Upper gi disease Flashcards
What medication can be used to eliminate formed acid?
- Antacids e.g. Rennie
What types of medications can be used to reduce acid secretion ? (2 points)
- H2 receptor blockers
- Proton pump inhibitors
How do antacids work?
- They convert acid into salt by neutralising it with alkali
- The salt is then absorbed
What is the name of the cells in the stomach that produce acid?
- Parietal cells
What are the 3 triggers for acid production in the stomach?
- Acetylcholine
- Gastrin
- Histamine
- Unless you block all 3 of these you will get acid secretion
How do H2 receptor antagonists reduce acid production?
- By preventing histamine activation of acid production
Are H2 receptor antagonists beneficial in reducing acid production?
- Limited benefit as alternative pathways are still active:
- Acetylcholine & gastrin
What is Cimetidine? (3 points)
- An original H2 blocker (not used so much nowadays)
- Has many drug interactions (bad)
- Not fully effective
What is Ranitidine? (3 points)
- A H2 blocker
- Safer in clinical use than Cimetidine
- Licensed for over the counter sales
What is more effective clinically: H2 blockers or proton pump inhibitors?
Proton pump inhibitors
What are 3 examples of proton pump inhibitors?
- Omeprazol
- Lansoprazole
- Pantoprazole
What are 3 examples of upper GI diseases?
- Oral diseases
- Oesophageal disease
- Gastric disease
What are the 3 main oral diseases?
- Recurrent oral ulceration
- Lichen planus
- Orofacial Granulomatosis
What is minor aphthae?
- A form of recurrent oral ulcers
- Driven by the immune system
Where can you get minor aphthae?
- Anywhere in the gut
How long do minor aphthae last for?
- Last for about 2 weeks then go away
How big are major aphthae?
- More than 1cm in size
How long do major aphthae take to heal?
- Can take more than 3 months to heal
What are herpetiform aphthae?
- Mouth ulcers
- Hundreds of small ulcers around the mouth
Where do you get herpetiform aphthae?
- Get on underside of tongue, lips etc
- Do not get on keratinised mucosa in the mouth
What is orofacial granulomatosis? (2 points)
- Problem where you get blockage of the lymphatics
- Channels blocked up by granulomatous cells
At what age can you get orofacial granulomatosis?
- Can get this at any age
In orofacial granulomatosis you can get swelling of the tissues and cobble stoning. What is cobble stoning?
- Longitudinal and circumferential fissures and ulcers separate islands of mucosa
What is an endoscopy?
- A procedure in which an instrument is introduced into the body to give a view of its internal parts
What are 3 examples of oesophageal disorders?
- Dysphasia
- Dysmotility disorders
- GORD
What is dysphasia?
- Problems swallowing
What happens in dysmotility disorders? (2 points)
- Fibrosis
- Neuromuscular dysfunction (nerves and muscles don’t work anymore)
What Is GORD?
- Gastro oesophageal reflux disease
What is a common reason for dysphasia? (2 points)
- Food getting stuck
- Can be intermittent or constant
What are the different types of dysphasia? (3 points)
- Functional (anxiety, nervous system)
- dysmobility
- May be external compression
What is a more common name for GORD?
- Heartburn
What are the 3 main causes of GORD?
- Defective lower oesophageal sphincter
- Impaired lower clearing
- Impaired gastric emptying
What are 3 consequences of GORD?
- Ulceration
- Inflammation
- Metaplasia
What is metaplasia?
The change in the type of adult cells in a tissue to form abnormal cells for that tissue
What are common signs & symptoms of GORD? (4 points)
- Epigastric burning
- Dysphasia
- GI bleeding
- Severe pain (mimics MI)
Epigastric burning is a common symptom of GORD. What makes this worse? (3 points)
- Lying down
- Bending
- Pregnancy
Severe pain is a common symptom of GORD. What causes this?
- Oesophageal muscle spasm
In GORD, dysphasia can be caused by oesophagitis, stricture or dysmotility. What do these 3 terms mean?
Oesophagitis = inflammation of the oesophagus
Stricture = Abnormal narrowing of a canal in the body
Dysmotility = muscles not working as they should
What is Barrett’s Oesophagus? (2 points)
- Recurrent acid reflux into the lower part of the oesophagus
- Metaplasia of the oesophageal lining to gastric type mucosa
What is Barrett’s oesophagus associated with?
- Malignant change - adenocarcinoma
What is a hiatus hernia?
- Where part of the stomach is in the THORAX
What are the symptoms of a hiatus hernia similar to?
- Similar to GORD symptoms
Are hiatus hernias more common in men or women?
- Women
How can you manage GORD? (5 points)
- Stop smoking
- Lose weight & avoid triggering activity
- Antacids
- H2 blockers & PPI’s (ranitidine & omeprazole)
- Increase GI motility & gastric emptying)
Why can stopping smoking manage GORD?
- It improves the sphincter
Where in the body does peptic ulcer disease affect? (3 points)
- Oesophagus, stomach, duodenum
- ANY acid affected site
What are the causes of peptic ulcer disease? (3 points)
- High acid secretion (duodenal)
- Normal acid secretion (stomach)
- Drugs (NSAIDS, steroids)
Where can peptic ulcer disease occur if there is EXCESSIVE acid production? (2 points)
- Oesophageal ulcers
- Duodenal ulcers
Why does peptic ulcer disease occur is there is a NORMAL acid production?
- Due to a reduced protective barrier
Which bacterium is involved in peptic ulcer disease when there is NORMAL acid production?
- Helicobacter pylori
How do helicobacter pylori cause peptic ulcer disease?
- They cause inflammation of the gastric mucosa so there is a loss of the mucous barrier
What effects can helicobacter pylori have? (2 points)
- Gastric ulcers
- Chronic gastric wall inflammation (lymphoma of the stomach)
How can you eliminate helicobacter pylori? (2 points)
- TRIPLE THERAPY
- 2 antibiotics and 1 proton pump inhibitor
What are the common signs and symptoms of peptic ulcer disease? (3 points)
- Asymptomatic
- Epigastric burning pain
- Usually NO physical signs (only when there are complications e.g. bleed)
A possible symptom of peptic ulcer disease is epigastric burning pain. When is this worse and how can it be relieved? (3 points)
- Worse before/just after meals
- Worse at night
- Relieved by food, alkali and vomiting
What investigations can be done for peptic ulcer disease? (4 points)
- Endoscopy
- Radiology (barium meal)
- Anaemia (FBC and faecal occult blood test
- H. pylori - breath, antibiotics, mucosa
What are local complications of peptic ulcer disease? (4 points)
- Perforation
- Haemorrhage
- Stricture
- Malignancy
What is a systemic complication of peptic ulcer disease?
- Anaemia
When can medical treatments of peptic ulcer disease be used? (3 points)
- Reversible problem
- Lifestyle changes
- H. pylori present
When can surgical treatments of peptic ulcer disease be used? (4 points)
- Stricture
- Acute bleed
- Perforation
- Malignancy
What are treatments of peptic ulcer disease? (9 points)
- Medical
- Stop smoking
- Small regular meals
- Eradication therapy
- Ulcer healing drugs (PPI)
- Surgical
- Endoscope
- Surgical repair (gastrectomy)
- Vagotomy
What is a vagotomy?
- A surgical operation in which one or more branches of the vagus nerve are cut, typically to reduce the rate of gastric secretion
What medication is used in upper GI disease to reduce acid secretion? (2 points)
- H2 receptor blockers
- Proton pump inhibitors
How can you improve the mucosal barrier in upper GI disease? (4 points)
Eliminate helicobacter
Inhibit prostaglandin removal:
- NSAID use encourages this - avoid
- Reduce steroid use
Triple therapy is used to eliminate helicobacter pylori. What antibiotic and PPI are used? (3 points)
Antibiotics:
- Amoxycillin
- Metronidazole
Proton pump inhibitor:
- Omeprazole
