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CSI 1a > Heartburn > Flashcards

Heartburn Flashcards

1
Q

Oesophagus originates where?

A

Inferior border of cricoid cartilage at C6
continuous superiorly with laryngopharynx

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2
Q

Oesophagus descends downwards in mediastinum between?

A

Trachea anteriorly and vertebral bodies of T1 to T11 posteriorly

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3
Q

Oesophagus enters abdomen via?

A

Oesophageal hiatus at T10.
abdominal portion is 1.25cm long

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4
Q

Oesophagus terminates by joining?

A

Cardiac orifice of the stomach at spinal level T11.

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5
Q

Oesophagus structure?

A

Adventitia, muscularis, submucosa, mucosa.

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6
Q

Dyspepsia definition and symptoms?

A

Combination of symptoms, present for 4+ weeks
Symptoms -epigastric pain or burning, early satiety, bloating, belching, nausea, discomfort in upper abdomen

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7
Q

Some causes of dyspepsia?

A

GORD, peptic ulcer disease, malignancy, drug side effects.

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8
Q

Functional dyspepsia?

A

Most common cause of symptoms
Symptoms but investigations do not show abnormalities

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9
Q

Gastritis?

A

Inflammation of gastric mucosa on endoscopy
Caused by infections, NSAIDs, alcohol
Can lead to gastric ulceration

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10
Q

Peptic ulcer disease?

A

Open sores in stomach or duodenum

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11
Q

Red flags?

A

Meningism (neck stiffness, photophobia, phonophobia)
High ICP
Thunderclap headache

Meningitis, tumour, infection, bleed.

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12
Q

Red flags for upper GI cancer?

A

Hx of cancer
Fever
Weight loss
Anaemia
Odynophagia
Persistent dysphagia
Haematemesis

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13
Q

First line investigations for dyspepsia?

A

Testing for H. pylori
FBC
LFTs
Alcohol history
Medication history
ECG
Weight

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14
Q

Helicobacter pylori adaptations?

A

For acid neutralisation - urease
For locomotion - flagella
For adhesion to host - LPS/BabA
Toxins - cagA and vacA

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15
Q

Tests for H. pylori?

A

Carbon-13 urea breath test
Stool antigen sample
Serum serology test
CLO test

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16
Q

Carbon-13 urea breath test?

A

Non invasive, simple safe, sensitive and specific

Requires specialist analysing equipment, fasting, if on antibiotics or PPIs can give false negative.

17
Q

Stool antigen test?

A

Non invasive, simple, safe, sensitive and specific

Can give false negatives if on antibiotics or PPIs, need refrigeration.

18
Q

Serum serology test?

A

Cheap and widely available

IgM poorly sensitive for new infection, IgG doesn’t tell if infection is current

19
Q

CLO test?

A

Highly sensitive and specific, instant results

Invasive, false negatives if in PPIs or ABs

20
Q

Pharmacology?

A

PPIs
H2 antagonists
Antacids/alginates

21
Q

Antacids vs alginates?

A

Antacids - neutralise acid in stomach
Alginates - precipitates into gel, reaches stomach contents and forms foamy raft floating above stomach contents to prevent reflux

22
Q

Initial management for uninvestigated dyspepsia and functional dyspepsia?

A

Un investigated dyspepsia - PPI for 4 weeks + tested for H. pylori, treated if positive

Functional dyspepsia - PPI or H2 receptor antagonist for 4 weeks, H. pylori test and treatment if positive

23
Q

Treatment for H. pylori?

A

Triple therapy - PPI and 2 antibiotics for 2 weeks

24
Q

Hiatus hernia?

A

When part of the abdominal viscera protrude through oesophageal opening in diaphragm. Compromises lower oesophageal sphincter.

Risk factors - male gender, obesity, age, pregnancy, genetic predisposition

25
Q

Sliding vs rolling hiatus hernia?

A

Sliding - GOJ slides up
Rolling - GOJ remains in place, portion of stomach, bowel, spleen or pancreas herniates into chest next to GOJ

26
Q

Barrett’s oesophagus?

A

Metaplasia from squamous to columnar in oesophagus
Red flags - dysphagia, haematemesis, odynophagia, angina.

27
Q

Urease?

A

Catalyses conversion of urea and water to ammonia and carbon dioxide.
Ammonia is basic, so neutralises stomach acid, thin buffering layer

28
Q

cagA?

A

Disrupts tight junctions between cells in stomach lining, leads to gastritis

29
Q

vacA?

A

Causes cells in stomach lining to undergo apoptosis and die

CSI 1a (8 decks)

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