Unit 2 Case 2: GERD Flashcards
anatomy of the oesophagus
C6 to T11
adventitia
muscularis externa
submucosa
mucosa
musculares externa in the superior third
voluntary striated muscle
musculares externa in the middle third
voluntary striated and smooth
muscularis externa in the inferior third
smooth muscle
layers in the muscularis externa of the stomach q
longitudinal
circular
oblique
4 regions of the stomach
cardia- surrounds opening of the oesophagus
fundus-area above the cardinal orifice
body-largest region
pylorus- stomach to the duodenum
2 sphincters inside of the stomach
inferior oesophageal
pyloric
inferior oesophageal sphincter
transition between stomach and oesophagus at T11
food passes from oesophagus through cardiac orifice and into body of the stomach
pyloric sphincter
lies between pylorus and start of the duodenum
controms exit of chyme (food and gastric acid mixture)
3 sublayers of the mucosa of the oesophagus
stratified squamous non-keratinised epithelium
lamina propria
muscularis mucosa
stratified squamous non-keratinised epithelium
mucous production
for lubrication and neutralisation of acid
protection
lamina propria
absorption via the capillaries
contains MALT for immune response
muscularis mucosa
for localised movement
uses muscular contraction
submucosa
large network of blood vessels
increases SA for nutrient absorption
mucus glands for lubrication of bolus
Meissen nerve cells to control effectors
histology of the stomach
simple columnar
what occurs in the fundus and the body of the stomach
the epithelial lining invaginate
forming gastric pits
cells that the gastric pits contain
surface lining
regenerative
mucous neck cells
parietal
chief
regenerative cells
replace any of the other cells
mucous neck cells
secrete mucous and neutralise acid
parietal cells
release hydrochloric acid, intrinsic factor and gastrin
chief cells
secretes pepsinogen and HCl converts pepsinogen to pepsin, active form
what is GERD
stomach contents regurgitate up into the oesophagus
oesophageal sphincter is in a relaxed state
impaired lower oesophageal sphincter mechanism
intragastric pressure
delayed gastric emptying
symptoms of GERD
heartburn
unpleasant sour taste in the mouth
upper GI pain
cough
hiccups
halitosis
bloating
nausea and vomiting
dysphagia
odynophagia
nocturnal asthma
when can GERd symptoms worsen
lying down
bending over
after eating
what is dyspepsia
collection of symptoms of upper GI pain: heartburn, nausea,vomiting
not a diagnosis
drug used in this case
lansoprazole
what is lansoprazole
proton pump inhibitor
chemical mature of benzimidazole sulfoxide
what can lansoprazole be used to treat
duodenal ulcers
gastric ulcers
erosive oesophagitis
GERD
Zollinger-ellison syndrome
mechanism of action of lansoprazole
in separate flashcards
mechanism of action of lansoprazole
binds to the proton pump inhibitors and prevent release of protons into the stomach from parietal cells
reduces amount of HCl produced by stomach
increases pH of the stomach
short term side effects of lansoprazole
headaches
abdominal pain
nausea
long term effects of lansoprazole
infections
deficiency in vitamin B12, magnesium, iron and calcium
diarrhoea
what is Barrett’s oesophagus
replacement of normal stratified squamous epithelium with metaplastic premalignant intestinal columnar epithelium in the distal oesophagus
what is oesophageal cancer
a malignancy that develops in tissues of the hollow, muscular canal along which food and liquid travel from the throat to the stomach
2 main types of oesophageal cancer
adenocarcinoma
squamous cell carcinoma
what are the risk factors for GERD
overweight
pregnancy
smoking
drugs
hiatus hernia
stress
diet
gender
other diseases
overweight as a risk factor
increased pressure
lower oesophageal sphincter releaxes
acid travels up the oesophagus
body less efficient at emptying stomach contents
increases acid secretion
pregnancy as a risk factor
increased weight and growth of foetus
increases pressure on the stomach
acid travels up the oesophagus
hormones such as plasma progesterone
weakens the lower oesophageal sphincter
stomach acid easily pushes up
smoking as a risk factor
nicotine relaxes smooth muscle and lower oesophageal sphincter
acid and stomach contents travel up oesophagus
reduces salvation, saliva contains acid-neutralising bicarbonate
less acid neutralisation takes place
short term implications of GERD
heartburn
dry cough
difficulty swallowing
asthma-like symptoms
sore throat
bad breath
nausea
long term implications of GERD
oesophagitis
oesophageal ulcers
oesophageal bleeding
oesophageal stricture
barrett’s oesophagus
oesophageal cancer
3 main types of medicine for indigestion q
antacids and alginates
PPIs
H2-blockers
examples of antacids and alginates
gaviscon
maalox
setlers
tums
case specific members of the MDT
dietician
endoscopist
gatroenterologist
diagnosing GERD
proton pump inhibitor trial
barium swallow
oesophageal pH monitoring
endoscopy
proton pump inhibitor trial
reduce amount of hydrochloric acid the stomach produces and are given to see if symptoms of acid reflux after 4-8 weeks
barium swallow
given a barium solution
coats the inside lining of the digestive tract
allows the silhouette of the oesophagus to be seen under an x-ray
shows the fluid travelling down oesophagus
assess for reflux or other issues
2 types of oesphageal pH monitoring
catheter
capsule
catheter monitoring
catheter down oesophagus for 24 hours
adds impedance to distinguish between acid and non-acid reflux
impedance monitoring detects changes in resistance to electrical current
capsule monitoring
endoscope
small wireless pH sensing capsule
measures and transmits signal onto belt
48 hours
patient can continue normal activities
what is manometry
assess muscle of the oesophagus
measures the pressure inside
fundoplication
strengthens the barrier acid reflux when sphincter doesn’t function correctly
top of the stomach, fungus is folded and sewn around the LEs
when would you have a fundoplication
when you fail to respond to adequate doses of medication
intolerable side effects from medication
not wanting to take long-term medication
effects of illness on other family members
emotional upheaval
somatic problems
cognitive and emotional problems
behavioural troubles
how can friends and family support GERD patients
educate themselves on GERD
help manage lifestyle factors that can alleviate GERD symptoms
quit smoking
encourage more exercise
