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Year 1 SBA revision > 106 - GORD/PUD > Flashcards

106 - GORD/PUD Flashcards

1
Q

Define GORD

A

Symptoms or mucosal damage produced by abnormal reflux of gastric contents into oesophagus

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2
Q

Key symptoms of GORD

A

Heartburn in retrosternal area and acid regurgitation

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3
Q

Physiological reflux likely if

A

Happens after eating
Short lived
Asymptomatic
Rarely occurs in sleep

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4
Q

What is dysphagia

A

Problems swallowing. Red flag symptom. Long term GORD - need to rule out adenocarcinoma

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5
Q

Differential diagnosis of GORD

A

Angina pectoris major differential

Stricture, ulcer, Barrett’s oesophagus, cancer. Exclude cardiorespiratory causes.

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6
Q

Practically - consider GORD in all cases of

A

Chronic heartburn

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7
Q

Severity and duration of GORD symptoms indicate

A

nothing about severity oesophagitis

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8
Q

Prevalence of GORD

A

Can be as high as 20% in US. Varies with geography and ethnicity.

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9
Q

Factors associated with GORD

A 
Family history
Pregnancy
High BMI
Lower educational level
Smoking
Alcohol
Prescription medications
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10
Q

Dyspepsia is

A

Pain/discomfort centred in the upper abdomen

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11
Q

Causes of dyspepsia

A

25% have underlying cause
Peptic ulcer disease most common
Also biliary pain, pancreatitis, chronic abdominal wall pain, cancer, medications.

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12
Q

Dyspepsia Rome III definition

A

Postprandial fullness
Early satiation
Epigastric pain/burning

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13
Q

Definition of Peptic Ulcer Disease

A

PUD - surface breach of mucosal lining of GI tract due to acid & pepsin mediated damage

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14
Q

Common sites of PUD

A

Duodenum (80%)

Stomach (20%)

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15
Q

Causes of chronic gastritis

A 
H. pylori - over 80% cases
Chemical damage (bile, reflux, drugs)
Autoimmune - Pernicious anaemia (Vit B12 malabsorption)
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16
Q

Causes of acute gastritis

A

Usually due to chemical injury - alcohol/drugs

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17
Q

What is gastritis

A

Inflammation of stomach lining

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18
Q

Peptic ulcer symptoms

A 
Wide variety or can be asymptomatic until complications start
Dyspepsia
Anorexia
Weight loss
Fatty food intolerance
Epigastric pain
Pain can radiate to back
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19
Q

Duodenal ulcer symptoms generally occur

A

2-5hrs after eating on empty stomach - as acid empties into duodenum

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20
Q

Gastric ulcer symptoms gennerally occur

A

soon after meals - acid in stomach

21
Q

Complications of peptic ulcer

A 
Perforation leading to peritonitis
Haemorrhage due to erosion of vessel
Penetration of surrounding organ 
Obstruction due to scaring - pyloric stenosis
Cancer - VERY RARE
22
Q

PUD alarm symptoms

A 
Weight loss
Persistant vomiting
Dysphagia (getting worse)
Haematemesis
Palpable abdominal mass
Unexplained anaemia
Family history of Upper GI cancer
Jaundice
Previous gastric surgery
23
Q

Common drugs that can cause PUD

A

NSAIDs

24
Q

What is Zollinger-Ellison syndrome

A

Gastrin secreting tumour in duodenum/pancreas results in increased acid production. Genetic link

25
Q

PUD risk factors

A

Male
Smoker
Excessive alcohol intake

26
Q

Common PUD presentation

A 
Pain - relieved by food/antacid/milk
Epigastric tenderness on palpation
Nausea/vomiting
Haemorrage
Can be associated with GORD
27
Q

Investigation of suspected PUD

A 
Test and treat approach.
Stop any drugs could be causing
FBC - check for anaemia
H Pylori testing
Endoscopy if indicated
28
Q

H. Pylori triple therapy

A

PPI - e.g. Omeprazole

2 x Abx - Amoxicillin (Metronidazole if allergic) and Clarithromycin.

29
Q

H Pylori testing

A

Either stool antigen test or Urea breath test

30
Q

How does Urea breath test work?

A

Urea swallowed and is broke down by H. pylori to CO2 and NH3

31
Q

Red flags for PUD

A 
Bleeding
Iron deficiency anaemia
Weight Loss
Dysphagia
Epigastric mass
H Pylori & NSAID negative
32
Q

Acid-reflux defences

A 
Lower oesophageal spincter
Angle of his
Mucosal flap and folds
Diaphragm
Peristalsis - clean reflux
Bicarbonate present in saliva
33
Q

Pathophysiologies for GORD

A 
Can be due to:
Poor oesophageal peristalsis
Incompetent lower oesophageal sphincter
Hiatus hernia - stomach herniating through diaphragm and angle of his is destroyed
Delayed gastric emptying
34
Q

GORD investigations

A

FBC - exclude anaemia
Trial PPIs
Barium swallow - look predisposing factors
pH monitoring - exclude oesophageal/peristaltic dysfunction
Endoscopy - look for Barretts

35
Q

Treatments for GORD

A

Lifestyle changes
Antacids
Acid suppressors - PPI (omeprazole) or H2 receptor antagonists (Ranitidine)
Surgery if needed

36
Q

What is Oesophagitis? What causes it?

A

Inflammation of oesophagus due to acid and pepsins

37
Q

Complications of Oesophagitis

A

Oesophageal stricture - dysphagia

May cause Barretts Oesophagus or chronic inflammation

38
Q

Barrett’s Oesophagus - What is it?

A

Normal stratified squamous epithelium is replaced with columnar epithelium. Potential to transform to adenocarcinoma.

39
Q

Stages of development of Barrett’s Oesophagus

A

Damage to epithelium
Metaplasia occurs during repair to acid damage.
Dysplasia occurs
Adenocarcinoma can occur

40
Q

Barrett’s Oesophagus changes to gastric columnar epithelium - risks?

A

No malignant potential

41
Q

Barrett’s Oesophagus changes to intestinal columnar epithelium - risks?

A

Malignant potential

42
Q

Barrett’s Oesophagus - appearance on endoscopy

A

Finger like projections or sheets/patches of reddened epithelium.

43
Q

Risk factors for Barrett’s Oesophagus

A

GORD, hiatus hernia
Male
Obesity
Smoking/Excessive alcohol

44
Q

Impact of NSAIDS and H.Pylori in patient with Barrett’s Oesophagus

A

Protective against malignant changes

45
Q

Symptoms of Barrett’s Oesophagus

A

Asymptomatic - found on endoscopy

46
Q

Investigations for Barretts Oesophagus

A

Endoscopy + biopsy

47
Q

Treatment for Barrett’s oesophagus

A

Acid suppression - slow progression.
Endoscopy to monitor.
If high grade dysplasis - ablation to burn away dysplastic epithelium or surgical resection of oesophagus.

48
Q

Alternative names for urea breath test for H. Pylori

A

Carbon 13 test
CLO test (breath test)
Urease test

49
Q

Surgical option for GORD

A

Nissen fundoplication

Wrap fundus of stomach around lower part of oesophagus.

Year 1 SBA revision (37 decks)

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