Heartburn Flashcards
Oesophagus originates where?
Inferior border of cricoid cartilage at C6
continuous superiorly with laryngopharynx
Oesophagus descends downwards in mediastinum between?
Trachea anteriorly and vertebral bodies of T1 to T11 posteriorly
Oesophagus enters abdomen via?
Oesophageal hiatus at T10.
abdominal portion is 1.25cm long
Oesophagus terminates by joining?
Cardiac orifice of the stomach at spinal level T11.
Oesophagus structure?
Adventitia, muscularis, submucosa, mucosa.
Dyspepsia definition and symptoms?
Combination of symptoms, present for 4+ weeks
Symptoms -epigastric pain or burning, early satiety, bloating, belching, nausea, discomfort in upper abdomen
Some causes of dyspepsia?
GORD, peptic ulcer disease, malignancy, drug side effects.
Functional dyspepsia?
Most common cause of symptoms
Symptoms but investigations do not show abnormalities
Gastritis?
Inflammation of gastric mucosa on endoscopy
Caused by infections, NSAIDs, alcohol
Can lead to gastric ulceration
Peptic ulcer disease?
Open sores in stomach or duodenum
Red flags?
Meningism (neck stiffness, photophobia, phonophobia)
High ICP
Thunderclap headache
Meningitis, tumour, infection, bleed.
Red flags for upper GI cancer?
Hx of cancer
Fever
Weight loss
Anaemia
Odynophagia
Persistent dysphagia
Haematemesis
First line investigations for dyspepsia?
Testing for H. pylori
FBC
LFTs
Alcohol history
Medication history
ECG
Weight
Helicobacter pylori adaptations?
For acid neutralisation - urease
For locomotion - flagella
For adhesion to host - LPS/BabA
Toxins - cagA and vacA
Tests for H. pylori?
Carbon-13 urea breath test
Stool antigen sample
Serum serology test
CLO test
Carbon-13 urea breath test?
Non invasive, simple safe, sensitive and specific
Requires specialist analysing equipment, fasting, if on antibiotics or PPIs can give false negative.
Stool antigen test?
Non invasive, simple, safe, sensitive and specific
Can give false negatives if on antibiotics or PPIs, need refrigeration.
Serum serology test?
Cheap and widely available
IgM poorly sensitive for new infection, IgG doesn’t tell if infection is current
CLO test?
Highly sensitive and specific, instant results
Invasive, false negatives if in PPIs or ABs
Pharmacology?
PPIs
H2 antagonists
Antacids/alginates
Antacids vs alginates?
Antacids - neutralise acid in stomach
Alginates - precipitates into gel, reaches stomach contents and forms foamy raft floating above stomach contents to prevent reflux
Initial management for uninvestigated dyspepsia and functional dyspepsia?
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
Treatment for H. pylori?
Triple therapy - PPI and 2 antibiotics for 2 weeks
Hiatus hernia?
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
Sliding vs rolling hiatus hernia?
Sliding - GOJ slides up
Rolling - GOJ remains in place, portion of stomach, bowel, spleen or pancreas herniates into chest next to GOJ
Barrett’s oesophagus?
Metaplasia from squamous to columnar in oesophagus
Red flags - dysphagia, haematemesis, odynophagia, angina.
Urease?
Catalyses conversion of urea and water to ammonia and carbon dioxide.
Ammonia is basic, so neutralises stomach acid, thin buffering layer
cagA?
Disrupts tight junctions between cells in stomach lining, leads to gastritis
vacA?
Causes cells in stomach lining to undergo apoptosis and die
