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Gastroenterology > Upper GI Disease > Flashcards

Upper GI Disease Flashcards

1
Q

What meds are used to eliminate formed acid?

A

Antacids

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2
Q

What meds are used to reduce acid secretions in Upper GI Disease? (2)

A
  1. H2 receptor blockers

2. PPIsexa

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3
Q

What type of cells produce stomach acid?

A

Parietal cells

- They have an acid secreting portion called a proton pump

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4
Q

Function of proton pump inhibitors?

A

To inhibit acid secretion

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5
Q

What 3 receptors must be blocked to inhibit acid secretion? (3)

A
  1. Acetylcholine
  2. Gastrin
  3. Histamine
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6
Q

Function of H2 receptor antagonists

A

Reduce acid production by preventing histamine activation for acid production

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7
Q

Why do H2 receptors have a limited benefit? (2)

A

Alternative pathways are still open

  • Acetylcholine
  • Gastrin
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8
Q

List examples of PPIs (3)

A
  1. Omeprazole
  2. Lansoprazole
  3. Pantoprazole
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9
Q

Name a steroid side effect that affects the GI

A

Gastric bleeding

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10
Q

Examples of upper GI disease (3)

A
  1. Oral disease
  2. Oesophageal disease
  3. Gastric disease
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11
Q

List examples of oral diseases (3)

A
  1. Recurrent oral ulceration
  2. Lichen Planus
  3. Orofacial granulomatosis
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12
Q

Name examples of recurrent oral ulcers (3)

A
  1. Minor Aphthae
    - Last for roughly 2 weeks
  2. Major Aphthae
    - More than 1cm in size
    - Can take 3 months to heal
    - Can scar and leave a mark in tissue
  3. Herpetiform Aphthae
    - Loads of small ulcers in the mouth
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13
Q

Where are herpetiform aphthae found?

A
  • Wont find them on the dorsum of the tongue or attached gingivae
  • Will find them on floor of mouth and lips
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14
Q

What is an orofacial granulomatosis?

A

Blockage of the lymphatics that drain away fluid that has moved from the capillaries into the tissues

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15
Q

When can you get orofacial granulomatosis?

A
  • Any age
  • Comes and goes
  • No harm, just cosmetic issues
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16
Q

How does orofacial granulomatosis present clinical?

A
  1. Cobblestoning of mucosa

2. Swelling of tissues as you have thick fissures holding tissues

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17
Q

List examples of oesophageal disorders (3)

A
  1. Dysphagia
    - Problems swallowing
    - Cant get bolus past blockage
    - Or if muscles don’t work properly the bolus can’t be propelled into the stomach
  2. Dysmotility Disorders
    - Fibrosis
    - Neuromuscular dysfunction
  3. GORD
    - Heart burn
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18
Q

What type of changes in mucosa occur in GORD (3)

A

Changes in mucosa from stratified squamous to simple columnar (more resistance to damage)

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19
Q

How does dysphagia present? (3)

A

Intermittent or constant

  1. May be functional
  2. Dysmotility
  3. May be external compression
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20
Q

What are the main causes of GORD? (3)

A
  1. Defective lower oesophageal sphincter
  2. Impaired lower clearing
  3. Impaired gastric emptying
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21
Q

The effects of GORD (3)

A
  1. Ulceration
  2. Inflammation
  3. Metaplasia
22
Q

How does GORD present problems with the stomach? (2)

A

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
23
Q

List signs + symptoms of GORD (4)

A
  1. Epigastric burning
    - More pressure on abdomen so more likely to push the pressure through
    - Worse lying down, bending and in pregnancy
  2. Dysphagia
  3. GI bleeding
  4. Severe pain
    - Mimics MI
    - Oesophageal muscle spasm
24
Q

What events lead to GI bleeding? (2)

A
  • Irritating lining of the oesophagus leads to it becoming inflamed and friable
  • When food passes it scrapes against this surface and bleeds
25
Q

Define Barretts Oesophagus (2)

A
  • Recurrent acid reflux into the lower part of the oesophagus
  • Metaplasia of the oesophageal lining to gastric type mucosa (strat squamous to simple columnar)
26
Q

What is Barretts Oesophagus associated with?

A

Malignant changes
- Adenocarcinoma

Inflamed lower 1/2 = high risk of developing a carcinoma

27
Q

How can the progression of Barretts Oesophagus be halted?

A

Stop acid reflux with PPIs

28
Q

What is Hiatus Hernia?

A
  • Part of the stomach moves to the thorax through a weakness in the diaphragm
  • Symptoms can be similar to GORD
29
Q

Who is more affected by Hiatus Hernia?

A

Women over 50s

Tx: Acid suppressing drugs

30
Q

What does a Hiatus Hernia make a person more prone to?

A

More prone to acid reflux into your oesophagus, which can lead to heart burn

31
Q

Name the 2 types of Hiatus Hernia

A
  1. Sliding Hiatus Hernia
    - Most common type
  2. Rolling Hiatus Hernia
32
Q

How does a sliding Hiatus Hernia present?

A

Sphincter at oesophagus and the top of the stomach protrudes through the hole hiatus in the diaphragm

33
Q

How does a rolling Hiatus Hernia present?

A

Part of the stomach protrudes through the hole in the diaphragm next to the oeosophagus

34
Q

How is GORD managed? (5)

A
  1. Stop smoking- improves sphincter
  2. Lose weight + avoid triggering activity
  3. Anacids
  4. H2 blockers + PPIs
    - Ranitidine + Omeprazole
  5. Increase GI motility + gastric emptying
35
Q

What sites does PUD affect, and how does it lead to low pH in the duodenum?

A

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

36
Q

Causes of PUD? (3)

A
  1. High acid secretion
    - Duodenal
  2. Normal acid secretion
    - Stomach
  3. Drugs
    - NSAIDs
    - Steroids
37
Q

How does PUD present clinically? (3)

A
  1. Hole in stomach lining may progress through stomach walls
  2. Acid protection has been removed and the acid starts to digest and burn a hole through the connective tissue in the mucosa
  3. Can get out from the hole into the peritoneum
38
Q

How does a gastric ulcer present in a patient?

A

Patient presents with vomiting blood because of the blood entering the stomach from the eroded artery

39
Q

How does:

  1. Excessive Acid
  2. Normal Acid

Present in PUD

A

Excessive Acid

  • Oesophageal
  • Duodenal Ulcers

Normal Acid
- Reduced protective barrier

40
Q

What bacterium causes PUD?

A

Helicobacter Pylori

  • Causes gastric inflammation
  • Often asymptomatic
41
Q

What can gastric inflammation by Helicobacter Pylori lead to? (2)

A
  1. Gastric ulcers
    - Severe complications include bleeding/perforated ulcers
  2. Chronic gastric wall inflammation
    - Lymphoma of the stomach
42
Q

PUD signs and symptoms (3)

A
  1. Asymptomatic
  2. Epigastric burning pain
    - Worse before/after meals
    - Worse at night
    - Relieved by food
  3. Usually no physical signs
    - Only when complications e.g. bleeding/perforations
43
Q

PUD investigations (4)

A
  1. Endoscopy
  2. Radiology
  3. Anaemia
  4. H. Pylori
    - Breath
    - Antibodies
    - Mucosa
44
Q

List examples of local PUD complications (4)

A
  1. Perforation
  2. Haemorrhage
  3. Stricture
  4. Malignancy
45
Q

Name an example of a systemic PUD complication

A

Anaemia

46
Q

PUD medical tx (4)

A

Reversible problem so lifestyle changes

  1. Stop smoking
  2. Small regular meals
  3. Eradication therapy
  4. Ulcer healing drugs
47
Q

PUD surgical tx (3)

A
  • Endoscope
  • Surgical repair (Gastrectomy)
  • Vagotomy
48
Q

Why should NSAIDs be avoided if a pt has upper GI disease?

A

Encourages prostaglandin removal instead of inhibiting prostaglandin removal

Reduce steroid use

49
Q

Functions of meds in Upper Gi disease (4)

A
  1. Reduce acid secretion
  2. Eliminate formed acid
  3. Improve mucosal barrier
  4. Eliminate helicobacter pylori
50
Q

What is triple therapy?

A

For elimination of Helicobacter Pylori

Two week course of:

2 antibiotics

  1. Amoxycillin
  2. Metronidazole

PPI
- Omeprazole

51
Q

Compare Bilroth 1 and Bilroth 2

A

BILROTH 1
- Top half of stomach reconnected to duodenum

BILROTH 2
- Part of stomach reconnected to small bowel

52
Q

Function of highly selective vagotomy

A

Cuts off branches that go to the parietal cells

  • Reduce gastric acid secretion without causing problems to stomach or GI motility

Gastroenterology (4 decks)

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