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GI System > Pathophysiology of gastric disease > Flashcards

Pathophysiology of gastric disease Flashcards

1
Q

What is GORD?

A

Gastro oesophageal reflux disease

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2
Q

What are the symptoms of GORD?

A
  • Chest pain
  • Acidic taste in mouth
  • Cough
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3
Q

What kind of things will trigger GORD?

A
  • Obesity
  • Pregnancy
  • Hiatus Hernia
  • LOS function
  • Delayed gastric emptying
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4
Q

What are some of the possible consequences of GORD?

A
  • Nothing
  • Oesophagitis
  • Strictures → causes vomiting everytime you swallow
  • Barret’s oesophagus→ metaplasia of oesphagus
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5
Q

What is Barret’s Oesophagus?

A

Metaplasia of the stratified squamous epithelia → simple columnar epithelia → can lead to an adenocarcinoma

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6
Q

What components make up to the Lower Oesophageal Sphincter?

A
  • Muscular element
  • Right crus of diaphragm (loops around oesophagus)
  • Oesphagus angled entry to stomach
  • Intra abdominal pressure

All act together to contract around the oesophagus

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7
Q

When is pressure around the LOS highest and lowest?

A

Highest at night

Lowest after meals

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8
Q

How would you treat someone with GORD?

A
  • Lifestyle modification → eat slower, smaller meals, lose weight
  • Pharmacological
    • Antacids → add a layer on top of the stomach
    • H2 antagonists → stop parietal cell release of H+
    • Proton Pump inhibitos
  • Surgery - rare!
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9
Q

What is a hiatal hernia and how can this lead to GORD?

A

A hernia where part of the stomach slips above the diaphragm

Mechanism relating to GORD not fully understood:

  • Loss of intra abdominal pressure creating basal tone
  • Don’t get the increase in LOS tone when straining
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10
Q

What is Gastritis?

A

Inflammation of the protective lining of the stomach (stomach mucosa)

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11
Q

What symptoms might present if someones suffering with gastritis?

A
  • pain
  • nausea
  • vomiting
  • bleeding
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12
Q

What kind of things will cause acute gastritis?

A
  • Heavy use of NSAIDs
  • Lots of alcohol- dissolves mucus lining
  • Chemotherapy
  • Bile reflux into the stomach

Any chemical injury damages stomach epithelia and reduces mucus production. Mucosa responds by vasodilation/ oedema and inflmmatory cells

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13
Q

How do you treat acute gastritis?

A

Remove the stimulus

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14
Q

What is chronic gastris and how can it be divided?

A

Perisitant stomach inflammation

  1. Bacterial
  2. Autoimmune
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15
Q

Explain what happen in autoimmune gastritis and what some of the consequences can be

A

Autoantibodies are made to gastric parietal cells, affects the fundus but spares the antrum

  • Can lead to pernicious anemia (B12 deficiency anaemia) as parietal cells produce intrici factor for B12 absorption and acid for iron absorption
  • B12 deficiency can lead to glossitis
  • Anorexia as painful to eat
  • neurological symptoms
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16
Q

What is the most common cause of bacterial, chronic gastritis?

A

Heliobacter Pylori

17
Q

Give some of the features of H. Pylori organism

A
  • Helix, gram negative, microaerophilic
  • Spread feaco-orally
  • Produces urease → converts urea to ammonium and increases local pH
  • Flagellum gives good motility and allows adhesion to mucus layer so remains in stomach
18
Q

What problems does helicobacter pylori cause?

A
  • Releases cytotoxins causing direct epithalial injury
  • Expresses urease producing ammonia whic is toxic to epithelia
  • Can degrade the mucus layer
  • Promotes inflammatory response
19
Q

How does the location of H. pylori affect the effect it has on the stomach?

A

Antrum colonisation only: affects G cells, increasing gastrin secretion. Increased parietal cell acid secretion

Can cause duodenal epithelial metaplasia and ulceration if colonises the duodenum

If in the antrum and body: effects cancel and the patient is asymptomatic

If predominantly in body: causes atrophy effect, stomach shrinks making breakdown and ulceration a lot easier → leads to intestinal metaplasia and potentially cancer

20
Q

How would you diagnose Helicobacter pylori?

A
  • Urea breath test using carbon 13
  • Stool antigen test
  • Can use upper GI endoscopy if needed
21
Q

How would you treat a patient who has helicobacter pylori?

A
  • Proton Pump inhibiotrs
  • Amoxicillin + (clarithromycin or metronidazole)
22
Q

Define Peptic ulcer disease

A

Defect in the gastric/ duodenal mucosa that extends through muscularis mucosa

Commonly affects lesser curve/ antrum of stomach and first part of duodenum

23
Q

Compare and contrast gastric ulcers and duodenal ulcers based on:

incidence, age distribution, social class, blood group, acid evels and H.pylori gastritis

A
24
Q

What are the normal defence mechanisms of the stomach?

A
  • Mucus
  • Bicarbonate
  • Adequate mucosal blood flow to remove acid that diffuses through injured mucosa
  • Prostaglandins
  • Epithelial renewal
25
Q

Why is the breakdown of normal stomach defences, more important than excessive acid in peptic ulcer disease?

A

Ulcers can develop in people with any level of acid; normal or low

Rpaid gastric emptying/ inadequare neutralisation from the bile/ pancreas is more implicated in duodenal ulcers

26
Q

What things can cause mucosal injury, leading to peptic ulcer disease?

A
  • H. Pylori
  • NSAIDs
  • Smoking (more involved in relapse than initial insult)
  • Major physiological stress e.g. burns
27
Q

Where do chronic peptic ulcers most frequently occur?

A

At mucosal junctions

e.g. where antrum meeds body and where antrum meets duodenum

28
Q

Describe the morphology of peptic ulcers

A
  • Generally <2cm
  • Base of ulcer is necrotic/ granulation tissue
  • Muscularis propria can be replaced by scar tissue
29
Q

What are some of the clinical consequences of peptic ulcer disease?

A
  • Narrowing of stomach due to repeated scar tissue
  • Perforation causing peritonitis
  • Erosion of adjacent structures (liver or pancreas)
  • Heamorrhage
  • Malignancy (rare)
30
Q

Give some of the symptoms of peptic ulcer disease

A
  • Epigastric pain, sometimes moving to the back
  • burning/ gnawing
  • pain often follows meal times
  • pain often at night
31
Q

What are some of the serious symptoms of peptic ulcer disease?

A
  • Haematemesis (vomiting blood) or malaena (dark stools)
  • Early satiety - from repeated scarring narrowing lumen
  • Weight loss - as reluctant to eat
32
Q

How do you manage someone with peptic ulcer disease?

A
  • lifestyle modification- avoids foods making it worse
  • Stop exacerbating medications
  • Test for H. pylori and eradicate if present
  • PPI’s
  • Endoscopy
33
Q

What is functional dyspepsia?

A

When someone present with the symptoms of ulcer disease but there is no physical evidence of organic disease

34
Q

What is Zollinger- Ellison syndrome?

A

A non beta islet cell gastrin secreting tumour of the pancreas

Consequence:

  • proliferation of parietal cells → lots of acid production
  • Causes severe ulceration of stomach and small bowel
  • Symtpoms of abdominal pain and diarrhoea
35
Q

What is stress related mucosal damage?

A

Broad term to describe pathology attributed to acute, erosive, inflammatory insult to the upper GI tract associated with critical illness:

  • Severe burns
  • raised intracranial pressure
  • sepsis
  • severe trauma
  • multiple organ failure
36
Q

What are some of the featurs of stomach cancer?

A

Has to be quite a large cancer before symptoms present

  • dysphagia
  • loss of appetite
  • malaena
  • weight loss
  • nausea/ vomiting
  • Virchow’s nodes
37
Q

What are some of the risk factors for developing stomach cancer?

A
  • Male
  • H. pylori
  • Dietary factors
  • Smoking

GI System (15 decks)

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