upper GIT Flashcards
how is LOS opened in stage 1 -pharyngeal phase of swallowing
vasovagal reflex- receptive relaxation reflex
peristaltic wave pressure
40mmHg
LOS resting pressure
20mmHg
pressureof LOS during receptive relaxation
under 5mmHg
what is motility and it’s measurement
The co-ordination of contraction and dilation of the muscles of the GI tract.
pressure measurement (manometry)
how is motility mediated
Mediated by inhibitory noncholinergic nonadrenergic (NCNA) neurons of myenteric plexus, these inhibit the contraction of oesophagus muscle
difference between regurgitation and reflux
regurg
return of oesophageal contents from above an obstruction
reflux
passive return of gastroduodenal contents to the mouth
hypermotility -achalasia what is it due to and cause
loss of gangion cells in aurebach’s myeteric plexus in LOS wall
primary=unknown
secondary- disease like chagas’ disease/oesophagitis
treatment for hypomotility (scleroderma)
1.remove obstruction
2.prokinetics (ie. cisapride)- improves force of peristalsis
once peristaltic failure occurs-usually irreversible
disordered coordination- corkscrew oesophagus
treatment
pneumatic dilation but not as effective
disordered coordination- corkscrew oesophagus
diagnosis and pressure
barium swallow
400-500nnHg
disordered coordination- corkscrew oesophagus- symptoms and what happens to the circular muscle
dysphagia and chest pain
hypertrophy of circular muscle
3 pathological cause of narrowing of oesophagus and what it cause
cancer
FB
Physiological dysfunction
oesophageal perforation
boerhaave’s cause and it’s weak point
Sudden ↑ in intra-oesophageal pressure with negative intra thoracic pressure
Vomiting against a closed glottis
Left posterolateral aspect of the distal oesophagus
FB - example and issue it cause
batteries- cause electrical burns in mucosa
what force need to cause trauma to neck and thorax for trauma/perforation
neck- penetrating
thorax-blunt
investigations for oesophageal perforation
CXR
CT
Swallow (gastrograffin)
OGD
oesophageal perforation primary management
surgical emergency
1.NBM/ IV fluids/ Broad spectrum A/Bs & Antifungals
ITU
Bloods (including G&S)
Tertiary referral centre
oesophageal perforation definitive management
- conservative management- cover with metal stent
- operative management-
primary repair//esophagectomy
cause of sliding hernias and what it is
phrenoesophageal ligament weak
gastro-oesophageal junction slides up
GORD treatment
lifestyle change
PPI
dilatation peptic strictures
laparoscopic Nissen’s fundoplication
what does
Cardia & Pyloric Region
Body & Fundus
Antrum
produce
Cardia & Pyloric Region: Mucus only
Body & Fundus: Mucus, HCl, pepsinogen
Antrum: Gastrin
what is Erosive & haemorrhagic gastritis
Acute ulcer – gastric bleeding & perforation
cause-NSAID/traume
types of gastritis
Erosive & haemorrhagic gastritis
Nonerosive, chronic active gastritis
Atrophic (fundal gland) gastritis
reactive gastritis
what is Nonerosive, chronic active gastritis
Antrum
Helicobacter pylori -
Triple Rx (amoxicillin, clarithromycin, pantoprazole) for 7-14days
what is Atrophic (fundal gland) gastritis
Fundus
Autoantibodies target parietal cells and it’s products
Parietal cells atrophy
↓acid & IF secretion
mechanism for repairing epithelial defects
- migration (of adjacent epithelial cells)
- gap closed by cell growth
- acute wound healing -BM detroyed-
ulcer treatment
primary med:
PPI/H2 blocker
triple Rx 7-14 d
12 weeks later:
check serum gastrin/OGD
- surg
treatment for ruptured peptic ulcer
laparoscopic omental patch
scan for biliary tree (ie cystic duct)
MRCP=magnetic resonance cholangio pancreatography
