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BDS2 BAMS Gastroenterology > Upper GI disease > Flashcards

Upper GI disease Flashcards

1
Q

What is the aim of medication in upper GI disease

A
  • eliminate formed acid (antacids)
  • reduce acid secretion (H2 receptor blockers, proton pump inhibitors)
  • improve mucosal barrier (eliminate helicobacter, inhibit prostaglandin removal)
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2
Q

What do antacids do

A

convert acid to salt, then absorb that

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3
Q

What produces acid in the stomach and how can it be stopped

A

parietal cells

proton pump inhibitors - otherwise need to block all of ACh, gastrin and histamine so easier to block the whole pump

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4
Q

what are the 3 triggers for making stomach acid

A
  • histamine
  • gastrin
  • acetylcholine
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5
Q

how do H2 receptor antagonists work

A

reduce acid production by preventing histamine activation of acid production

limited benefit as alternative pathways are still open (ACh and gastrin)

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6
Q

Name H2 receptor antagonists

A

Cimetidine

Ranitidine

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7
Q

What does cimetidine do

A

H2 receptor antagonist

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8
Q

what does ranitidine do

A

H2 receptor antagonist

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9
Q

Name some proton pump inhibitors

A
  • omeprazole
  • lansoprazole
  • pantoprazole
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10
Q

What are the 3 types of upper GI disease

A
  • oral diseases
  • oesophageal disease
  • gastric disease
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11
Q

What are some oral diseases

A
  • recurrent oral ulceration
  • lichen planus
  • orofacial granulomatosis
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12
Q

What is a minor/major/ herpetiform aphthae

A

form of recurrent oral ulcer, can get anywhere in gut.

Driven by immune system, very common

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13
Q

How do orofacial granulomatosis’s occur

A
  • blockage of lymphatics by giant cell granulomas
  • swelling of cheek mucosa
  • ulceration forming
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14
Q

what technique is often used to explore the upper GI tract

A

endoscopy

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15
Q

What are some oesphageal disorders

A
  • dysphagia
  • dysmotility disorders
  • GORD
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16
Q

What is dysphagia

A
  • food sticking
  • localised well by patient
  • may be ‘functional’
  • may be dysmotility
  • may be external compression
17
Q

what are different types of dysmotility disorders

A
  • fibrosis (common for acid reflux, tissues looses stretch)

- neuromuscular disorders

18
Q

What is GORD also known as

A

heartburn

19
Q

3 main causes of GORD

A
  • defective lower oesophageal sphincter
  • impaired lower clearing
  • impaired gastric emptying
20
Q

what are the effects of GORD

A
  • ulceration
  • inflammation
  • metaplasia
21
Q

Signs and symptoms of GORD

A
  • epigastric burning (worse lying down)
  • dysphagia (oesophagitis, stricture, dysmotility)
  • GI bleeding
  • severe pain - mimics MI (oesophageal muscle spasm)
22
Q

What is Barrett’s oesophagus

A
  • recurrent acid reflux into lower part of the oesophagus
  • metaplasia of the oesophageal lining to gastric type mucosa
  • associated with malignant change
23
Q

What is hiatus hernia

A
  • part of stomach is in thorax
  • symptoms can be similar to GORD
  • commoner in women
24
Q

How is GORD managed

A
  • stop smoking
  • lose weight
  • antacids
  • H2 blockers and PPI’s
  • increase GI motility and gastric emptying
25
Q

Where can you get peptic ulcer disease (PUD)

A

any acid affected site e.g. oesophagus, stomach, duodenum

26
Q

what are the causes of peptic ulcer disease

A
  • high acid secretion (duodenal)
  • normal acid secretion (stomach), helicobacter pylori involvement
  • drugs (NSAIDS, steroids)
27
Q

When does peptic ulcer disease become quite serious

A

A hole in the stomach wall, that hole might even perforate.
Most people get a bit of a pot hole where the acid protection has been removed and then the acid starts burning through
Perforation can cause periotonitis - potentially fatal
Serious disease if allowed to get out of hand
Wall of duodenum is much thinner than the wall of the stomach
Most common reason is hormone related, too much gastrin however within the stomach you should have protection from mucus lining

28
Q

what organism is involved in causing peptic ulcer disease, how does it do this

A

helicobacter pylori

causes inflammation of the gastric mucosa

29
Q

What are severe complications of duodenal or gastric ulcers

A

bleeding ulcers and perforated ulcers

30
Q

How do you eliminate helicobacter pylori

A

triple therapy:
- 2 antibiotics (amoxycilin, metronidazole)
- 1 proton pump inhibitor
(omeprazole)

31
Q

Signs and symptoms of PUD

A
  • asymptomatic
  • epigastric burning pain
  • usually no physical signs without complications
32
Q

How is PUD investigated

A
  • Endoscopy (oesphagus, stomach & duodenum)
  • Radiology (barium meal)
  • Anaemia (F.B.C and faecal occult blood test)
  • H.pylori (breath, antibodies, mucosa)
33
Q

Complications of PUD

A

Local

  • perforation
  • haemorrhage
  • stricture
  • malignancy

Systemic
- anaemia

34
Q

PUD treatment

A

Medical (reversible, lifestyle, H.pylori present)

  • stop smoking
  • small regular meals
  • eradication therapy
  • ulcer healing drugs

Surgical (stricture, acute bleed, perforation, malignancy)

  • endoscope
  • surgical repair
  • vagotomy
35
Q

What are the 2 surgical procedures possible for PUD treatment

A
  • bilroth

- vagotomy

BDS2 BAMS Gastroenterology (5 decks)

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