Upper GI tract disorders Flashcards
What are the embryological foregut structures?
The embryological foregut structures include the oesophagus, stomach, duodenum (to D2), liver, gallbladder, pancreas, and spleen.
Which artery supplies blood to the embryological foregut structures?
The coeliac artery supplies blood to most of the embryological foregut structures.
What is the primary nerve supply for most embryological foregut structures?
The vagus nerve provides significant autonomic nerve supply to most of the embryological foregut structures.
What structures help maintain the function of the lower oesophageal sphincter (LOS)?
The lower oesophageal sphincter (LOS) is maintained by the diaphragmatic crura, which are muscle fibers of the diaphragm.
Besides the diaphragmatic crura, what else contributes to the function of the lower oesophageal sphincter (LOS)?
While not essential, gravity can assist in the function of the lower oesophageal sphincter (LOS). Additionally, the normal anatomical position of the stomach in the abdomen helps maintain LOS function.
What influences stimulate the production of acid by gastric parietal cells?
Acid production by gastric parietal cells is influenced by both autonomic and hormonal factors.
How is acid production in gastric parietal cells stimulated?
Acid production in gastric parietal cells can be stimulated both directly and indirectly.
What is the effect of proton pump inhibitors (PPI) on acid suppression?
Proton pump inhibitors directly inhibit “the proton pump” in gastric parietal cells, leading to a significant reduction in acid secretion (over 95%).
What are some side effects associated with proton pump inhibitors (PPI)?
Side effects of proton pump inhibitors are rare but may include diarrhea and an increased risk of gastrointestinal infection.
How does an H2 receptor antagonist work to reduce acid secretion?
An H2 receptor antagonist reduces histamine stimulation, which helps to decrease acid production in gastric parietal cells.
What is Gastro-oesophageal reflux disease (GORD)?
Gastro-oesophageal reflux disease (GORD) is a condition characterised by the reflux of gastric contents into the oesophagus.
How common is GORD?
GORD is very common, affecting a significant number of individuals.
What are the causes of GORD?
GORD is caused by the failure of the “gatekeeper,” which refers to the lower oesophageal sphincter (LOS) not closing fully or experiencing frequent non-physiological temporary relaxations. Additionally, the diaphragmatic sphincter and increased intra-abdominal pressure can contribute to GORD.
What factors contribute to the failure of the “gatekeeper” in Gastro-oesophageal reflux disease (GORD)?
Some factors that contribute to the failure of the “gatekeeper” (lower oesophageal sphincter) in GORD include hiatus hernia, obesity, smoking, pregnancy, excess alcohol consumption, ascites, older age, and lifestyle factors such as meals and stress.
What are some lifestyle factors that can exacerbate GORD?
Lifestyle factors such as stress, excess alcohol consumption, and smoking can worsen GORD symptoms.
Is Helicobacter pylori infection associated with GORD?
Helicobacter pylori infection is not typically associated with GORD. However, it can contribute to other digestive disorders like gastritis and peptic ulcers.
Are many individuals with Gastro-oesophageal reflux disease (GORD) asymptomatic?
Many individuals with GORD are asymptomatic, meaning they do not experience any noticeable symptoms.
What are some common symptoms of GORD?
Common symptoms of GORD include dyspepsia (acid reflux), heartburn, a burning discomfort in the chest or throat, reflux of acid into the mouth, upper abdominal or chest pain, a sensation of a “globus” (a lump in the throat), respiratory symptoms, persistent nausea with or without vomiting, and poor dentition.
How is Gastro-oesophageal reflux disease (GORD) mostly diagnosed?
GORD is mostly diagnosed based on clinical assessment and evaluation of symptoms.
What are some diagnostic tests used for GORD?
Diagnostic tests for GORD may include endoscopy (to visualize the oesophagus and stomach), oesophageal manometry (to measure pressure and function of the oesophagus), pH studies (to assess acid levels in the oesophagus), faeces or breath testing for H. pylori infection, and X-ray contrast swallow or meal (to evaluate the movement and function of the oesophagus).
What are some management strategies for Gastro-oesophageal reflux disease (GORD)?
Management of GORD typically involves lifestyle advice such as dietary and positional modifications. Acid suppression therapy is a common approach and includes using proton pump inhibitors (PPIs) as the mainstay of treatment. H2 receptor antagonists may also be used, although they primarily reduce acid levels and do not directly address reflux. If relevant, Helicobacter pylori eradication may be recommended.
When is surgery considered as a management option for GORD?
Surgery is typically reserved for cases where medical treatment fails or long-term medical management is undesirable. Proof of reflux, often confirmed through pH studies, is usually required before considering surgical intervention. Surgery, such as fundoplication, aims to restore normal anatomy and improve symptoms.
What is a hernia?
A hernia is the protrusion of all or part of a viscus (organ) through its coverings and into an abnormal position.
What is a hiatus hernia?
A hiatus hernia is the protrusion of the stomach through the diaphragm and into the chest. It occurs when part of the stomach pushes up into the chest cavity through the opening in the diaphragm called the hiatus.
What are the two types of hiatus hernia?
Hiatus hernias can be categorized as “sliding” or “rolling.” In a sliding hiatus hernia, the junction between the oesophagus and the stomach and a portion of the stomach slide up into the chest. In a rolling hiatus hernia, a part of the stomach rolls up through the diaphragm beside the oesophagus.
What percentage of hiatus hernias are sliding hiatus hernias?
Sliding hiatus hernias account for approximately 85-95% of all hiatus hernia cases.
What happens in a sliding hiatus hernia?
In a sliding hiatus hernia, the gastroesophageal junction (GOJ) becomes mobile, and part or all of the stomach enters the chest cavity. This results in a loss of the diaphragmatic sphincter effect, allowing negative thoracic pressure to pull gastric contents into the oesophagus.
How do sliding hiatus hernias typically present?
Sliding hiatus hernias are mostly asymptomatic. However, they can manifest as gastroesophageal reflux disease (GORD) symptoms, such as heartburn, regurgitation, and acid reflux. Dysphagia (difficulty swallowing) can also occur.
What percentage of hiatus hernias are rolling hiatal hernias (paraoesophageal hernias)?
Rolling hiatal hernias, also known as paraoesophageal hernias, account for approximately 5-15% of all hiatus hernia cases.
What is the characteristic feature of a rolling hiatal hernia?
In a rolling hiatal hernia, the gastroesophageal junction (GOJ) remains fixed in its normal position below the diaphragm. However, the gastric fundus serves as the lead point of the hernia and protrudes into the chest cavity.
How do rolling hiatal hernias typically present?
Rolling hiatal hernias often do not cause symptoms and are frequently asymptomatic. However, they can manifest as chronic, non-specific symptoms that are difficult to diagnose, including abdominal pain, early satiety (feeling full quickly), anaemia, dysphagia (difficulty swallowing), and, in rare cases, strangulation (1% risk) where the blood supply to the herniated portion becomes compromised.
What are the management options for hiatus hernia?
Managing hiatus hernia can include conservative, medical, and surgical approaches.
