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Flashcards in GI List Deck (36):
1

Define GORD

Reflux of food/acid and troublesome symptoms

2

Histology of Oesophagus

Stratified squamous epithelium

3

Causes of GORD

Obesity
Overeating
Smoking
Drugs - CCB Nitrates
Hiatus Hernia
LOS Hypotension/weakness

4

GORD Pathophysiology

Reduced tone
Increased mucosal sensitivity to acid
Reduced oesophageal acid clearance
Delayed gastric emptying
LOS relaxations independent to swallowing

5

GORD Symptoms

Heartburn - burning chest pain worse when lying down/sitting forward/bending/stooping
Belching
Painful swallowing
Food/Acid regurgitation

Nocturnal asthma
Chronic cough
Laryngitis

6

GORD Diagnosis

ALARM BELL SIGNS: Dysphagia, weight loss and haemetesisi

Barium swallow - Hiatus hernia
Endoscopy - assess oesophagitis

7

GORD Treatment

Antacids - Magnesium Trisicilate Mix
Alginate - Gaviscon
PPI - Lansoprazole
H2 Receptor Antagonist - Cimetidine

Nissen Fundoplication - LOS pressure reduction

8

COmplicaition of GORD

Barret's - squamous to columnar
Mallory Weiss Tear - Linear mucosal tear due to retching/dry heaving
Vomiting with blood/ Retching
Self heals or sew the tear

9

Define Peptic Ulcer

Break in superficial epithelial cells in submucosa of stomach and oesophagus

10

Peptic ulcers causes

H. Pylori
NSAID use
Obesity
Smoking
Alcohol

11

Peptic ulcer pathophysiology

NSAID use - COX inhibition, reduced mucosal prostaglandins = mucosal ischaemia
Reduced musocal defence
Increased acid production

12

Peptic ulcer Ix

H.Pylori - serological test/ blood culture/stool sample/histology
FBC
Endoscopy

13

Peptic ulcers rRx

Selective COX2 inhibitor
H.Pylori treatment - Omeprazole, Metronidazole
PPI - Lansoprazole, Omeprazole
H2 Receptor antagonist - Cimetidine

14

Define Gastritis

Inflammation due to mucosal injury

Gastropathy - Epithelial cell injury and regeneration without inflammation

15

Gastritis cause

H.Pylori
Autoimmune
- Serum autoantibodies
Affects fundus and body of stomach
leads to atrophic gastritis and IF deficiency = pernicious anaemia

16

Oesophageal cancer types

squamous - common in China
RF - Obesity Smoking Alcohol

adenocarcinoma - common in West
RF - GORD

17

Oesophageal cancer stages

Normal stratified squamous epithelium > Metaplastic glandular oesophageal > Dysplastic glandular oesophageal > Neoplastic glandular oesophageal

18

Oesophageal cancer causes

Smoking Alcohol Obesity GORD

19

Oesophageal cancer symptoms

Vomiting, GI bleed, Dyspepsia, Dysphagia, Weight loss

20

Oesophageal cancer Ix

Endoscopy + biopsy
CT/PET scan

21

Oesophageal cancer treatment

Chemotherapy and radiotherapy
Stent
Oesophageal replacement

22

Gastric cancer Types

1. Intestinal
Local ulcerated lesion
Rolled edges

2. Diffuse
Extensive spread

23

Gastric cancer pathology

normal gastric mucosa > metaplasia > dysplasia > intermucosal carcinoma > invasive carcinoma

24

Gastric cancer Ix

gastroscopy
Biopsy
CT

25

Gastric cancer causes

Obesity
Smoking
NSAID use
H. pylori

26

Gastric cancer staging

1. In situ
2. Early invasive
3. Late invasive

27

Gastric cancer treatment

Gastric Resection
Reconstruction
Lymphadenectomy

28

Define Coeliac Disease

Autoimmune gluten sensitive enteropathy

29

Coeliac Disease intolerance

Prolamin intolerance - specifically Gliadin in wheat

30

Coeliac Disease cause

GENETIC
HLA-DQ2 HLA-DQ8 receptor

ENVIRONMENTAL
age of gluten exposure

31

Coeliac Disease Risk Factors

IBS
IgA Deficiency
Type 1 DM

32

Coeliac Disease Epidemiology

1 in 100
present in infancy and 40-60yrs

33

Coeliac Disease symptoms

Weight loss
Diarrhoea
Steatorrhoea
Failure to thrive

34

Coeliac Disease pathology

Gliadin peptide transported to lamina propria
DIsaminated by tTG
binds to APC which binds to CD4+ Thelper cells
which binds to HLA class 2 molecules.
Leads to inflammatory cascade > Villous atrophy and Crypt hyperplasia

Gliadin also directly damages intestinal epithelial cells using IL15

35

Coeliac Disease Diagnosis

FBC low HB, ferritin, folate, B12
Duodenal and small biopsy
Serology
tTG
EMA

Histology - villous atrophy and crypt hyperplasia
Endoscopy - absent folds

36

Coeliac Disease treatment

Lifelong gluten free diet
Correct deficiency
DEXA scan for osteoporosis