PBL 3 Flashcards
(27 cards)
Gastro-oesophageal reflux
this is a common condition where acid from the stomach leaks into the oesophagus
Gaviscon
– this is a medication that is used to treat acid reflux and indigestion, it is made out of Potassium hydrogen carbonate and sodium alginate, it forms a protective layer that floats on top of the contents of the stomach, this prevents stomach acid escaping into the food pipe, contains an antacid that neutralises excess stomach acid and pain and discomfort
Heart burn
this is a burning sensation in the middle of the chest, this is a symptom of acid reflux
Hiatus Hernia
this is when part of the stomach moves up into the chest
Parietal cells
these are the epithelial cells that secrete HCL and IF, they are located in the gastric glands in the fundus and cardia of the stomach
TLOSR
transient lower oesophageal sphincter relaxations, these can lead to acid reflux
Oesophagitis
inflammation of the inner lining of the oesophagus caused by repeated episodes of reflux
Retrosternal
behind the sternum
Gastritis
– general term for a group of conditions with one thing in common, inflammation of the lining of the stomach
CLO testing
rapid diagnostic test for diagnosis of H.pylori
Triple therapy
2 antibiotics and 1 proton pump inhibitor
Urea breath test
rapid diagnostic procedure that is used to identify infections by helicobacter pylori
what is the pathogenesis of GORD
- Caused by the LOS becoming weakened- TLOSR
- This exposes the damaged squamous mucosa of the oesophagus to acid
- Repeated exposure causes oesophagitis
- Abnormal spaces in the epithelium of the mucosa causing excessive stimulation of nerve endings and peripheral sensation
- Gas reflux – experienced as heartburn
- Stomach acid is able to pass back up into the oesophagus
- May be caused due to a hiatal hernia (oesophageal junction is displaced), delayed gastric emptying and impaired oesophageal clearance – slows the movement of material down the digestive tract, obesity – increases pressure gradient between the abdomen and thorax
- Can be caused by stress, smoking, alchol
- Often experienced after a meal when acid production is at its lowest because after eating an unbuffered volume of acid is in the proximal region of the stomach
what is a treatment of H pylori
- Use triple therapy – this is 2 antibiotics (clarithromycin and amoxicillin) and 1 proton pump inhibitor such as omeprazole,
- This is used for a week
- Lowering the stomach acid helps the antibiotics work better
- Metronidazole can also be used
- Spicy foods, alcohol and smoking can worsen a peptic ulcer and prevent it from healing person
how do proton pumps work
- Omeprazole is an example of a proton pump inhibitor
- It prevents the hydrogen potassium ATPase that is present on the parietal cell
- This reduces the acid secretion that is produced in the stomach
- Can get diarrhoea, constirpcation, feeling sick, abdominal pain, dizziness and a rash
how do antacids work
- These neutralise the effects of stomach acid
how do H2 inhibitors work
- Histamine inhibitors
- These inhibit the release of histamine from the ECL cells that are in the gut
- Histamine binds to parietal cells and causes more acid to be secreted
- Prevents histamine from being released and binding to the histamine receptors on the parietal cell thus preventing histamine from binding to it
- Last option, taken on a short term bases
- oral ranitidine
what are the lifestyle changes for GORD
- Eat smaller but more frequent meals
- Avoid foods that trigger the symptoms
- Raise head in bed
- Over counter medicines such as Gaviscon
- Don’t wear tight clothing around stomach
- Try to relax as stress can make GORD worse
- Stop smoking – smoking irritates digestive system and makes the symptoms worse
what is the surgery for GORD
Surgery - Fundoplication - magnetic anti-reflux device Fundoplication • Tightens and reinforces the LOS. • The upper part of the stomach is wrapped around the outside of the lower oesophagus to strengthen the sphincter. Magnetic anti-reflux device - this extends when the chyme goes through and restricts when nothing is going through via magnets
how to diagnose GORD
May have
- endoscopy
- barium swallow or barium meal test
- manometry
- 24-hour pH monitoring
- Blood tests
Endoscopy
- Procedure where the inside of the body is examined using an endoscope – this is inserted in the mouth and down the throat
- Carried out while your away
- Can show if the oesophagus has been damaged by stomach acid
Barium swallowing
- Test your swallowing ability and look for any blockages and abnormalities in the oesophagus
- Given some barium solution and then some X rays are taken
- Barium is a harmless substance that shows up clearly on X rays as it passes through the digestive system
Manometry
- Used to assess how well the ring of muscle at the end of the oesophagus is working
- Measure the pressure in the oesophags
- Small tube is passed up through your nose and then down into the oesophagus
- The tube contains pressure sensors that detect the pressure in the oesophagu
24 hour pH monitoring
- May be necessary to measure the acidity level in the oesophagus to confirm a diagnosis of GORD if nothing is found during and edoscopy
- Thin tube containing a sensory is passed up nose and into the oesophagus usually connected to a recording device worn on your waist
- Press button every time you get symptoms
Blood test
- Check for anaemia which can be a sign of inernal bleeding
how do you test for H.pylori
Urea breath test: urea C14 is given to patient and H. Pylori converts urea C14 to ammonia (NH3) + C14O2
• CLO test: biopsy placed in media with urea and pH indicator conversion of urea to ammonia raises pH ( if H. pylori present), which changes the colour of pH indicator.
• blood antibody test: antibodies to H. Pylori
• stool antigen test (H. Pylori proteins)
what is the role of pharmacy
- the quality of medicines supplied to patients
- ensuring that the supply of medicines is within the law
- ensuring that the medicines prescribed to patients are suitable
- advising patients about medicines, including how to take them, what reactions may occur and answering patients’ questions.
what are the anatomical features to prevent reflux
The lower oesophageal sphincter provides a high pressure
which closes the lumen
The angle at which the oesophagus enters the stomach
The presence of the terminal portion of the oesophagus inside
the abdominal cavity
what are acid reflux symptoms
= Heartburn – a burning sensation in the middle of your
chest
= An unpleasant sour taste in your mouth, caused by
stomach acid
- a cough or hiccups that keep coming back
- a hoarse voice
- bad breath
- bloating and feeling sick
