Podcast
Questions and Answers
Failure of which anatomical structure is most directly associated with acid reflux into the esophagus?
Failure of which anatomical structure is most directly associated with acid reflux into the esophagus?
- Lower esophageal (cardiac) sphincter (correct)
- Sphincter of Oddi
- Ileocecal valve
- Pyloric sphincter
Which of the following best describes the primary etiological difference between peptic and gastric ulcers?
Which of the following best describes the primary etiological difference between peptic and gastric ulcers?
- Peptic ulcers have an acidic etiology, while gastric ulcers can arise from various factors. (correct)
- Peptic ulcers are confined to the stomach, while gastric ulcers affect the duodenum.
- Peptic ulcers are solely caused by _Helicobacter pylori_, while gastric ulcers are due to NSAID use.
- Gastric ulcers are more commonly associated with bleeding than peptic ulcers.
An ulcer located in the duodenum is most likely classified as which type of ulcer?
An ulcer located in the duodenum is most likely classified as which type of ulcer?
- Gastric ulcer only
- Stress ulcer
- Peptic ulcer (correct)
- Esophageal ulcer only
What is the underlying common mechanism by which acid and pepsin contribute to both peptic and gastric ulcer formation?
What is the underlying common mechanism by which acid and pepsin contribute to both peptic and gastric ulcer formation?
Which of these medications is least likely to trigger peptic ulcer disease?
Which of these medications is least likely to trigger peptic ulcer disease?
Why should dentists exercise caution when treating patients with peptic ulcers?
Why should dentists exercise caution when treating patients with peptic ulcers?
What is the key histological difference between chronic and acute duodenal ulcers?
What is the key histological difference between chronic and acute duodenal ulcers?
Which of the following signs could indicate a peptic ulcer with significant bleeding?
Which of the following signs could indicate a peptic ulcer with significant bleeding?
What is the most severe, life-threatening consequence of peptic ulcer scarring spreading through the gut wall?
What is the most severe, life-threatening consequence of peptic ulcer scarring spreading through the gut wall?
Which combination of diagnostic tools is most effective in confirming the presence and severity of peptic ulcers?
Which combination of diagnostic tools is most effective in confirming the presence and severity of peptic ulcers?
Which of the following medication combinations represents the standard quadruple therapy for treating H. pylori infection?
Which of the following medication combinations represents the standard quadruple therapy for treating H. pylori infection?
Achlorhydria resulting from chronic gastritis can lead to which of the following conditions?
Achlorhydria resulting from chronic gastritis can lead to which of the following conditions?
Reduced intrinsic factor production due to gastritis impairs the absorption of which vitamin, potentially leading to macrocytic anemia and a sore mouth?
Reduced intrinsic factor production due to gastritis impairs the absorption of which vitamin, potentially leading to macrocytic anemia and a sore mouth?
What is the underlying cause of Barrett's esophagus?
What is the underlying cause of Barrett's esophagus?
What is the most significant risk factor for carcinoma of the esophagus?
What is the most significant risk factor for carcinoma of the esophagus?
What is a typical symptom of carcinoma of the oesophagus?
What is a typical symptom of carcinoma of the oesophagus?
Which local spread effect of carcinoma of the esophagus can result in a hoarse voice?
Which local spread effect of carcinoma of the esophagus can result in a hoarse voice?
What is the most common histological type of carcinoma found in the esophagus?
What is the most common histological type of carcinoma found in the esophagus?
Which of the following represents the diagnostic approach for esophageal carcinoma?
Which of the following represents the diagnostic approach for esophageal carcinoma?
What specific surgical intervention is typically used to treat carcinoma of the esophagus with curative intent?
What specific surgical intervention is typically used to treat carcinoma of the esophagus with curative intent?
Flashcards
Peptic Ulcer Disease/Reflux
Peptic Ulcer Disease/Reflux
Failure of the upper (cardiac) sphincter leads to acid reflux into the esophagus, potentially causing pain, ulceration, and spasms.
Aetiology Difference: Peptic vs. Gastric Ulcers
Aetiology Difference: Peptic vs. Gastric Ulcers
Peptic ulcers have an acidic cause, while gastric ulcers can arise from various factors.
Location: Peptic vs. Gastric Ulcers
Location: Peptic vs. Gastric Ulcers
Peptic ulcers can affect the esophagus, stomach, or duodenum, while gastric ulcers are limited to the stomach.
Common Aetiology: Peptic & Gastric Ulcers
Common Aetiology: Peptic & Gastric Ulcers
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Triggers of Peptic Ulcer Disease
Triggers of Peptic Ulcer Disease
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Dentist Considerations with Peptic Ulcers
Dentist Considerations with Peptic Ulcers
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Acute vs. Chronic Duodenal Ulcers
Acute vs. Chronic Duodenal Ulcers
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Symptoms of Peptic Ulcer Disease
Symptoms of Peptic Ulcer Disease
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Peptic Ulcer Scar Paths
Peptic Ulcer Scar Paths
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Peptic Ulcer Diagnosis
Peptic Ulcer Diagnosis
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Peptic Ulcer Treatments
Peptic Ulcer Treatments
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Consequences of Gastritis
Consequences of Gastritis
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Barrett's Oesophagus Cause
Barrett's Oesophagus Cause
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Major Risk Factors: Carcinoma of the Oesophagus
Major Risk Factors: Carcinoma of the Oesophagus
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Symptoms of Carcinoma of the Oesophagus
Symptoms of Carcinoma of the Oesophagus
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Local Spread Effects: Oesophageal Carcinoma
Local Spread Effects: Oesophageal Carcinoma
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Treatments for Carcinoma of the Oesophagus
Treatments for Carcinoma of the Oesophagus
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Pyloric stenosis
Pyloric stenosis
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Haematemesis
Haematemesis
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Infective cause of haematemesis
Infective cause of haematemesis
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Study Notes
- Peptic ulcer disease/reflux arises from the failure of the upper (cardiac) sphincter, leading to acid reflux into the oesophagus. Consequences include pain, ulceration, and spasms.
Peptic vs. Gastric Ulcers: Aetiology
- Peptic ulcers have an acidic aetiology.
- Gastric ulcers can arise from any means.
Peptic vs. Gastric Ulcers: Affected Areas
- Peptic ulcers can affect the oesophagus (reflux), stomach (decreased resistance), or duodenum (increased acid).
- Gastric ulcers affect the stomach only.
Peptic and Gastric Ulcers: Common Aetiology
- Mucosal inflammation results from acid and pepsin destroying the lining mucosa.
- The mucus protection coat is also removed.
Triggers of Peptic Ulcer Disease
- Aspirin & NSAIDs block cyclooxygenase and prostaglandin production.
- Steroids act similarly to Aspirin & NSAIDs.
- Smoking is a trigger.
- Helicobacter pylori infection colonizes mucus.
Dental Considerations for Patients with Peptic Ulcers
- Avoid NSAID use.
- Steroids may complicate treatment.
Acute vs. Chronic Duodenal Ulcers
- Chronic ulcers penetrate the submucosa and muscular wall.
- Acute ulcers only reach the muscularis mucosae.
Symptoms of Peptic Ulcer Disease
- Pain.
- Vomiting.
- Haematemesis (increased bleeding).
- Ulcer with scarring.
Paths of Peptic Ulcer Scarring
- Scarring may lead to a stricture or obstruction.
- Healing leads to local scarring.
- Scarring can spread through the gut wall, causing perforation, bleeding, peritonitis, and potentially death.
Diagnosing Peptic Ulcers
- Endoscopy.
- Barium meal.
Treatments for Peptic Ulcers
- Control predisposing factors with antacids.
- Decrease secretions with H-2 blockers (ranitidine) or proton pump inhibitors (omeprazole).
- Treat H. pylori with quadruple therapy: PPI, Bismuth, and 2 antibiotics (amoxicillin and clarithromycin).
Consequences of Inflamed Stomach (Gastritis)
- Chronic inflammation/irritation: Can cause erosion, ulceration, bleeding & potentially malignant conversion.
- Reduced acid production (achlorhydria): Reduces the potential conversion of ferric to ferrous iron, increasing the risk of iron deficiency, glossitis, and microcytic anaemia.
- Reduced intrinsic factor production: Impairs Vitamin B12 binding and reabsorption, leading to macrocytic anaemia and a sore mouth; gastric parietal cell antibody production can mimic this.
Barrett’s Oesophagus
- Long-standing reflux from the stomach causes a change in inflammation in the lower oesophageal lining.
Carcinoma of the Oesophagus: Age
- Most common in those over 50s.
Risk Factors for Carcinoma of the Oesophagus
- Heavy alcohol use (20x risk).
- Smoking (5x risk).
- Food toxins.
- Peptic disease.
- Achalasia of cardia.
- Pharyngeal pouch.
- Iron deficiency.
- Coeliac disease from malabsorption.
Symptoms of Carcinoma of the Oesophagus
- Presents with dysphagia (difficulty swallowing).
- Gradual onset, solids become difficult to swallow before liquids.
- Possible pain on swallowing.
Local Spread Effects of Carcinoma of the Oesophagus
- Fistulae to trachea.
- Spread to the recurrent laryngeal nerve, causing a hoarse voice.
Common Type of Carcinoma
- Squamous cell carcinoma is what is most common.
Oesophageal Carcinoma Spread to the Liver
- Carcinoma fungates into the lumen.
- Structures like the mediastinum are diffusely infiltrated.
- Spreads to the lymph nodes.
- Mets to the liver.
Diagnosing Carcinoma of the Oesophagus
- Barium swallow.
- Endoscopy and biopsy.
- CT scan to stage and plan treatment.
Treatments for Carcinoma of the Oesophagus
- Surgery is needed to cure which requires a 5cm resection margin- this is very dangerous.
- Palliative treatment with surgery or radiotherapy- less dangerous, but not a cure.
- Stent
Pyloric Stenosis
- Paediatric projectile vomiting.
- Pyloric sphincter is closed.
Haematemesis
- Vomiting of blood.
Presentation of Haematemesis
- Vomited blood is usually partially digested & dark (coffee grounds), mixed with food.
Source of Vomited Blood in Haematemesis
- Usually from the upper GI tract.
Congenital Causes of Haematemesis
- Haemophilia.
- Ehlers-Danlos syndrome.
- Peutz-Jeghers syndrome.
Infective Cause of Haematemesis
- Helicobacter pylori-induced ulceration.
Inflammatory Causes of Haematemesis
- Peptic ulceration.
- Gastritis.
- Oesophagitis.
Traumatic Causes of Haematemesis
- Surgery.
- Swallowed blood from epistaxis.
- Foreign body perforation.
- Tear in oesophagus due to excessive vomiting.
Venous Engorgement Cause of Haematemesis
- Oesophageal varices.
Vascular Malformation Cause of Haematemesis
- Haemangioma.
Neoplasia Causes of Haematemesis
- Oesophageal SCC.
- Gastric carcinoma.
Fistula Cause of Haematemesis
- Aorto-oesophageal fistula.
Drug-Induced Causes of Haematemesis
- Warfarin.
- NSAID induced gastric erosion/peptic ulceration.
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