Upper GI Disease Flashcards
What meds are used to eliminate formed acid?
Antacids
What meds are used to reduce acid secretions in Upper GI Disease? (2)
- H2 receptor blockers
2. PPIsexa
What type of cells produce stomach acid?
Parietal cells
- They have an acid secreting portion called a proton pump
Function of proton pump inhibitors?
To inhibit acid secretion
What 3 receptors must be blocked to inhibit acid secretion? (3)
- Acetylcholine
- Gastrin
- Histamine
Function of H2 receptor antagonists
Reduce acid production by preventing histamine activation for acid production
Why do H2 receptors have a limited benefit? (2)
Alternative pathways are still open
- Acetylcholine
- Gastrin
List examples of PPIs (3)
- Omeprazole
- Lansoprazole
- Pantoprazole
Name a steroid side effect that affects the GI
Gastric bleeding
Examples of upper GI disease (3)
- Oral disease
- Oesophageal disease
- Gastric disease
List examples of oral diseases (3)
- Recurrent oral ulceration
- Lichen Planus
- Orofacial granulomatosis
Name examples of recurrent oral ulcers (3)
- Minor Aphthae
- Last for roughly 2 weeks - Major Aphthae
- More than 1cm in size
- Can take 3 months to heal
- Can scar and leave a mark in tissue - Herpetiform Aphthae
- Loads of small ulcers in the mouth
Where are herpetiform aphthae found?
- Wont find them on the dorsum of the tongue or attached gingivae
- Will find them on floor of mouth and lips
What is an orofacial granulomatosis?
Blockage of the lymphatics that drain away fluid that has moved from the capillaries into the tissues
When can you get orofacial granulomatosis?
- Any age
- Comes and goes
- No harm, just cosmetic issues
How does orofacial granulomatosis present clinical?
- Cobblestoning of mucosa
2. Swelling of tissues as you have thick fissures holding tissues
List examples of oesophageal disorders (3)
- Dysphagia
- Problems swallowing
- Cant get bolus past blockage
- Or if muscles don’t work properly the bolus can’t be propelled into the stomach - Dysmotility Disorders
- Fibrosis
- Neuromuscular dysfunction - GORD
- Heart burn
What type of changes in mucosa occur in GORD (3)
Changes in mucosa from stratified squamous to simple columnar (more resistance to damage)
How does dysphagia present? (3)
Intermittent or constant
- May be functional
- Dysmotility
- May be external compression
What are the main causes of GORD? (3)
- Defective lower oesophageal sphincter
- Impaired lower clearing
- Impaired gastric emptying
The effects of GORD (3)
- Ulceration
- Inflammation
- Metaplasia
How does GORD present problems with the stomach? (2)
Problems with stomach:
- As what goes in doesn’t go to duodenum, so the stomach becomes fuller
- Easier for pressure to build up and force acid back up the oesophagus
List signs + symptoms of GORD (4)
- Epigastric burning
- More pressure on abdomen so more likely to push the pressure through
- Worse lying down, bending and in pregnancy - Dysphagia
- GI bleeding
- Severe pain
- Mimics MI
- Oesophageal muscle spasm
What events lead to GI bleeding? (2)
- Irritating lining of the oesophagus leads to it becoming inflamed and friable
- When food passes it scrapes against this surface and bleeds
Define Barretts Oesophagus (2)
- Recurrent acid reflux into the lower part of the oesophagus
- Metaplasia of the oesophageal lining to gastric type mucosa (strat squamous to simple columnar)
What is Barretts Oesophagus associated with?
Malignant changes
- Adenocarcinoma
Inflamed lower 1/2 = high risk of developing a carcinoma
How can the progression of Barretts Oesophagus be halted?
Stop acid reflux with PPIs
What is Hiatus Hernia?
- Part of the stomach moves to the thorax through a weakness in the diaphragm
- Symptoms can be similar to GORD
Who is more affected by Hiatus Hernia?
Women over 50s
Tx: Acid suppressing drugs
What does a Hiatus Hernia make a person more prone to?
More prone to acid reflux into your oesophagus, which can lead to heart burn
Name the 2 types of Hiatus Hernia
- Sliding Hiatus Hernia
- Most common type - Rolling Hiatus Hernia
How does a sliding Hiatus Hernia present?
Sphincter at oesophagus and the top of the stomach protrudes through the hole hiatus in the diaphragm
How does a rolling Hiatus Hernia present?
Part of the stomach protrudes through the hole in the diaphragm next to the oeosophagus
How is GORD managed? (5)
- Stop smoking- improves sphincter
- Lose weight + avoid triggering activity
- Anacids
- H2 blockers + PPIs
- Ranitidine + Omeprazole - Increase GI motility + gastric emptying
What sites does PUD affect, and how does it lead to low pH in the duodenum?
Any acid affected site:
Oesophagus
Stomach
Duodenum
Occurs if acid secretion is too high (too much acid, too little neutralisation) leads to lower pH in duodenum
Causes of PUD? (3)
- High acid secretion
- Duodenal - Normal acid secretion
- Stomach - Drugs
- NSAIDs
- Steroids
How does PUD present clinically? (3)
- Hole in stomach lining may progress through stomach walls
- Acid protection has been removed and the acid starts to digest and burn a hole through the connective tissue in the mucosa
- Can get out from the hole into the peritoneum
How does a gastric ulcer present in a patient?
Patient presents with vomiting blood because of the blood entering the stomach from the eroded artery
How does:
- Excessive Acid
- Normal Acid
Present in PUD
Excessive Acid
- Oesophageal
- Duodenal Ulcers
Normal Acid
- Reduced protective barrier
What bacterium causes PUD?
Helicobacter Pylori
- Causes gastric inflammation
- Often asymptomatic
What can gastric inflammation by Helicobacter Pylori lead to? (2)
- Gastric ulcers
- Severe complications include bleeding/perforated ulcers - Chronic gastric wall inflammation
- Lymphoma of the stomach
PUD signs and symptoms (3)
- Asymptomatic
- Epigastric burning pain
- Worse before/after meals
- Worse at night
- Relieved by food - Usually no physical signs
- Only when complications e.g. bleeding/perforations
PUD investigations (4)
- Endoscopy
- Radiology
- Anaemia
- H. Pylori
- Breath
- Antibodies
- Mucosa
List examples of local PUD complications (4)
- Perforation
- Haemorrhage
- Stricture
- Malignancy
Name an example of a systemic PUD complication
Anaemia
PUD medical tx (4)
Reversible problem so lifestyle changes
- Stop smoking
- Small regular meals
- Eradication therapy
- Ulcer healing drugs
PUD surgical tx (3)
- Endoscope
- Surgical repair (Gastrectomy)
- Vagotomy
Why should NSAIDs be avoided if a pt has upper GI disease?
Encourages prostaglandin removal instead of inhibiting prostaglandin removal
Reduce steroid use
Functions of meds in Upper Gi disease (4)
- Reduce acid secretion
- Eliminate formed acid
- Improve mucosal barrier
- Eliminate helicobacter pylori
What is triple therapy?
For elimination of Helicobacter Pylori
Two week course of:
2 antibiotics
- Amoxycillin
- Metronidazole
PPI
- Omeprazole
Compare Bilroth 1 and Bilroth 2
BILROTH 1
- Top half of stomach reconnected to duodenum
BILROTH 2
- Part of stomach reconnected to small bowel
Function of highly selective vagotomy
Cuts off branches that go to the parietal cells
- Reduce gastric acid secretion without causing problems to stomach or GI motility
