Unit 2 Case 2 Flashcards

1
Q

What is Unit 2 Case 2 about?

A

A 15-year-old female has trouble swallowing and is overcome by a deep, painful burning sensation in her throat and chest. She is told she has GERD due to a weak esophageal sphincter.
She is advised to change lifestyle choices but loses control of that which results in nausea, vomiting, and trouble swallowing. She has been prescribed a proton pump inhibitor and is in danger of developing Barrett’s esophagus. She has an endoscopy to reveal the extent of the damage as her family looks at treatment options.

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2
Q

What are the 2 types of peristalsis?

A

Primary peristalsis

Secondary peristalsis

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3
Q

What is primary peristalsis?

A

Peristalsis that is swallow induced- the most common form of peristalsis

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4
Q

What is secondary peristalsis?

A

Activated by oesophageal distension, e.g from food let from primary peristalsis

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5
Q

What normally makes cells resistant to stomach acid?

A

Mucous cells secrete an alkaline mucus that protects the epithelium against the stomach acid

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6
Q

How does acidic PH effect a cell and its function?

A

Acidic PH levels denature enzymes and alter virtually all cellular processes within the cell which leads to loss of function

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7
Q

What is Lansoprazole?

A

A type of drug

A proton pump inhibitor

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8
Q

What does Lansoprazole do and what is it prescribed for?

A

Lansoprazole reduces the amount of acid your stomach makes

Prescribed for indigestion, heartburn, and acid reflux and GERD

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9
Q

What is the mechanism of action for Lansoprazole?

A
  • selectively inhibits the membrane enzyme H+/K+ ATPase in gastric parietal cells
  • Therefore reduces the amount of acid your stomach makes
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10
Q

What are parietal cells?

A

Cells that secrete hydrochloric acid

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11
Q

What are antacids?

A

Antacids are a combination of compounds containing salts of calcium, magnesium, and aluminum-an alkaline
-neutralise stomach acid

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12
Q

What is the mechanism of action for antacids?

A
  • H+ ions fullys dissociated in HCL
  • Antacids containing bicarbonate ions combine with the H+ ions to form an unstable complex which dissociates into H2O AND CO2
  • Decrease H+ conc (neutralises the acid)
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13
Q

What are the pros and cons of antacids?

A

Pros: Do not have to be prescribed such as gaviscon

Cons: Not a long term solution, the long term solution is a proton pump inhibitor

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14
Q

What are displasic cells?

A

Precancerous cells - has potential to become cancerous

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15
Q

What does GERD stand for?

A

Gastro-Oesophageal Reflux Disease

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16
Q

What is a weak esophageal sphincter and what does it allow?

A

A weak esophageal sphincter is when the sphincter doesnt close tightly enough
-allows stomach acid to flow back up into the esophagus

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17
Q

Can acid reflux reach the lungs and what are the consequences of this?

A

It can reach the lungs when you are in a supine position (sleeping)
- when acid gets into the lungs it can cause throat irritation and lung inflammation possibly leading to bronchitis/pneumonia

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18
Q

What are the most common ages of people with GERD?

A

Highest in the 20-29 age group

Lowest in the 70-79 age group

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19
Q

What causes a weak esophageal sphincter?

A

When a person regulary eats or is overweight, their stomach swells and puts alot of extra pressure on the Lower Esophageal sphincter
-over time it looses its shape and strength making it weak

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20
Q

Why is the rate of mutation increased during constant acid exposure in oesophageal cells?

A

Oesophageal epithelium don’t have a protective mucus layer like stomach epithelium
-the acid causes DNA damge to the cells leading to point mutations

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21
Q

What is Barrett’s oesophagus?

A

When the epithelium in the oesophagus changes from simple squamous to simple columnar. Resembling the lining of the small intestine

  • more likely to get oesophageal cancer
  • often reffered to as a pre cancerous condition
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22
Q

What is heart burn?

A

When acid reflux travels up your oesophagus from your stomach. Which causes a burning feeling in your chest

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23
Q

What causes heart burn?

A

The most common cause is food that is acidic or high in fat. As this increases acid reflux

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24
Q

How is peristalsis affected by GERD?

A

Affects secondary peristalsis

Reducing the response to oesophageal distention

25
Q

How is the oesophagus scarred and what does this cause?

A

Scarring can occur when the oesophagus becomes inflammed

-can lead to oesophageal stricture (narrowing of the oesophagus)

26
Q

What is oesophageal stricture?

A

The narrowing of the oesophagus

27
Q

What are symptoms of oesophageal stricture?

A

Main symptom is dysphagia (difficulty swallowing)

  • regurgitation of foods/liquids
  • sensation of something stuck in the chest after eating
28
Q

What is dysphagia?

A

Difficulty swallowing

29
Q

What is dyspepsia?

A

Indigestion

30
Q

How do you take a patients history?

A
  • Introduce yourself
  • Presenting complaint
  • History of presenting complaint
  • Past medical history
  • Drug, family and social history
  • Summary of history and questions
31
Q

What is BMI?

A

BMI (body mass index) is a measure using a patient’s height and weight to assess whether their body weight is healthy.

32
Q

How do you calculate BMI?

A

Mass (kg) divided by Height^2 (M^2)

33
Q

What are the ideal ranges for BMI?

A

The ideal range in adults is 18.5-24.9

34
Q

What are the cons to using BMI to determine if the body is healthy?

A

Dosen’t take into account certain factors, such as muscle density (which will increase BMI), gender or frame size

35
Q

What are the clinical use of BMI?

A

Used as a good gauge of body fat

To determine if the too much or too little body fat presents a risk to health

36
Q

What are the risk factors of obesity?

A

Lack of excersize, unhealthy eating patterns, not enough sleep and stress

37
Q

How can an unhealthy lifetsyle lead to GERD?

A

Poor eating habits and eating alot of acidic or fatty food can increase acid reflux.

38
Q

What diseases are obese people more susceptible to?

A

Type 2 diabetes
Coronary heart disease
Some types of cancers- bowel or breast cancer
Stroke

39
Q

What are the treatment options for GERD?

A

Antacids, Histamine blockers, Proton pump inhibtors which all work to reduce acid reflux

40
Q

What are the treatments for dysphagia?

A

Surgery to treat GERD
Dietary changes-softer foods
Speech therapy-teach how to swallow

41
Q

What is esophagitis?

A

Inflammation that may damage tissues of the oesophagus

42
Q

What is gaviscon?

A

An over the counter antacid that reduces acid reflux

43
Q

What are the side effects of over the counter medicine such as gaviscon?

A

Constipation
Diarrhea
Nausea
Stomach cramps

44
Q

What is an endoscopy?

A

A procedure to look inside the body (medical imaging)

Uses an endoscope to examine the interior of a hollow organ or cavity of the body

45
Q

What type of endoscopy is used to image the oesophagus and what is it looking for?

A

Upper GI endoscopy

-Looking for any narrowing or blockages in the oesophagus

46
Q

What is an oesophageal manometry?

A

A test to show if the oesophagus sphincter and muscles of the oesophagus are working properly
- measures the contractions of the oesophagus and the sphincter

47
Q

What is oesophageal pH monitoring?

A

Oesophageal ph monitoring is the current gold standard for diagnosis of GERD

48
Q

What are normal ranges of oesophageal pH monitoring?

A

Normal oesophageal pH considered to be close to pH 7

- People with GERD have an oesophageal pH of below pH 4

49
Q

Is there a cure for Barrett’s oesophagus?

A

No cure for Barrett’s oesophagus

- but a care plan canbe put in place to stop any more damage due to acid reflux

50
Q

What is Gillick competence?

A

A term used in medical law to decide whether a child is able to consent to their own medical treatment, without the need for parental permission or knowledge

51
Q

How can having GERD have a mental and social impact on people?

A

GERD impacts daily life, such as affecting sleep or physcial activity
Or due to the lifestyle changes involved in managing GERD people may have social anxiety

52
Q

How does the health belief model influence patients with GERD?

A

GERD is common but it is often unrecognised

  • Symptoms are misunderstood- reduced percieved threat and severity lower therefore people dont go to the GP about it
  • more likely to develop into Barrett’s oesophagus
53
Q

What are the main mechanisms of DNA reapir?

A

Base excision
Nucleotide excision
Mismatch repair

54
Q

What is trans differentiation?

A

A process where one mature somatic cell is transformed into another mature somatic cell without undergoing an intermediate pluripotent state

55
Q

What is meant by oesophageal strictures?

A

Narrow spots on the oesophagus which narrow the oesophagus making it harder to swallow
Caused by a build up of scar tissue

56
Q

What is manometry?

A

Putting a tube up the nose into stomach

Tests how well the oesophagus preforms peristalsis and the strength of the lower oesophageal sphincter

57
Q

What is the process of 24 hour pH monitoring?

A

This is when you swallow a Bluetooth capsule which then measures the amount of acid reflux over 24 hours to establish if symptoms are due to acid reflux

58
Q

What makes cells resistant to acid?

A

Presence of mucus barrier

Presence of bicarbonate barrier

59
Q

What are the 2 surgical treatments of Barrett’s oesophagus?

A

Oesophagectomy- remove affected area

Nissan fundoplication- wrapping the fundus around the lower oesophageal sphincter to strengthen it