Paul Mueller- Heartburn Flashcards
What re the 5 common causes of dyspepsia?
GORD
Gastritis
Functional dyspepsia
Stress
Peptic ulcer disease
What investigations would be prioritised with a presentation of dyspepsia?
- ECG
- Weight
- Alcohol history (XS= chronic gastritis –>dyspepsia)
- Medication history (may include meds that affect gastric mucosa or relax sphincter -> reflux)
- Test for H.pylori
- Full blood count (Identify anaemia and/or thrombocytosis to indicate upper GI malignancy)
- Liver function tests (Biliary disease, alcohol induced changes?)
How does H.pylori usually colonise the stomach?
Ingestion
How does H.pylori survive in the acidic environment of the stomach?
Acid neutralisation and locomotion
How does H.pylori neutralise stomach acid?
- Synthesises urease that catalyses conversion of urea and water into ammonia and CO2
- Ammonia is basic so neutralises stomach acid creating layer around H.pylori
How does H.pylori use locomotion?
- HP has flagella which propels it into the mucus layer where pH is much safer
How does H.pylori adhere to th host?
Uses LPS/BabA molecules to adhere to cells on stomach lining.
How does HP become a potential pathogen?
Production of toxins:
- cagA disrupts tight junction between stomach lining cells leading to gastritis
- vacA causes cells in stomach lining to undergo apoptosis and die
- This disrupts continuity of stomach lining so underlying cells exposed to HCl leading to stomach ulcers
What are the three types of drugs used to treat H.pylori and dyspepsia?
- Proton pump inhibitors
- H2 Antagonist
- Antacids - neutralise HCl
What is the definition of a red flag?
Signs and symptoms found in patient history and clinical exam that are indicators of a possible serious unerlying condition
What are the red flag features of upper GI cancers
-Dysphagia
- Weight loss
- Anaeia
What is the treatment regimen for H.pylori?
- Omeprazole
- Amoxicillin
- Clarithromycin
Then CARBON 13 breath test to test for H.pylori
What is the treatment regimen for when H.pylori is negative yet dyspepsia persist?
Omeprazole then Ranitidine
What type of medication is omeprazole and lanzaprazole?
PPIs
Why is the carbnon 13 breath test used?
Only test validated by NICE as a test of cure
When can the carbon 13 test be used?
POST two weeks of no PPis and 4 weeks of no antibiotics so avoid false negatives
If dyspepsia persists after second line treatment, what is the protocol?
Non urgent upper GI endoscopy
(OGD) for treatment resistant dyspepsia.
What is a hiatus hernia
When part of the abdominal viscera herniate through the oesphageal hiatus in the diaphragm
What are the risk factors for a hiatus hernia?
- Male
- Obesity
- Age
- Pregnancy
- Genetic predisposition
What are the mechanisms for the formation of a hiatus hernia?
- Widening of the diaphragmatic hiatus
- Pulling up of the stomach
- Pushing up of the stomach
What causes refluc with a hiatus hernia?
Lower oesophageal sphincter compromised and antireflux barrier lost
What are the 2 variants of a hiatus hernia
Sliding and rolling
What happens to GOJ in a sliding hiatus hernia compared to rolling?
sliding: GOJ moves upwards
rolling: GOJ stays in same place
How common is a sliding hiatus hernia compared to rolling?
sliding: 85-95% of cases
rolling: 5-15% of cases
What kind of symptoms does a sliding hiatus hernia cause?
Symptoms of GORD
What is Barrett’s Oesphagus?
Metaplasia of lower oesophageal squamous epithelium to gastric columnar epithelium
