Upper GI Diseases Flashcards
2 functions of medications of upper GI Diseases
eliminate formed acid (antacids)
reduce acid secretion
medicines which reduce acid secretion (2)
H2 receptor blockers
proton pump inhibitors
how do antacids work
Covert acid to salt
Adsorb that
Depend on what is in can poison with too high magnesium levels
what cell makes acid in GI
parietal cell
what is the secreting portion of parietal cell
proton pump
how can parietal cell be inhiited
by proton pump inhibitor
- stops acid production
3 triggers for acid production on parietal cell
histamine H2 recpetor
gastrin
ACh (cholinergic)
Gastrin
local hormone caused by stomach stretch
when is ACh released and thus detected by parietal cells
in anticipation of food - salivation
how many pathways do you need to block to stop acid secretion by parietal cells
all 3
what do you need to block to stop acid being made
proton pump at top of parietal cell
other 3 pathways trigger acid to be made
role of H2 receptor antagonists
Reduce acid production by preventing histamine activation of acid production
- Revolution for medicine, used to be surgical treatment only
Limited benefit as alternative pathways still operative
-Acetylcholine, Gastrin
cimetidine
H2 receptor antagonist
Original H2 blocker
Many drug interactions
Not fully effective
ranitidine
H2 receptor antangonist
Not any more effective
Safer in clinical use
Licensed for over the counter sale
examples of proton pump inhibitors
Omeprazole
Lansoprazole
Pantoprazole
all end in prazole
what are more effective clinically - proton pump inhibitors of H2 receptor antagonists
proton pump inhibitors
- acid secretion completely stopped
dyspepsia
indigestion
causes of dyspepsia
diet
medicine side effect
3 classes of upper GI disease
Oral diseases
Oesophageal disease
Gastric disease
3 main commonly seen of oral diseases
Recurrent oral ulceration
Lichen planus
Orofacial granuomatsis
minor apthae
Form of recurrent oral ulcers
Get anywhere in gut including mouth
Driven by immune system
Last for 2 weeks and then go away and heal
Less than 1cm
major apthae
More than 1cm in size
3 months to heal
Scar when heal
Can be nuisance but can be significant pain to patient
herpetiform apthae
Lots of small ulcers around mouth
Don’t get on keratinised mucosa
Dorsal of tongue
Will on underside of tongue, masticatory mucosa etc
orofacial granulomatosis
Blockage of lymphatics
- Move from venules into tissues
Drains through lymphatics back into circulation
Get blocked up by giant granulomatous cells
Cannot be easily phagocytosed and removed
Chunky and when get washed into lymphatics - blocked by giant cell granuloma
- Build up, tissue puffy and swollen
Peri-oral and intraoral swelling
Can be temporary or permanent
Any age
Reason for happening is unclear
Psychological issue
- Cosmetic, no physical harm
Intraoral swelling
- Fixed tether hold tissue - so swelling between tethers
- Cobble stoning
- Blobs separated by fissure
Ulcerations and fistula of fissures
- Holes forming between tissues e.g. bowel
Can be a nuisance to very disfiguring - range
main effect of orofacial granulomatosis
Psychological issue
- Cosmetic, no physical harm
how to examine the mouth
by eye
can see subtle changes
to examine the inside of gut use
endoscopy
endoscopy
use to examine inside of gut
Not flexible - Rigid glass rods - Can steer them round borders Pocket at far end - Grab bits of tissue
oesophagus
Joining between gut and mouth
where does embryonic gut begin down the oesphagus
2/3 way down
- head and skin above is ectoderm
change of mucosa in embryonic gut part of oesophagus
stratified squamous to simple columnar