1.1. Oesophageal Disease - Gastro-Oesophageal Reflux Disease Flashcards
What is Gastro-Oesophageal Reflux Disease (GORD) also known as?
Chronic Heartburn
What are some changeable risk factors for Gastro-Oesophageal Reflux Disease (GORD)?
- Obestity
- Smoking
- High Dietary Levels of:
a) Chocolate
b) Coffee
c) Alcohol
What abnormal Gastric Anatomy can result in Gastro-Oesophageal Reflux Disease (GORD)?
A Hiatus Hernia
What are some unchangeable risk factors for Gastro-Oesophageal Reflux Disease (GORD)?
- Pregnancy
2. Those who have been Treated for Achalasia
What other conditions can cause Gastro-Oesophageal Reflux Disease (GORD)?
- A Hypotensive (An increase in Transient Relaxing) Lower Oesophageal Sphincter
- Delayed Gastric Emptying
- Delayed Oesophageal Emptying
- A Decrease in Oesophageal Acid Clearance (Tissue Resistance to Acid)
What drugs can leave you predisposed to Gastro-Oesophageal Reflux Disease (GORD)?
- Anti-muscarinics
- Calcium Channel Blockers
- Nitrates
What is the Pathology of Gastro-Oesophageal Reflux Disease (GORD)?
- There is a flow, for whatever aetiology, of Gastric Acid and Pepsin out of the Stomach, into the Oesophagus
- The Mucosa of the Oesophagus becomes damaged due to this excessive exposure to the Gastric Contents
What can the Over-Exposure of Gastric Acid and Pepsin, to the Oesophageal Mucosa, result in?
- Erosion
- Ulceration
- Stricture
- Metaplasia
What are the signs of Gastro-Oesophageal Reflux Disease (GORD)?
- Increased Oesophageal pH
2. Oesophageal Mucosal Metaplasia - in late stage GORD
What can Oesophageal Mucosal Metaplasia (which occurs in late-stage Gastro-Oesophageal Reflux Disease (GORD)) cause?
Barrett’s Oesophagus
What symptoms would a patient with Gastro-Oesophageal Reflux Disease (GORD) present with?
- Heart Burn
- Regurgitation
- Cough
- Water-Brash
- Sleep Disturbances
What causes the feeling of “Heartburn” in Gastro-Oesophageal Reflux Disease (GORD)?
The actions of Gastric Acid and Pepsin on the Oesophageal Mucosa
What causes the “Regurgitation” in Gastro-Oesophageal Reflux Disease (GORD)?
The Weakened Lower Oesophageal Sphincter
When would “Rregurgitation” occur most often in Gastro-Oesophageal Reflux Disease (GORD)?
When lying flat
Why would the patient present with a “Cough” in Gastro-Oesophageal Reflux Disease (GORD)?
Due to the Body’s natural response to any potential Aspiration of Gastric Contents
What is “Water Brash”?
The Over-production of Saliva in the Oral Cavity
Why would “Water Brash” occur in Gastro-Oesophageal Reflux Disease (GORD)?
An action of the Mouth to try and Dilute and Counteract the effect the Gastric Contents are having on the Oesophageal Mucosa
What investigations are required in Gastro-Oesophageal Reflux Disease (GORD)?
- None
- Upper G.I. Endoscopy
- 24-hour pH monitoring with Manometry
Why is no investigation usually required in Gastro-Oesophageal Reflux Disease (GORD)?
As this can be Diagnosed on a Detailed History alone
When would an Upper G.I. Endoscopy be required in Gastro-Oesophageal Reflux Disease (GORD)?
When Alarm features are present
What is the 24-hour pH with Manometry measuring?
- The average pH in the Oesophagus over a 24-hour period
2. The Internal Pressure within the Oesophagus over a 24-hour period
What are the Treatments for Gastro-Oesophageal Reflux Disease (GORD)?
(1st line to last option)
- Lifestyle Changes
- Alginates
- H2 Receptor Antagonists
- Proton Pump Inhibitors
- Anti-Reflux Surgery
What lifestyle changes should occur?
A reduction in:
- Alcohol Consumption
- Coffee Consumption
- Chocolate Consumption
- Stress
What is the most common example of an Alginate?
Gaviscon
What is the Method of Action for Alginates?
Once ingested, these lie on top of the Gastric Contents (Closer to the Lower Oesophageal Sphincter) and prevent “Splash Back” into the Oesophagus
What is the most common example of H2 Receptor Antagonists?
Ranitidine
What is the Method of Action of H2 Receptor Antagonists?
These block the actions of Histamine at the Gastric Parietal Cells, reducing the Stomach Gastric Acid content
What is the most common example of Proton Pump Inhibitors?
Omeprazole
Or Lansoprazole
What is the Method of Action of Proton Pump Inhibitors?
These block the H/KATPase Enzyme in the Gastric Parietal Cells, preventing the Final Step in Gastric Acid Production (The Secretion of H+)
What is the last option as treatment of Gastro-Oesophageal Reflux Disease (GORD)?
Anti-Reflux Surgery
What is the Anti-Reflux surgery available?
Fundoplication
What is a Fundoplication?
The Surgical Fully (or Partially) wrapping of the Fundus of the Stomach around the Lower Oesophageal Sphincter
