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Medicine: PBL wrap-ups > Unit 2 Case 2: GERD > Flashcards

Unit 2 Case 2: GERD Flashcards

1
Q

anatomy of the oesophagus

A

C6 to T11
adventitia
muscularis externa
submucosa
mucosa

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2
Q

musculares externa in the superior third

A

voluntary striated muscle

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3
Q

musculares externa in the middle third

A

voluntary striated and smooth

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4
Q

muscularis externa in the inferior third

A

smooth muscle

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5
Q

layers in the muscularis externa of the stomach q

A

longitudinal
circular
oblique

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6
Q

4 regions of the stomach

A

cardia- surrounds opening of the oesophagus
fundus-area above the cardinal orifice
body-largest region
pylorus- stomach to the duodenum

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7
Q

2 sphincters inside of the stomach

A

inferior oesophageal
pyloric

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8
Q

inferior oesophageal sphincter

A

transition between stomach and oesophagus at T11
food passes from oesophagus through cardiac orifice and into body of the stomach

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9
Q

pyloric sphincter

A

lies between pylorus and start of the duodenum
controms exit of chyme (food and gastric acid mixture)

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10
Q

3 sublayers of the mucosa of the oesophagus

A

stratified squamous non-keratinised epithelium
lamina propria
muscularis mucosa

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11
Q

stratified squamous non-keratinised epithelium

A

mucous production
for lubrication and neutralisation of acid
protection

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12
Q

lamina propria

A

absorption via the capillaries
contains MALT for immune response

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13
Q

muscularis mucosa

A

for localised movement
uses muscular contraction

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14
Q

submucosa

A

large network of blood vessels
increases SA for nutrient absorption
mucus glands for lubrication of bolus
Meissen nerve cells to control effectors

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15
Q

histology of the stomach

A

simple columnar

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16
Q

what occurs in the fundus and the body of the stomach

A

the epithelial lining invaginate
forming gastric pits

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17
Q

cells that the gastric pits contain

A

surface lining
regenerative
mucous neck cells
parietal
chief

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18
Q

regenerative cells

A

replace any of the other cells

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19
Q

mucous neck cells

A

secrete mucous and neutralise acid

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20
Q

parietal cells

A

release hydrochloric acid, intrinsic factor and gastrin

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21
Q

chief cells

A

secretes pepsinogen and HCl converts pepsinogen to pepsin, active form

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22
Q

what is GERD

A

stomach contents regurgitate up into the oesophagus
oesophageal sphincter is in a relaxed state
impaired lower oesophageal sphincter mechanism
intragastric pressure
delayed gastric emptying

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23
Q

symptoms of GERD

A

heartburn
unpleasant sour taste in the mouth
upper GI pain
cough
hiccups
halitosis
bloating
nausea and vomiting
dysphagia
odynophagia
nocturnal asthma

24
Q

when can GERd symptoms worsen

A

lying down
bending over
after eating

25
what is dyspepsia
collection of symptoms of upper GI pain: heartburn, nausea,vomiting not a diagnosis
26
drug used in this case
lansoprazole
27
what is lansoprazole
proton pump inhibitor chemical mature of benzimidazole sulfoxide
28
what can lansoprazole be used to treat
duodenal ulcers gastric ulcers erosive oesophagitis GERD Zollinger-ellison syndrome
29
mechanism of action of lansoprazole
in separate flashcards
30
mechanism of action of lansoprazole
binds to the proton pump inhibitors and prevent release of protons into the stomach from parietal cells reduces amount of HCl produced by stomach increases pH of the stomach
31
short term side effects of lansoprazole
headaches abdominal pain nausea
32
long term effects of lansoprazole
infections deficiency in vitamin B12, magnesium, iron and calcium diarrhoea
33
what is Barrett's oesophagus
replacement of normal stratified squamous epithelium with metaplastic premalignant intestinal columnar epithelium in the distal oesophagus
34
what is oesophageal cancer
a malignancy that develops in tissues of the hollow, muscular canal along which food and liquid travel from the throat to the stomach
35
2 main types of oesophageal cancer
adenocarcinoma squamous cell carcinoma
36
what are the risk factors for GERD
overweight pregnancy smoking drugs hiatus hernia stress diet gender other diseases
37
overweight as a risk factor
increased pressure lower oesophageal sphincter releaxes acid travels up the oesophagus body less efficient at emptying stomach contents increases acid secretion
38
pregnancy as a risk factor
increased weight and growth of foetus increases pressure on the stomach acid travels up the oesophagus hormones such as plasma progesterone weakens the lower oesophageal sphincter stomach acid easily pushes up
39
smoking as a risk factor
nicotine relaxes smooth muscle and lower oesophageal sphincter acid and stomach contents travel up oesophagus reduces salvation, saliva contains acid-neutralising bicarbonate less acid neutralisation takes place
40
short term implications of GERD
heartburn dry cough difficulty swallowing asthma-like symptoms sore throat bad breath nausea
41
long term implications of GERD
oesophagitis oesophageal ulcers oesophageal bleeding oesophageal stricture barrett's oesophagus oesophageal cancer
42
3 main types of medicine for indigestion q
antacids and alginates PPIs H2-blockers
43
examples of antacids and alginates
gaviscon maalox setlers tums
44
case specific members of the MDT
dietician endoscopist gatroenterologist
45
diagnosing GERD
proton pump inhibitor trial barium swallow oesophageal pH monitoring endoscopy
46
proton pump inhibitor trial
reduce amount of hydrochloric acid the stomach produces and are given to see if symptoms of acid reflux after 4-8 weeks
47
barium swallow
given a barium solution coats the inside lining of the digestive tract allows the silhouette of the oesophagus to be seen under an x-ray shows the fluid travelling down oesophagus assess for reflux or other issues
48
2 types of oesphageal pH monitoring
catheter capsule
49
catheter monitoring
catheter down oesophagus for 24 hours adds impedance to distinguish between acid and non-acid reflux impedance monitoring detects changes in resistance to electrical current
50
capsule monitoring
endoscope small wireless pH sensing capsule measures and transmits signal onto belt 48 hours patient can continue normal activities
51
what is manometry
assess muscle of the oesophagus measures the pressure inside
52
fundoplication
strengthens the barrier acid reflux when sphincter doesn't function correctly top of the stomach, fungus is folded and sewn around the LEs
53
when would you have a fundoplication
when you fail to respond to adequate doses of medication intolerable side effects from medication not wanting to take long-term medication
54
effects of illness on other family members
emotional upheaval somatic problems cognitive and emotional problems behavioural troubles
55
how can friends and family support GERD patients
educate themselves on GERD help manage lifestyle factors that can alleviate GERD symptoms quit smoking encourage more exercise

Medicine: PBL wrap-ups (21 decks)

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