Week 105: GORD Flashcards
How does GORD present?
⇒ Indigestion
- Burning sensation
- Mainly when lying down
- Throwing up in mouth
⇒ Vomiting
What are the risk factors for GORD?
- Obesity
- Alcohol
- Smoking
- Diet
- Caffeine
- NSAID use
- Family history
- Pregnancy
What is dyspepsia?
- Post pharyngeal fullness
- Epigastric pain
- Burning sensation
Where is referred pain likely to occur?
Diaphragm to shoulder
What is odynophagia?
Painful swallowing
What is dysphagia?
Difficulty swallowing
⇒ RED FLAG SYMPTOM
What is water brash?
Heartburn with regurgitation into the mouth of sour fluid or saliva
What is GORD?
Retrograde flow of gastric content into oesophagus
What are the investigations for GORD?
- Generally none, mainly based on history
- Contrast radiology
- Endoscopy - for Barrett’s oesophagus
What are red flag symptoms of GORD?
⇒ Dysphagia
⇒ Unintended weight loss
⇒ Blood anywhere
What is Zollinger-Ellison Syndrome?
Gastrin secreting tumour of the pancreas
What would you treat Zollinger-Ellison Syndrome with?
High dose H2 receptor antagonists
⇒ Randitidine
What is gastritis?
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
What can gastritis be caused by?
- H. pylori
- Infection
- Autoimmune
How would you treat an H. pylori infection?
Amoxicillin with a PPI
What are anatomical factors of GORD?
- 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
What is Barrett’s Oesophagus?
- Long term GORD can result in this
- Squamous metaplasia into columnar/gastric epithelium
Where is Verkow’s Node?
Left supraclavicular fossa
What are the endoscopic treatments for GORD?
⇒ 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
What is a laparoscopic treatment?
Nissen fundoplication
What pharmacological treatments can be used?
⇒ 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
Where is COX 1 found?
In the tissue - acts as a constitutive isoform
Where is COX 2 found?
At the sites of inflammation
- Cytokines stimulate the induction of COX 2
- COX 2 is responsible for the anti-inflammatory action of NSAIDs
What are the three regions of the stomach?
- Cardiac (top, near opening)
- Fundus (body)
- Pyloric (pipe out)
What cells are found in the cardiac region of the stomach?
Mucous secreting cardiac glands
What is the epithelium of the fundus of the stomach composed of?
Simple mucous columnar epithelium
What is the function of the simple mucous columnar epithelium in the fundus?
Secrete thick mucous to protect the gastric mucosa from being digested by acid and enzymes found in the lumen of the stomach
What cells line the epithelium of the surface of the stomach and the gastric pits of the fundus?
Tall columnar mucous-secreting cells
Where are peptic (chief) cells found?
At the base of the gastric glands in the fundus
What do peptic (chief) cells secrete?
Enzymes: pepsinogen, gastric lipase, rennin
Where are stem cells found in the stomach?
In the isthmus
Where is the muscularis mucosa found?
Underneath the glands
What is the function of the muscularis mucosa?
Its contraction helps to expel the contents of the gastric glands - it has two layers (the inner is circular and the outer is longitudinal)
Where are neuroendocrine cells (G-cells) found?
Towards the base of the gastric gland
What is the function of neuroendocrine cells (G-cells)?
Part of the diffuse neuroendocrine system- Secrete gastrin which stimulates the secretion of acid by parietal cells
Where are parietal (oxyntic) cells found?
Gastric glands of the fundus of the stomach
What is the function of parietal (oxyntic) cells?
Secrete hydrochloric acid and are eosinophilic- Secretion is stimulated by acetylcholine and the hormone gastrin
Where are neck mucous cells found?
In the gastric glands in the fundus of the stomach
What is the function of neck mucous cells?
Secrete mucous to protect the surface epithelium from being digested by the secretions of the gastric glands
What cells are found in the pyloric region of the stomach?
Similar to the fundus but the mucosal layer is reduced in size and there are no parietal cells
