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What are the differences between physiological reflux and pathological reflux?(GORD)

• Physiological reflux typically occurs post-prandially, short-lived, asymptomatic and rarely occur at night.

• GORD is associated with symptoms of mucosal injury and often occur at night.


What are the six factors that lead to pathological reflux?

1) Delayed gastric emptying.
2) Transient LES relaxation.
3) Decreased LES tone.
4) Decreased salivation.
5) Decreased tissue resistance (In oesophagus)
6) Impaired oesphageal clearance.


What are the two common symptoms of GORD?

1) Heartburn; most commonly occurred in post prandial period.

2) Acid regurgitation.


What is the red flag symptom of GORD? And what can it mean?

• Dysphagia
- Slowly progressive dysphagia can indicate an oesophageal stricture, Long term GORD can lead to adenocarcinoma.


Aside from heartburn, acid regurgitation and dysphagia, what are the other presenting symptoms of GORD? 

Chest pain, Water brash (Excess salivating), odynophagia and nausea.


What factors are associated with GORD?

• Family History
• Pregnancy
• High BMI


What behavioural factors are associated with GORD?

• Smoking
• Alcohol consumption
• Prescription medication


What are the complications of GORD?

• Oesophagitis

• Barrett's Oesophagus, Stricture, Cancer

• Extra-oesophageal problems (Laryngeal, respiratory problems)


What is the definition of dyspepsia?

• Pain or discomfort in the upper abdomen.

• Rome III classification - 
-Post-prandial fullness
-Early satiation
-Epigastric pain


What are the two patterns of helicobacter gastritis?

1) Pan gastritis; body and antrum associated with diminished acid output.

2) Antral gastritis; associated with increased acid output.


What is peptic ulcer disease?

A breach in the mucosal lining of the gut due to attack by acid and pepsin.


What are the symptoms of peptic ulcers?

They may be asymptomatic and not present until a complication such as a perforation has occurred.

However, symptoms may include;
- Dyspepsia, radiation to back may occur, anorexia, weight loss, fatty food intolerance.


What are the complications of peptic ulcers?

• Perforation leading to peritonitis.

• Haemorrhage, by erosion to vessel.

• Penetration of surounding organ.

• Obstruction


What are the red flags associated with peptic ulcer disease?

• Weight loss
• Persistant vomiting
• Dysphagia/odynophagia
• Haematemesis
• Palpable mass or lymphadenopathy
• Unexplained iron deficient anaemia
• Family history of upper GI cancer
• Previous GI surgery
• Jaundice


What are the five types of gastric ulcers and which two are associated with acid hypersecretion?

1) Primary gastric ulcer. Associated with diffuse antral gastritis.

2) Gastric ulcers with duodenal ulcers, most likely secondary to duodenal ulcers.

3) Prepyloric or channel ulcers.

4) Proximal stomach or gastric cardia.

5) Can occur throughout stomach. Associated with chronic NSAID use.


What are the red flag symptoms associated with dyspepsia?

Anaemia, Loss of apetite, Anorexia, Recent progressive symptoms, Malaena/hemetemesis.

• Dysphagia
• Family history
• Previous gastric surgery
• Jaundice


What are the lifestyle changes used to treat dyspepsia?

• stop smoking, decrease alcohol, decrease caffeine, weight loss, balanced diet.


What two types of medication are used in the treatment of dyspepsia?


• Acid suppression - PPIs and H2 antagonists.


What are the symptoms of peptic ulcers?

• Weight loss, dyspepsia, anorexia, IBS

Can be asymptomatic and only present when a complication occurs (i.e. perforation)


What are the complications of peptic ulcers?

1) Perforation

2) Haemorrhage

3) Obstruction


What are the symptoms of a duodenal ulcer?

• 2-5 hours after eating / empty stomach.

• Burning/hunger like pain.

• Radiation to back.

• Intermittent.


What is the presentation of a gastric ulcer?

Severe pain after meals and less frequently relieved by antacids than duodenal ulcers.


What are the causes of peptic ulcers?

• >Age
• Male > Femal
• Helicobacter pylori
• Smoking
• Stress/diet/familial


Why does the longterm use of NSAIDS increase the risk of peptic ulcers?

Reduces COX1 levels in mucosa which in turn reduces the levels of prostaglandins.

The risk is further increased if elderly/comorbities.


How does Helicobacter pylori increase the risk of peptic ulcers?

• Pan gastritis, decreases acid production leading to GU/cancer.

• Antral gastritis, increases acid production causing DU.


What drugs are used to treat peptic ulcers?

PPIs - Inhibits the transport of H+ from the parietal cell.
- Promotes ulcer healing and reduces symptoms and chance of recurring.

• H pylori erradication- 
- Buffer with antacids.
- Reduce H+ secretory stimuli; H2 antagonists, Anticholinergics, Gastrin antagonists.


Which four secretory cells are present in the body of the stomach and what do they secrete?

1) Parietal cells - Acid, intrinsic factor.

2) Chief cells - pepsinogens 
 - Initiate protein breakdown/break peptide bonds.

3) Mucous cells - In neck of gland, mucous.

4) Endocrine cells - Histamine.


What seceretory cells are present in the antrum of the stomach and what do they secrete?

1) Chief cells - Pepsinogens

2) Endocrine cells-
-  G-cells - Gastrin
- D-Cells - Somatostatin


At what pH is optimal pepsin activity?



What are the four stages of gastric secretion?

1) Basal (Background always present)

2) Cephalic
3) Gastric
4) Intestinal