Problems With Swallowing and Peptic Ulcers Flashcards
How and where can things go wrong with swallowing throughout the upper GI tract?
Mouth - problems with muscles of mastication, lack of saliva, poor dentition
Pharynx - obstructive lesions, pharyngeal diverticulum
Oesophagus - obstruction (goitre, tumour, trachea, lymph nodes)
Abnormal oesophageal motility
Neuromuscular
Patient presents with dysphagia - what would you ask?
Duration and progression of symptoms Difficulty swallowing both liquids and solids? Is food sticking anywhere? Swallowing painful? Regurgitation of food? Associated symptoms (red flags)
NICE: patients with acute stroke need to have swallow screened within 4 hours of admission before being given any oral food, fluid or medication
Why and what is a swallow screen?
To prevent aspiration, choking and aspiration pneumonia
Speech and language therapist performs clinical assessment, bedside swallow test and instrumental assessment
Can perform barium test and manometry
Outline the consequences of being nil by mouth for extended lengths of time
(Starvation mode)
Fed state: 0-4 hours after food
Fasting: 4-12 hours
Starved state: 12+ hours after food
Glycogen stores broken down for energy
Body fat stores broken down into fatty acids for cell energy
Protein broken down to amino acids and glucose for energy
Ketone bodies used for energy for nervous system (dangerous) from amino acids and fatty acid break down
Signs that someone may have difficulty swallowing?
Cough Choking Gurgling/wet voice Sign of chest infection Shortness of breath Weight loss Food/fluid falling out of mouth
What’s aspiration pneumonia?
Lower respiratory tract infection resulting from the inhalation of material
What’s the mechanism of HCL secretion by gastric parietal cells?
Inside cell CO2 + H20 = H2CO3
H2CO3 dissociates into H+ and HCO3-
H+ secreted across canaliculus membrane into the stomach lumen by H+/K+ ATPase pump
HCO3- moves out of cell via anti port with Cl-
Cl- diffuses passively across canaliculus membrane into lumen via Cl- channel
Gastrinoma (or zoo linger-Ellison syndrome) is tumour of gastrin secreting cells.
Explain why this might lead to a duodenal ulcer
Excess gastrin secreted into circulation
Gastrin stimulates parietal cells to secrete H+
Pathological therefore not controlled by physiological negative feedback so gastrin continues to stimulate H+ secretion
Insufficient buffer levels of HCO3-
Pentagasgtrin is a gastrin analogue used as a test for gastric H+ secretion.
Explain the results you’d expect in a healthy individual and a patient with gastrinoma
Normal: pentagastrin would stimulate H+ secretion so H+ levels would rise
Gastrinoma: no change to H+ levels as pentagastrin works the same as endogenous gastrin so wouldn’t stimulate H+ secretion when the levels are already high
How do the two main types of IBD differ?
Crohn’s - can affect any part of the GI tract, skip lesions
UC - only affects colon
What are the macroscopic and microscopic features of Crohn’s disease?
Macroscopic: Can affect anywhere Bowel has cobblestone appearance as it's thickened and narrowed with ulcers and fissures Fistulae Abscesses
Microscopic: Transmural inflammation Patchy, skip lesions Granulomas Chronic inflammatory cells predominate
What are the macroscopic and microscopic features of Ulcerative Colitis?
Macroscopic: Colon only Mucosa red, inflamed and bleeds easily Ulceration Polyps
Microscopic:
Chronic inflammatory cell infiltrate
Abscesses
