OESOPHAGUS AND STOMACH DISORDERS LECTURE: WEEK : 4 GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD) CLASSIFICATIONS: CAUSES: Reflux of gastric acid (From stomach) is the most common cause of oesophagitis (inflammation of the oesophagus) Clinical condition of GORD/GERD Damage of the mucosal lining (mucosal injury) in the oesophagus as it is not adapted to acidity Most common symptoms Heartburn Difficulty swallowing (dysphagia) Less common symptoms Regurgitation Severe chest pain Oesophagus Diaphragm Stomach RISK FACTORS: Alcohol Tobacco Pregnancy Obesity over the age of 40 Esophagus Stomach LINX derice Magnets move apart Acid rollux and food passes into stomach BARRETT OESOPHAGUS CLASSIFICATIONS: A complication of chronic GORD Intestinal metaplasia within the oesophageal squamous mucosa Increased risk For development of oesophageal adenocarcinoma cancer MultiFactoral Transient lower oesophageal sphincter relaxations The lower oesophageal sphincter (LOS) pressure abnormalities COMPLICATIONS: Oesophageal ulceration Vomiting of blood (hematemesis) Blood in Faeces (melena) Barrett oesophagus Lower oesophageal sphincter (LOS) Reduced oesophageal sphincter tone permitting acid retux 0 MANAGEMENT: Medications Neutralise stomach acid Antacids Reduce stomach acid production H2 blockers Block stomach acid production Proton pump inhibitor's surgery LINK device Acidic conditions From reflux over long periods of time cause regions that shouldn't have columnar cells to now have them A B
WEEK : OESOPHAGUS AND STOMACH DISORDERS LECTURE: 4 PEPTIC ULCERS CLASSIFICATIONS: Found in the stomach and duodenum A crater like lesion where the mucosal lining is eroded Depending on the severity erosion can go deeper than mucosal layer and into the ssubmucosa where bleeding can occur In some instances ulceration can perforate through the entire lining (4 layers ) through the serosa as well H. pylori Gastric acid Pepsin NSAIDS symptoms and signs Epigastric pain that is relieved with ingestion of Food Peptic ulcer (Microscopic view) Necrotic cells Blood vessel- Stomach pains sometime soon after a meal Duodenal ulcer - pain 2-3 hours after a meal Nausea Dyspepsia (abdominal upset) MANAGEMENT: Eradication of H. pylori Reduction in the use of NSAIDS Avoiding alcohol, smoking Reduced stress GASTRITIS CLASSIFICATIONS: Inflammation of the mucosal lining in the stomach Asymptomatic H. pylori NSAIDS Mild epigastric pain Nausea/vomiting CAUSES: Alcohol CAUSES: Gastritis Due to the pathogen H. pylori Implicated in the development OF peptic ulcers NSAIDS Excessive long-term use Eventually lead to the development of peptic ulcers Disruption to the slightly alkaline mucus of the stomach A breakdown in the normally protective gastric epithelial lining Pronounced vagus nerve Mucosa stimulation causes more HCI to be Submucose externa produced Muscularis Malicubacter Pleri Induction Loichella Mitcsiaris Mucosas -Sammattias COMPLICATIONS GI tract bleeding Gastric cancer Weakness or injury to the mucus-lined barrier COMPLICATIONS: Chronic great gastritis is a risk Factor For development of gastric dysplasia and adenocarcinoma
LECTURE: OESOPHAGUS AND STOMACH DISORDERS WEEK: 4 INFLAMMATORY BOWEL DISEASE (BD) CLASSIFICATIONS: Chronic condition resulting in inappropriate mucosal immune activation: IBD is an umbrella term For: Crohn's disease Involves any area of the small and/or large intestine At the terminal ileum or valve of the caecum CAUSES: Intestinal microbiota Host immune responses Genetically predisposed individuals COMPLICATIONS: A long-term complication is the