Week 105: GORD

Question 1

How does GORD present?

Answer 1

⇒ Indigestion

• Burning sensation
• Mainly when lying down
• Throwing up in mouth

⇒ Vomiting

Question 2

What are the risk factors for GORD?

Answer 2

• Obesity
• Alcohol
• Smoking
• Diet
• Caffeine
• NSAID use
• Family history
• Pregnancy

Question 3

What is dyspepsia?

Answer 3

• Post pharyngeal fullness
• Epigastric pain
• Burning sensation

Question 4

Where is referred pain likely to occur?

Answer 4

Diaphragm to shoulder

Question 5

What is odynophagia?

Answer 5

Painful swallowing

Question 6

What is dysphagia?

Answer 6

Difficulty swallowing

⇒ RED FLAG SYMPTOM

Question 7

What is water brash?

Answer 7

Heartburn with regurgitation into the mouth of sour fluid or saliva

Question 8

What is GORD?

Answer 8

Retrograde flow of gastric content into oesophagus

Question 9

What are the investigations for GORD?

Answer 9

• Generally none, mainly based on history
• Contrast radiology
• Endoscopy - for Barrett’s oesophagus

Question 10

What are red flag symptoms of GORD?

Answer 10

⇒ Dysphagia
⇒ Unintended weight loss
⇒ Blood anywhere

Question 11

What is Zollinger-Ellison Syndrome?

Answer 11

Gastrin secreting tumour of the pancreas

Question 12

What would you treat Zollinger-Ellison Syndrome with?

Answer 12

High dose H2 receptor antagonists

⇒ Randitidine

Question 13

What is gastritis?

Answer 13

Inflammation of the stomach lining

• Can’t produce intrinsic factor as layer of cells goes
• Can’t absorb B12
• Goes into stool
• End up with pernicious anaemia

Question 14

What can gastritis be caused by?

Answer 14

• H. pylori
• Infection
• Autoimmune

Question 15

How would you treat an H. pylori infection?

Answer 15

Amoxicillin with a PPI

Question 16

What are anatomical factors of GORD?

Answer 16

• Lower oesophageal sphincter being too relaxed- Decreased oesophageal muscle tone
• Pyloris sternosis - harder for stomach content to get out of stomach so goes up
• Barrett’s Oesophagus

Question 17

What is Barrett’s Oesophagus?

Answer 17

• Long term GORD can result in this

- Squamous metaplasia into columnar/gastric epithelium

Question 18

Where is Verkow’s Node?

Answer 18

Left supraclavicular fossa

Question 19

What are the endoscopic treatments for GORD?

Answer 19

⇒ Gastroplication

• Creates flap of oesophagus
• More likely for fluid to not go up

⇒ Stretta
- Ball in to block to route back slightly

⇒ Injectable agents
- Increase tone of oesophageal sphincter

Question 20

What is a laparoscopic treatment?

Answer 20

Nissen fundoplication

Question 21

What pharmacological treatments can be used?

Answer 21

⇒ Antacids

• Neutralise acid
• Calcium carbonate

⇒ Alginate

• Creates something that protects lining
• Raff to produce reflux

⇒ Promote mucosal defence

• Sucralfate: increases production of prostaglandin
• Misoprostol: works as a prostaglandin analogue, common to give with an NSAID in high risk people
• Both work as prostaglandins

⇒ Gastric stimulants

• Increase rate stomach empties
• Metaclopramide
• Domperidome

⇒ Reducing acid productions

• PPIs: omeprazole, rantidine
• H2 receptor antagonists

Question 22

Where is COX 1 found?

Answer 22

In the tissue - acts as a constitutive isoform

Question 23

Where is COX 2 found?

Answer 23

At the sites of inflammation

• Cytokines stimulate the induction of COX 2
• COX 2 is responsible for the anti-inflammatory action of NSAIDs

Question 24

What are the three regions of the stomach?

Answer 24

• Cardiac (top, near opening)
• Fundus (body)
• Pyloric (pipe out)

Question 25

What cells are found in the cardiac region of the stomach?

Answer 25

Mucous secreting cardiac glands

Question 26

What is the epithelium of the fundus of the stomach composed of?

Answer 26

Simple mucous columnar epithelium

Question 27

What is the function of the simple mucous columnar epithelium in the fundus?

Answer 27

Secrete thick mucous to protect the gastric mucosa from being digested by acid and enzymes found in the lumen of the stomach

Question 28

What cells line the epithelium of the surface of the stomach and the gastric pits of the fundus?

Answer 28

Tall columnar mucous-secreting cells

Question 29

Where are peptic (chief) cells found?

Answer 29

At the base of the gastric glands in the fundus

Question 30

What do peptic (chief) cells secrete?

Answer 30

Enzymes: pepsinogen, gastric lipase, rennin

Question 31

Where are stem cells found in the stomach?

Answer 31

In the isthmus

Question 32

Where is the muscularis mucosa found?

Answer 32

Underneath the glands

Question 33

What is the function of the muscularis mucosa?

Answer 33

Its contraction helps to expel the contents of the gastric glands - it has two layers (the inner is circular and the outer is longitudinal)

Question 34

Where are neuroendocrine cells (G-cells) found?

Answer 34

Towards the base of the gastric gland

Question 35

What is the function of neuroendocrine cells (G-cells)?

Answer 35

Part of the diffuse neuroendocrine system- Secrete gastrin which stimulates the secretion of acid by parietal cells

Question 36

Where are parietal (oxyntic) cells found?

Answer 36

Gastric glands of the fundus of the stomach

Question 37

What is the function of parietal (oxyntic) cells?

Answer 37

Secrete hydrochloric acid and are eosinophilic- Secretion is stimulated by acetylcholine and the hormone gastrin

Question 38

Where are neck mucous cells found?

Answer 38

In the gastric glands in the fundus of the stomach

Question 39

What is the function of neck mucous cells?

Answer 39

Secrete mucous to protect the surface epithelium from being digested by the secretions of the gastric glands

Question 40

What cells are found in the pyloric region of the stomach?

Answer 40

Similar to the fundus but the mucosal layer is reduced in size and there are no parietal cells