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Gasto/Hep > 2)Common GI/Liver Conditions > Flashcards

2)Common GI/Liver Conditions Flashcards

1
Q

Pathophysiology of GORD?

A

LOS dysfunction leads to reflux of gastric contents -> Oesophagitis

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2
Q

Risk Factors for GORD?

A
  • Hiatus Hernia
  • Smoking
  • Drinking
  • Obesity
  • Pregnancy
  • Drugs (antiCh, Nitrates, CCB,TCAs)
  • Iatrogenic (Hellers myotomy)
  • LOS hypotension
  • loss of peristaltic fx
  • Gastric acide hypersectretion
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3
Q

Symptoms of GORD?

A

Oesophageal

  • Heartburn related to meals, worse lying down/stooping. relieved by antacids
  • Belching
  • Odonophagia
  • Incr salivation

Extra-oesophageal

  • Nocturnal Asthma
  • Laryngitis
  • Chronic cough
  • IDA?
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4
Q

Complications of GORD?

A
  • Oesophagitis: heartburn
  • Ulceration: rarely → haematemesis, melaena, ↓Fe
  • Benign stricture: dysphagia
  • Barrett’s oesophagus
    • Intestinal metaplasia of squamous epithelium
    • Metaplasia → dysplasia → adenocarcinoma
  • Oesophageal adenocarcinoma
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5
Q

DD for GORD?

A
  • Oesophagitis
    • Infection: CMV, candida
    • IBD
    • Caustic substances / burns
  • PUD
  • Oesophageal Ca
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6
Q

Ix for GORD?

A 
Isolated symptoms dont need investigating. 
CXR may show hiatus hernia
OGD IF:
->55
-Symptoms >4wks
-Dysphagia
-Persistent symptoms despite Rx
-Wt. loss
-OGD allows grading by Los Angeles
Classification
Ba swallow: hiatus hernia, dysmotility
-24h pH testing ± manometry
-pH <4 for >4hrs
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7
Q

Treatment for GORD?

A

Conservative

  • Lose wt.
  • Raise head of bed
  • Small regular meals ≥ 3h before bed
  • stop smoking and ↓ EtOH
  • Avoid hot drinks and spicy food
  • Stop drugs: NSAIDs, steroids, CCBs, nitrates

Medical

  • OTC antacids: Gaviscon, Mg trisilicate
  • 1: Full-dose PPI for 1-2mo
  • Lansoprazole 30mg OD
  • 2: No response → double dose PPI BD
  • 3: No response: add an H2RA
  • Ranitidine 300mg nocte
  • Control: low-dose acid suppression PRN
Surgical
Nissen Fundoplication
-Indications: all 3 of:
-severe symptoms
-Refractory to medical therapy
-Confirmed reflux (pH monitoring)
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8
Q

Complications of Nissen Fundoplication?

A
  • Gas-bloat syn.: inability to belch / vomit

- Dysphagia if wrap too tight

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9
Q

How is peptic ulcer disease classified?

A

Acute v Chronic

Acute: Usually due to drugs (NSAIDS/Steroids) or ‘Stress’
Chronic: Drugs, H.Pylori, Zollinger-Ellison

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10
Q

Pathology of Duodenal Ulcers?

A
  • 4x more common than gastric ulcers
  • M>F
  • First part of duodenum
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11
Q

Risk factors for duodenal ulcers?

A

H. pylori (90%)

  • Drugs: NSAIDs, steroids
  • Smoking
  • EtOH
  • ↑ gastric emptying
  • Blood group O
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12
Q

Presentation of duodenal ulcers?

A

Epigastric pain:

  • Before meals and at night
  • Relieved by eating or milk
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13
Q

Pathology of Gastric Ulcers?

A
  • Lesser curve of gastric antrum

- Beware ulcers elsewhere as often malignant

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14
Q

Presentation of Gastric ulcers?

A

Epigastric pain
-Worse on eating
-Relieved by antacids
May be weight loss

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15
Q

Complications of PUD?

A 
Haemorrhage
-Haematemeis or melaena
-Fe deficiency anaemia
Perforation
-Peritonitis
Gastric Outflow Obstruction
-Vomiting, colic, distension
Malignancy
- ↑ risk c¯ H. pylor
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16
Q

Investigations in PUD?

A

Bloods: FBC, urea (↑ in haemorrhage)

  • C13 breath test
  • OGD (stop PPIs >2wks before)
  • CLO / urease test for H. pylori
  • Always take biopsies of ulcers to check for Ca
  • Gastrin levels if Zollinger-Ellison suspected
17
Q

What are non-surgical management options for PUD?

A

Conservative

  • Lose wt.
  • Stop smoking and ↓ EtOH
  • Avoid hot drinks and spicy food
  • Stop drugs: NSAIDs, steroids
  • OTC antacids

Medical

  • OTC antacids: Gaviscon, Mg trisilicate
  • H. pylori eradication: PAC500 or PMC250
  • Full-dose acid suppression for 1-2mo
  • PPIs: lansoprazole 30mg OD
  • H2RAs: ranitidine 300mg nocte
  • Low-dose acid suppression PRN
18
Q

What are the surgical options for PUD?

A 
Vagotomy (truncal or selective)
Antrectomy +/- vagotomy
Subtotal gastrctomy (for zollinger ellison)
19
Q

What are the physical complications of PUD surgery?

A

Stump leakage

  • Abdominal fullness
  • Reflux or bilious vomiting (improves c¯ time)
  • Stricture
20
Q

What are the metabolic complications of PUD surgery?

A

Dumping syndrome

  • Abdo distension, flushing, n/v
  • Early: osmotic hypovolaemia
  • Late: reactive hypoglycaemia

Blind loop syndrome → malabsorption, diarrhoea

  • Overgrowth of bacteria in duodenal stump
  • Anaemia: Fe + B12
  • Osteoporosis

-Wt. loss: malabsorption of ↓ calories intake

21
Q

What is dyspepsia?

A

Non specific group of symptoms:

  • Epigastric pain
  • Bloating
  • Heartburn
22
Q

What are alarm symptoms in dyspepsia?

A 
Anaemia
Loss of wt.
Anorexia
Recent onset progressive symptoms
Melaena or haematemesis
Swallowing difficulty
23
Q

What are the causes of dyspepsia?

A
  • Inflammation: GORD, gastritis, PUD
  • Ca: oesophageal, gastric
  • Functional: non-ulcer dyspepsia
24
Q

What is the management of new onset dyspepsia?

A 
OGD if >55 or ALARMS
 Try conservative measures for 4 wks
 Stop drugs: NSAIDs, CCBs (relax LOS)
 Lose wt., stop smoking, ↓ EtOH
 Avoid hot drinks and spicy food
 OTC
 Antacids: magnesium trisilicate
 Alginates: gaviscon advance
 Test for H. pylori if no improvement: breath or serology
 +ve → eradication therapy
 Consider OGD if no improvement
 -ve → PPI trial for 4wks
 Consider OGD if no improvement
 PPIs can be used intermittently to control
symptoms.
25
Q

Management of proven GORD?

A

Full dose PPI for 1-2mo

Then, low-dose PPI PRN

26
Q

Management of proven PUD?

A

Full dose PPI for 1-2mo
H. pylori eradication if positive
Endoscopy to check for resolution if GU
Then, low-dose PPI PRN

27
Q

What is H Pylori eradication therapy?

A 
7 day course
NB PPIs and cimetidine → false –ve C13 breath tests
and antigen tests t/f stop >2wks before. 
PAC 500
 PPI: lansoprazole 30mg BD
 Amoxicillin 1g BD
 Clarithromycin 500mg BD
PMC 250
 PPI: lansoprazole 30mg BD
 Metronidazole 400mg BD
 Clarithromycin 250mg BD
28
Q

What is the failure rate of eradication therapy?

A

95% success rate, failure mainly due to poor compliance. Can add bismuth (make stool black)

29
Q

What is barretts and how is it graded?

A

Distal oesophageal epithelium undergoes metaplasia from squamous to columnar.

  • Gastric metaplasia is low risk
  • Intestinal metaplasia is 2 yrly surveillance
  • Low grade dysplasia= 90% chance of Ca at 6yr
  • High Grade dysplasia+ half will already have adenocarcinoma
30
Q

What is the classification system in GORD?

A 
LA classification
1- mucosal break <5mm
2- mucosal break >5 mm
3- large mucosal break but <75% of circumference
4- mucosal break > 75% of circumference
31
Q

What are the two types of hiatus hernia? which gives yu reflux?

A

Sliding and rolling
Sliding gives you reflux as sphincter is in chest and becomes less competent
Rolling rarely gives reflux as sphincter is in abdomen, needs repair though as more likely to strangulate= bad

Gasto/Hep (5 decks)

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