils
- Basal cell hyperplasia
- Yes
Pathophysiology:
- Atypical symptoms?
2 complications?
Stricture/stenosis: due to chronic oesophagitis –> scarring
Barrett’s oesophagus –> oesophageal adenocarcinoma
Risk factors?
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
History
- Typical symptoms?
- Atypical symptoms?
- Red flag symptoms?
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
Investigations
Investigations: an additional investigation?
- It isn’t always indicated; when is it indicated?
Ambulatory pH monitoring
Indicated when endoscopy comes back normal, used to establish diagnosis and severity of GORD.
Management
- Lifestyle changes?
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
Management
- Medications?
- Proton pump inhibitor (eg. esomeprazole/Nexium)
- Can add a H2 receptor antagonist (less effective)
- Patients can take antacids (Mylanta, Gaviscon) for symptomatic relief.
Management: surgeries
- When are they indicated?
- 2 examples?
- Indicated when pharmacological treatment isn’t effective
- Fundoplication: wrapping the fundus around the LOS, to make it tighter
- Hiatus hernia repair
