Upper Gastrointestinal Tract Flashcards
(10 cards)
What is the pathophysiology of GORD?
GORD is a common condition where acid from the stomach leaks/regurgitates into the the oesophagus due to the weakening of the lower oesophageal sphincter. This leads to irritation/damage to the lining of the oesophageal mucosa.
What is GORD?
Gastro-oesophageal reflux disease
What do you notice during a physical assessment in GORD? include rationale
- onset, duration, frequency of symptoms - to establish a baseline
- pain on swallowing - indicates inflammation from reflux
- dental erosions - evidence that reflux is occurring
- cough/wheeze or hoarse voice - indicates damage to the vocal cords
What do you assess during a holistic assessment in GORD? include rationale
- assess diet and fluids - high-fats and spicy foods can worsen symptoms
- assess smoking status - smoking weakens the lower oesophageal sphincter
- history of anxiety - anxiety can exacerbate the symptoms of GORD
- medications - some OTC drugs can worsen GORD symptoms
What are the red flags when assessing GORD?
- coughing up blood - indicates a perforation
- signs of infection (either local/systemic) - indicates a perforation
- difficulty swallowing - indicates a stricture has developed
- signs of anaemia - indicates blood loss from perforation
What is the common treatment for GORD?
proton-pump inhibitors
What is PPIs?
proton-pump inhibitors
Give examples of PPIs
esomeprazole, lansoprazole, omeprazole, pantoprazole
What is the pharmacodynamics of PPIs?
PPIs works by reducing stomach acid production. This is achieved by inhibiting the proton pumps in the luminal membranes of parietal cells of the mucosa which slows the formation of hydrochloric acid (stomach acid). By blocking the action of the proton pump, it reduces the amount of hydrogen ions (protons/H+) from being released into the stomach lumen. This suspends its mechanism of binding with chloride (Cl-) to form hydrochloric acid, which essentially decreases the overall amount of acid produced.
Give some non-pharmacological management for GORD (patient education) include rationale
- lose weight - excess weight increases pressure on the stomach which increases likelihood of reflux
- stop smoking - smoking weakens the lower oesophageal sphincter
- healthy eating - avoid high-fatty and spicy foods as they worsen GORD symptoms
- psychological therapies - manage the psychological impact of anxiety on the condition
- drink fluids between and not during meals - drinking water during meals increases stomach volume which pushes the acid back up
- eating smaller meals - large meals put pressure on the lower oesophageal sphincter which cause reflux
- avoid eating before exercise - increased movement pushes acid back up
- avoid going to bed soon after meals - wait 2-3 hours as gravity does not help to keep stomach contents in (reflux)
- elevate the head of the bed - reduce acid reflux by counteracting gravity
- lie on the left side of the bed - the oesophagus is slightly higher than the lower oesophagus sphincter when in that position which prevents reflux
