Upper GI tract disease Flashcards
What medication is used to treat upper GI tract diseases?
Antacids: Eliminate acid that has already been formed.
Reduce acid secretion:
H2 receptor antagonists
Proton pump inhibitors
(PPI’s more effective as they stop secretion of Ach, histamine and gastrin whereas H2 receptor antagonists only target histamine)
Name proton pump inhibitors.
Omeprazole
Lansoprazole
What are the 3 categories of disease encompassed by upper GI tract disease?
Oral
Oesophageal
Gastric
What kinds of conditions are included in oral GI tract diseases?
Oral lichen planus
Recurrent oral ulceration
Orofacial granulomatosis
What is lichen planus? How does this present in the oral cavity?
Chronic inflammatory condition.
Presents as white patches and red swollen tissues
What causes recurrent oral ulcerations? How do they present in the oral cavity?
Red inflamed bored with a yellow centre caused by the immune system.
Minor aphthae: < 1cm
Major aphthae: > 1cm and leave behind a scar.
Herpetiform aphthae:
Many small ulcers on non-keratinised tissue.
What causes orofacial granulomatosis?
Large granulous cells (that cannot be phagocytosed) block the lymphatics system whilst the capillaries continue to bring fluid to the area.
Can either be permanent or temporary
What are the two types of orofacial granulomatosis?
Cobblestoning
Fistula
What is dysphagia? (oesophageal GI disease) What are it’s possible causes?
Difficulty swallowing
Causes:
Anxiety
External compression via tumour
(Dysmotility caused by; fibrosis of the oesophagus or neuromuscular dysfunction.)
Fibrosis - irritation from acid reflux causes the muscular tissue to change to fibrous tissue. Lack of functioning muscle to carry out peristalsis.
Neuromuscular dysfunction - lack of muscle control to carry out peristalsis (propelling the bolus into the stomach)
What is GORD?
Acid from the stomach enters the oesophagus and causes irritation.
What causes GORD?
Defective lower oesophageal sphincter
Impaired gastric emptying
Impaired lower clearing
What are the signs and symptoms of GORD?
Epigastric burning
Severe pain - similar to MI
Bleeding - anaemia
Dysphagia
What are the effects of GORD?
Can cause metaplasia of the columnar oesophageal epithelium to squamous epithelium (more resilient to damage)
Ulceration of the oesophagus
Inflammation of the oesophagus
Risk of developing a carcinoma
How do you manage GORD?
Stop smoking - improves the lower sphincter
Drugs to encourage GI motility and emptying
Avoid triggering activity
Lose weight
Drugs to reduce/stop acid secretion into the stomach:
H2 receptor antagonists
PPI’s
What is Barrett’s oesophagus?
Condition where continuous irritation from acid reflux/GORD causes the oesophageal epithelium to change to gastric epithelium.
What is a hiatus hernia?
Where part of the stomach moves up into the thorax.
What are the types of hiatus hernia?
Sliding
Rolling/paraoesophageal - no connection to the bottom of the oesophagus.
What are the symptoms of hiatus hernia? When of they occur/
GORD like symptoms;
Epigastric burining
Dysphagia
Pain
Only in sliding hernias.
Where can peptic ulcer disease occur? (PUD)
Anywhere in the GI tract that is affected by acid:
Oesophagus, stomach and duodenum.
What causes ulcers PUD in the oesophagus?
High acid secretion and a defective sphincter
What causes PUD in the stomach?
Normal acid secretion and a less resistant lining of the stomach from;
Tumour affecting hormone production that stimulates secretion that protect the stomach lining.
Drugs - NSAIDS and steroids
Helicobacter pylori
What causes PUD in the duodenum?
High acid secretion - duodenum is affected as it doesn’t have a resistant/protective lining and has a thinner wall.
What part of the stomach is infected by H.pylori?
The antrum
What effect does H.Pylori have on the stomach?
Causes inflammation of the gastric mucosa.
Leads to;
Ulceration
Lymphomas from the continuous inflammation.
How is H.pylori treated?
Triple therapy for 2 weeks;
2 x antibiotics;
Amoxycillin
Metronidazone
1 x proton pump inhibitor
How is the lymphoma of the stomach caused by H.pylori treated?
Treated by the H.Pylori itself
What are the signs and symptoms of PUD?
Epigastric burning;
worse before/after meals
worse at night
Relieved by food, alkaline substances and vomiting.
Usually asymptomatic until complications arise
i.e. perforated ulcers.
What are the investigations carried out for PUD?
Endoscopy Radiology - barium meal Faecal occult blood sample Test for anaemia Test for H.pylori
What are the complications of PUD, both local and systemic.
Local:
Perforated ulcers - can lead to peritonitis = possible death.
Haemorrhage - ulcer erodes through an artery
Stricture - narrowing
Malignancy
Systemic:
Anaemia from low level blood loss from the ulcers
Describe the process of healing peptic ulcers and their consequences.
Ulcer replaced by scar tissue
Scar tissue shrinks and the elastic tissue is replaced by fibrous tissue.
Since ulcers usually occur at the antrum of the stomach the pylorus is commonly affected.
The fibrous tissue causes narrowing of the pylorus and restricts food emptying from the stomach.
What are the two types of treatments for PUD? When would each be used?
Medical -
Used when the effects of the disease would disappear once the causative agent is removed.
Used when H.pylori is the causative agent.
Surgical - Used in perforated ulcers, acute bleeding, malignancy and stricture.
What are the medical interventions carried out in PUD?
Bases upon lifestyles changes
Stop smoking
Smaller and regular meals
Drugs that aid the healing of ulcers
Eradication therapy of H.pylori
What are the surgical interventions carried out in PUD?
Surgical repair
Highly selective vagotomy
What are the historic surgeries that used to be carried out on patients with PUD?
Bilroth 1 and 2
Describe a highly selective vagotomy.
The specific branch of the vagus nerve that is responsible for the secretion of acetylcholine from parietal cells is cut.
This allows the amount of acid secretion in the stomach to be reduced whilst maintaining GI motility.
