Session 4- Gastric disease

Question 1

how do most pathological conditions of tbe stomach arise

Answer 1

inability of the stomach to protect itself from it acidic contents

Question 2

what is dyspepsia

Answer 2

complex of upper GI symptoms which are typically present for 4 or more weeks

• upper abdominal pain or discomfort
• heartburn
• acid reflux
• nausea
• vomiting

Question 3

common triggers for GORD

Answer 3

Altered LOS function
delayed gastric emptying 
obesity 
pregnancy
smoking

Question 4

treatment for GORD

Answer 4

lifestyle modidications

pharmacological interventions

Question 5

what is GORD

Answer 5

gastro-oesophageal reflux disease

Question 6

what are the consequences of GORD

Answer 6

reflux of the acidic stomach contents into the oesophagus can lead to metaplasia of the loweer oesophageal epithelia- Barret’s oesophagus

Question 7

gastritis

Answer 7

inflammatory process in the stomach mucosal layer

Question 8

what causes acute gastritis

Answer 8

heavy NSAID use or excessive alchohol consumption

Question 9

what causes chronic gastritis

Answer 9

H-pylori infection

autoimmune- antibodies against gastic parietal cells

Question 10

what is H pylori

Answer 10

a gram negative bacterium well adapted to the acidic environment of the stomach.
It produces ureases which allow it to produce ammonium from the urea present in the stomach- withstand acidic conditions in the stomach

Question 11

what effect does H pylori have

Answer 11

damages the epithelia of stomach an dis pro-inflammatory

Question 12

what is peptic ulcer disease

Answer 12

breach in the gastric or duodenal mucosa that EXTENFS THROUGH THE MUSCULARIS MUCOSA

Question 13

treatment of chronic ulcer disease

Answer 13

removing the exacerbating factors - H pylori, NSAIDS, reducing acus

Question 14

pharmalogical intervention to gastric diseases

Answer 14

they are a result of acid damage to teh mucosa

therefore they target the parietal cell at either the proton pumo or the H2 receptor

Question 15

Hiatus hernia

Answer 15

herniation of the stomach through the diaphragm into the thorax when the LOS herniates through the diaphragm and ends up in the thorax it looses its function

Question 16

mechanism of the LOS

Answer 16

muscular element- intrinsic muscles that contract to close it

as the oesophagus pierces the diaphragm it comes through the crural part - right crus- muscular element that helps to contract the sphincter - when pressure increases it closes the LOS off

travels obliquely into the stomach

Question 17

what is the normal state of teh LOS

Answer 17

normally contracted

only relaxes when it detects food moving through the oesophagus

Question 18

what epithelial change occur in barrets oesophagus

Answer 18

repeated exposure to gastric elements causes the reversible change of stratified squamous to become columnar cells w

Question 19

adenocarcinoma

Answer 19

glandular cancer in oesophagus

Question 20

how is GORD treated surgically

Answer 20

fundoplication

-fundus of stomach wrapped around the oesophagus to help with sphincter mechanism

Question 21

pathological changes that occur in gastrtis

Answer 21

epithelial damage
epithelial hyperplasia
vasodilataion
neutrophil response

OR

lymphocyte respinse
glandular atrophy
fibrotic changes

Question 22

automimmune cause of gastritis

Answer 22

1. antibodies to parietal cells
2. lose parietal cells
3. reduction in acid and intrinsic factor production
4. atrophy of body of stomach

Question 23

what is intrinsic factor essential for

Answer 23

absorption of b12 in the ileum

Question 24

symptoms of gastritis

Answer 24

megaloblastic anaemia
neurological symptoms
anorexia
glositis

Question 25

where are H pylori normally found in the stomach

Answer 25

antrum

Question 26

how do we diagnosis H pylori

Answer 26

urease breath test stool antigen test endoscopy with biopsy

Question 27

eradication of H pylori

Answer 27

proton pump inhibitor- PPI | 2 x antibiotics - clarithromycin and metronidazole

Question 28

what are the stomac defences

Answer 28

``` mucus layer HCO3- secretion mucosal blood flow prostagandins epithelial renewal ```

Question 29

what are the effects of NSAIDS

Answer 29

they prevent the release of prostaglandins which are needed to stimulate mucosal blood flow

Question 30

risk factors for peptic ulcer disease

Answer 30

H pylori NSAIDS smoking massive physiological stress- burn

Question 31

what is teh difference beween acute and chronic ulcers

Answer 31

acute ulcers develop as a part of acute gastritis chronic ulcers occur at the mucosal junctions

Question 32

morphology of Peptic ulcer disease

Answer 32

erosion to yhe muscularis externa which is replaced by scar tissue this narrows the stomach lumen causes pyloric stenosis

Question 33

what artery can stomach ulcers erode into

Answer 33

gastro-duodenal artery causing the stomach to fill with blood this causes malaena as the haem component is oxidised by passing through GI tract which causes black faeces

Question 34

symptoms of PUD

Answer 34

epigastric pain leading to back pain pain at night- duodenal ulcers early satiety weight loss

Question 35

management of PUD if H pylori is involved and there is no active bleeding

Answer 35

eradicate H pylori through PPI and 2 antibiotics which promotes ulcer healing

Question 36

management of PUD if H pylori isnt involved and there osnt active bleeding

Answer 36

stop NSAIDS

Question 37

if there is active bleeding how do we manage a PUD

Answer 37

adrenaline injected cauteru clip application

Question 38

What basic factors (related to the stomach and abdomen) contribute to Gastro Oesophageal Reflux Disease (GORD)?

Answer 38

Incompetent LOS raised intraabdominal pressure (after meals, obesity, pregnancy) and delayed gastric emptying.

Question 39

State three lifestyle changes that can improve symptoms associated with GORD

Answer 39

Weight loss, avoid trigger foods, smaller meals, eating earlier in the evening, propping up in bed with pillows etc

Question 40

Briefly describe the components of the lower oesophageal sphincter mechanism and how they prevent reflux

Answer 40

The acute angle of entry of the oesophagus into the stomach Intrinsic smooth muscle of the LOS Crural part of the diaphragm has smooth muscle that is distinct from the rest of the diaphragm. The right crus forms a sling around the lower oesophagus which tightens when intraabdominal pressure rises. The smooth muscle elements of the LOS contract when pressure in the stomach rises