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medicine unit 2 > PBL week 2 wrap up > Flashcards

PBL week 2 wrap up Flashcards

1
Q

describe the location of the oesophagus

A

long fibromuscular tube
pharynx to stomach, C6 to C11

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2
Q

cross-sectional anatomy of the oesophagus

A

adventitia
muscularis externa
submucosa
mucosa

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3
Q

adventitia

A

outer layer of connective tissue (very distal and intraperitoneal portion of oesophagus has an outer covering of serosa instead)

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4
Q

muscularis externa

A

external layer of longitudinal muscle and inner layer of circular muscle
in superior third: voluntary striated muscle
middle third: voluntary striated and Smooth muscle
inferior third: smooth muscle

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5
Q

how is food transported through the oesophagus

A

peristalsis
rhythmic contractions of the muscles which propagate down the oesophagus, coordinated by the myenteric plexus
hardening of the muscles can interfere and cause dysphagia

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6
Q

dysphagia

A

difficulty swallowing

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7
Q

upper oesophageal sphincter

A

anatomical, striated muscle sphincter
junction between the pharynx and oesophagus
produced by cricopharyngeus

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8
Q

lower oesophageal sphincter

A

located at the gastro-oesophageal junction
between the stomach and oesophagus
left of the T11 vertebra and marked by change from oesophageal and gastric mucosa
relaxed in peristalsis

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9
Q

layers of the muscularis externa

A

from superficial to deep
longitudinal muscle
circular muscle
oblique muscle

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10
Q

which region of abdomen is the stomach located

A

epigastric
partly in the left hypochondriac and umbilical

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11
Q

4 regions of the stomach

A

cardia: surrounds opening of oesophagus into stomach
fundus: area above the cardia orifice
body: largest region
pylorus: connects stomach to duodenum, divided into the pyloric antrum and pyloric canal and is the distal end of the stomach

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12
Q

2 sphincters of the stomach

A

inferior oesophageal sphincter: marks transition between oesophagus and stomach at T11, food passes from oesophagus through cardiac orifice into the body of the stomach
pyloric sphincter: lies between pylorus and the start of the duodenum and controls exit of chyme

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13
Q

histology of the oesophagus

A

mucosa is comprised of 3 different layers
stratified squamous non-keratinised epithelium
lamina propria
muscularis mucosa

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14
Q

stratified squamous non-keratinised epithelium

A

mucous production
(for lubrication and neutralisation of acid)
protection

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15
Q

lamina propria

A

absorption via capillaries and also contains MALT for immunological response

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16
Q

muscularis mucosa

A

for localised movement using muscle contractions to move food down the oesophagus

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17
Q

submucosa

A

has a large network of blood vessels to increase surface area for nutrient absorption
contains mucus glands for lubrication of bolus
contains Meissen nerve cells which control the effectors

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18
Q

histology of the stomach

A

simple columnar epithelium
the mucosa and submucosal layer are folded in on themselves which allows them to unfold when the stomach expands

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19
Q

what do gastric pits of the stomach contain

A

surface lining cells
regenerative cells
mucous neck cells
parietal cells
chief cells

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20
Q

regenerative cells

A

replace any of the other cells

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21
Q

mucous neck cells

A

secret mucous and neutralise acid

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22
Q

parietal cells

A

release hydrochloride acid which is an intrinsic factor for protein digestion

23
Q

chief cells

A

secrete pepsinogen and HCl converts pepsinogen to pepsin (active form)

24
Q

parietal cells

A

secrets gastrin
stimulates parietal cells

25
Q

what is GERD

A

gastro-oesophageal reflux disease
when stomach acid flows back up the oesophagus, backwash is called acid reflux
irritate lining of the oesophagus, damages the cells
impaired lower oesophageal sphincter mechanism (may be due to intragastric pressure or delayed gastric emptying)

26
Q

symptoms and presentation of GERD

A

heartburn (may present as a heart attack)
sour taste in mouth
upper GI pain
cough
hiccups
halitosis
bloating
nausea/vomiting
dysphagia
odynophagia (pain on swallowing)

27
Q

when may GERD symptoms be worse

A

when lying down
bending over
after eating

28
Q

difference between dyspepsia and GORD

A

dyspepsia is a collection of symptoms of upper GI pain, heartburn, reflux, nausea and vomiting
may lead to diagnosis of GERD

29
Q

what is the drug often prescribed to manage GERD

A

lansoprazole

30
Q

definition of Barrett’s oesophagus

A

the replacement of normal stratified squamous epithelium with metaplastic, premalignant intestinal columnar epithelium in the distal oesophagus

31
Q

definition of oesophageal cancer

A

a malignancy that develops in tissues of the hollow muscular canal along which food and liquid travel from the throat to the stomach

32
Q

what is the difference between Barrett’s oesophagus and oesophageal cancer

A

Barrett’s oesophagus has stratified squamous epithelium
then in oesophageal cancer there is specialised intestinal metaplasia which is metaplastic intestinal columnar epithelium

33
Q

2 main types of oesophageal cancer

A

adenocarcinoma
squamous cell carcinoma

34
Q

adenocarcinoma

A

begins in the glandular tissue in the lower part of the oesophagus

35
Q

squamous cell carcinoma

A

starts in the squamous cells that line the oesophagus
usually develop in the upper and middle part of the oesophagus

36
Q

risk factors of GERD

A

overweight
pregnancy
smoking
drugs
hiatus hernia
stress
certain foods and drinks

37
Q

overweight

A

increased pressure
lower oesophageal sphincter relaxes
acid travels up the oesophagus
body is less efficient at emptying the stomach contents, increases acid secretion, gastroesophageal pressure gradient potential refluxate

38
Q

pregnancy

A

increased weight and growth of the foetus increases the pressure on the stomach, acid travels up the oesophagus
hormones such as plasma progesterone weakens the lower oesophagus and stomach acid pushes through easily

39
Q

smoking

A

nicotine relaxes the smooth muscle and lower oesophageal sphincter, acid and stomach contents travel up the oesophagus
redues salvation, saliva contains acid-neutralising bicarbonate, less acid neutralisation
increases acid secretion from the stomach

40
Q

drugs

A

mucosal damage, relaxes the LES due to the pressure reduction/oesophageal inflammation/delay gastric emptying
non-steroidal anti-inflammatory drugs, inhibit Cyclooxygenase enzymes, increase acid secretion

41
Q

short term implications of GERD

A

heartburn
dry cough
difficulty swallowing
asthma like symptoms
sore throat
bad breath
nausea

42
Q

long term implications of GERD

A

esophagitis: inflammation of oesophagus
oesophageal ulcers
oesophageal bleeding
oesophageal stricture
Barrett’s oesophagus
oesophageal cancer

43
Q

age as a risk factor for GERD

A

increases with age
peaking at age 75-79 for both sexes
large 95% confidence interval for both sexes

44
Q

methods used in GERD diagnosis

A

endoscopy
barium swallow
pH monitoring
nonmetry

45
Q

endoscopy

A

camera down oesophagus to the stomach

46
Q

barium swallow

A

chalky drink followed with an x-ray to look at the shape and size of the pharynx and oesophagus
monitors how you swallow

47
Q

pH monitoring

A

for acid levels
24 hour long helps to determine how well the oesophageal sphincter is working to prevent acid reflux

48
Q

manometry

A

shows how well the oesophagus is able to move food down the oesophagus by measuring the changes in pressure

49
Q

management of GERD

A

maintain healthy weight
stop smoking
eat smaller and more frequent meals
avoid food and drink
avoid fatty food
don’t wear tight clothing
raise head of the bed by up to 20cm
try to relax to reduce stress

50
Q

examples of short term GERD management

A

antacids and alginates

51
Q

antacids

A

drugs that neutralise the hydrochloric acid in your stomach
calcium carbonate, magnesium hydroxide and/or sodium bicarbonate

52
Q

alginate

A

derived from seaweed and form a physical protective barrier on top of the stomach

53
Q

combo products

A

contain an antacid and a raft-forming alginate
purchased over the counter
Gaviscon, Rennie Duo

54
Q

biomarkers associated with various stages of oesophageal adenocarcinoma

A

DNA content abnormalities and loss of heterozygosity
DNA content abnormalities
tumour suppressor loci
p53 loss of heterozygosity
p53 staining
epigenetics
p16 methylation
proliferation
cell cycle markers
cyclin A
cyclin D1

medicine unit 2 (28 decks)

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