Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

ANKI GI > [21] Gastro-Oesophageal Reflux Disease > Flashcards

[21] Gastro-Oesophageal Reflux Disease Flashcards

(69 cards)

Start Studying
1
Q

What is GORD?

A

A long-term condition where the stomach contents come back up into the oesophagus, resulting in symptoms or complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is GORD caused by?

A

The failure of the lower oesophageal sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What prevents reflux in healthy individuals?

A

The Angle of His, which is the angle at which the oesophagus enters the stomach, creates a valve that prevents duodenal bile, enzymes, and stomach acid from travelling back into the oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does duodenal bile, enzymes, and stomach acid cause when they come into contact with the oesophagus?

A

Burning and inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the risk factors for the development of GORD?

A
  • Lower oesophageal sphincter hypotension
  • Hiatus hernia
  • Oesophageal dysmotility
  • Obesity
  • Gastric acid hypersecretion
  • Delayed gastric emptying
  • Smoking
  • Alcohol
  • Pregnancy
  • Drugs, including tricyclics, anticholinergics, and nitrates
  • Helicobacter Pylori
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the symptoms of GORD?

A
  • Heartburn
  • Belching
  • Acid brash
  • Waterbrash
  • Odynophagia
  • Noctural asthma
  • Chronic cough
  • Laryngitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is acid brash?

A

Acid or bile regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is waterbrash?

A

Increased salivation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How may GORD be investigated?

A
  • Endoscopy
  • 24 hour oesophageal pH monitoring, with or without manometry
  • H. Pylori testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When is endoscopy used to investigate GORD?

A

If dysphagia, or if over 55 years old with alarming symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When is 24 hour oesophageal pH monitoring used to investigate GORD?

A

When endoscopy is normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the management options in GORD?

A
  • Lifestyle
  • Drugs
  • Surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is involved in the lifestyle management of GORD

A
  • Weight loss
  • Smoking cessation
  • Small, regular meals
  • Reduce certain foods and drinks
  • Avoid eating <3hours before bed
  • Raise bed head
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What foods and drinks should be reduced in GORD?

A
  • Alcohol
  • Citrus fruits
  • Tomatoes
  • Onions
  • Fizzy drinks
  • Spicy foods
  • Things containing caffeine
  • Chocolate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What drugs are used in the management of GORD?

A
  • Antacids
  • PPIs
  • Histamine blockers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the types of antacids used in GORD?

A
  • Simple antacids
  • Compound antacids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Give an example of a simple antacid

A

Aluminium hydroxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What course of PPI should patients with GORD be given initially?

A

Offer people with GORD a full-dose PPI for 4-8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What should be done if symptoms reoccur after initial treatment with PPI in GORD?

A

Offer PPI at lowest possible dose to control symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When should a histamine blocker be added in the management of GORD?

A

For refractory symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What drugs should be avoided in GORD?

A
  • Drugs affecting oesophageal motility
  • Drugs that damage mucosa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Give 3 examples of drugs that affect oesophageal motility

A
  • Nitrates
  • Anticholinergics
  • Calcium channel blockers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Give 3 examples of drugs that can damage the oesophageal mucosa

A
  • NSAIDs
  • Potassium salts
  • Bisphosphonates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are antacids?

A

Weak bases that react with gastric acid to form water and a salt to diminish gastric acidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What effects do antacids have on pepsin activity?
They reduce it
26
Why do antacids reduce pepsin activity?
Because pepsin is inactive at a pH greater than 4
27
What is aluminium hydroxide used for?
* Symptomatic relief of GORD and peptic ulcer disease * May promote healing of duodenal ulcers
28
What are the adverse effects of aluminium hydroxide?
* Tends to cause constipation * Can sometimes cause hyperphosphataemai
29
What can happen to aluminium hydroxide in renal impairment?
Absorption of the cations from antacids, in this case Mg2+, can cause accumulation in renal impairment. ## Footnote *This is not normally a problem in patients with normal renal function*
30
When can the sodium content of antacids be an important consideration?
In patients with hypertension or congestive heart failure
31
How do compound alginates work in GORD?
They form a raft floating on the surface of the stomach contents, and therefore reduce reflux and protect the oesophageal mucosa
32
Where are compound alginates used?
In dyspepsia and GORD
33
What are the side effects of compound alginates?
* Stomach distention * Nausea
34
What effect might taking compound alginates at the same time as other medications have?
May impair the medications absorption, or damage its enteric coating
35
What secretes gastric acid?
The parietal cells of the gastric mucosa
36
What stimulates gastric acid secretion from parietal cells?
* Acetylcholine * Histamine * Gastrin
37
How do acetylcholine, histamine, and gastrin stimulate the secretion of gastric acid?
They bind to receptors and stimulate the proton pump to secrete hydrogen ions in exchange for potassium ions in the lumen of the stomach
38
What is ranitidine?
A copmetitive antagonist of histamine receptors
39
What effect does ranitidine have?
it inhibits histamine receptors to partially inhibit gastric acid secretion
40
What is ranitidine particularly effective against?
Noctural acid secretion
41
How effective are histamine antagonists at inhibiting acid secretion?
They can inhibit greater than 90% of basal, food-stimulated, and noctural secretion of gastric acid after a single dose
42
Is the action of histamine receptor antagonists fully reversible?
Yes
43
Why has the use of histamine receptor antagonists decreased?
With the advent of PPIs
44
What kind of drug is ranitidine?
A long-acting histamine receptor antagonist
45
What are the side effects of ranitidine?
Minimal side effects, but if present may include; * Headache * Dizziness * Diarrhoea * Muscular pain
46
What effect might histamine receptor antagonists have on drugs?
Drugs which depend on acidic medium for gastric absorption, such as ketoconazole, may not be efficiently absorbed if taken with a histamine receptor antagonist
47
Give 3 examples of PPIs?
* Omeprazole * Lansoprazole * Esomeprazole
48
How do PPIs work?
They bind to the H/K/ATPase enzyme system (proton pump) of the parietal cell which acts to suppress the secretion of the hydrogen ions into the gastric lumen
49
How effective are PPIs?
At standard doses, they inhibit basal and stimulated gastric acid secretion by more than 90%
50
In what respects are PPIs superior over histamine receptors?
For suppressing acid production and healing peptic ulcers
51
What are the indications for the use of PPIs?
* Stress ulcer treatment and prophylaxis * Treating erosive oesophagitis and active duodenal ulcers * Long-term treatment of pathologic hypersecretory conditions * GORD Gastroprotection with use of drugs such as NSAIDs and aspirin
52
Give an example of a pathologic hypersecretory condition
Zollinger-Ellison syndrome
53
When should PPIs be taken for maximum effect?
30 to 60 minutes before breakfast or the largest meal of the day
54
When should a histamine antagonist be taken if used alongside a PPI?
Well after the PPI
55
Why should a histamine receptor be taken well after a PPI if both are needed?
Because histamine antagonists reduce the activity of the proton pump, and PPIs require active pumps to be effective
56
Which PPIs are effective orally?
All
57
How are PPI metabolites excreted?
In urine and faeces
58
Are PPIs generally well tolerated?
Yes
59
What are the adverse effects of PPI?
* Nausea * Diarrhoea * Headache * Increased risk of bone fractures
60
Why does omeprazole interact with some drugs?
Because of competitive inhibition of CYP450 enzymes
61
What drugs may omeprazole effect?
It has been shown to inhibit the metabolism of warfarin, phenytoin, diazepam, and cyclosporin
62
What effect have PPIs been shown to have on clopidogrel?
All PPIs have been shown to decrease the effectiveness of clopidogrel
63
What are the options for the surgical management of GORD?
* Laparoscopic Nissen fundoplication * Laparoscopic insertion of a magnetic bead band * Radiofrequency-induced hypertrophy
64
What is the aim in the surgical management of GORD?
To increase resting lower oesophageal sphincter pressure
65
When should surgery be considered in the management of GORD?
If severe GORD where drugs are not working
66
What symptoms of GORD are less likely to improve with surgery?
Atypical symptoms, such as cough and laryngitis
67
What are the complications of GORD?
* Oesophagitis * Ulcers * Benign strictures * Iron-deficiency * Barrett's oesophagus
68
What is Barrett's oesophagus?
Where the distal oesophageal epithelium undergoes metaplasia from squamous to columnar
69
What % of people with Barrett's oesophagus progress to oesophageal cancer?
0.1-0.4%/year

ANKI GI (43 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions