Upper GI disease Flashcards
What is the aim of medication in upper GI disease
- eliminate formed acid (antacids)
- reduce acid secretion (H2 receptor blockers, proton pump inhibitors)
- improve mucosal barrier (eliminate helicobacter, inhibit prostaglandin removal)
What do antacids do
convert acid to salt, then absorb that
What produces acid in the stomach and how can it be stopped
parietal cells
proton pump inhibitors - otherwise need to block all of ACh, gastrin and histamine so easier to block the whole pump
what are the 3 triggers for making stomach acid
- histamine
- gastrin
- acetylcholine
how do H2 receptor antagonists work
reduce acid production by preventing histamine activation of acid production
limited benefit as alternative pathways are still open (ACh and gastrin)
Name H2 receptor antagonists
Cimetidine
Ranitidine
What does cimetidine do
H2 receptor antagonist
what does ranitidine do
H2 receptor antagonist
Name some proton pump inhibitors
- omeprazole
- lansoprazole
- pantoprazole
What are the 3 types of upper GI disease
- oral diseases
- oesophageal disease
- gastric disease
What are some oral diseases
- recurrent oral ulceration
- lichen planus
- orofacial granulomatosis
What is a minor/major/ herpetiform aphthae
form of recurrent oral ulcer, can get anywhere in gut.
Driven by immune system, very common
How do orofacial granulomatosis’s occur
- blockage of lymphatics by giant cell granulomas
- swelling of cheek mucosa
- ulceration forming
what technique is often used to explore the upper GI tract
endoscopy
What are some oesphageal disorders
- dysphagia
- dysmotility disorders
- GORD
What is dysphagia
- food sticking
- localised well by patient
- may be ‘functional’
- may be dysmotility
- may be external compression
what are different types of dysmotility disorders
- fibrosis (common for acid reflux, tissues looses stretch)
- neuromuscular disorders
What is GORD also known as
heartburn
3 main causes of GORD
- defective lower oesophageal sphincter
- impaired lower clearing
- impaired gastric emptying
what are the effects of GORD
- ulceration
- inflammation
- metaplasia
Signs and symptoms of GORD
- epigastric burning (worse lying down)
- dysphagia (oesophagitis, stricture, dysmotility)
- GI bleeding
- severe pain - mimics MI (oesophageal muscle spasm)
What is Barrett’s oesophagus
- recurrent acid reflux into lower part of the oesophagus
- metaplasia of the oesophageal lining to gastric type mucosa
- associated with malignant change
What is hiatus hernia
- part of stomach is in thorax
- symptoms can be similar to GORD
- commoner in women
How is GORD managed
- stop smoking
- lose weight
- antacids
- H2 blockers and PPI’s
- increase GI motility and gastric emptying
