Gastro - Gastro-oesophageal Reflux Disease Flashcards
GERD definition?
Disease where acid from stomach flows through the lower esophageal sphincter into the esophagus causing irritation to the lining of the esophagus.
Acid can reach as far as the back of the throat
GERD specifically is reflux episodes more than 2x week
What is the difference between the esophagus and the stomach that makes it susceptible to the stomach acid?
The stomach has a columnar epithelial lining which protects the stomach from the acid, however the esophagus has squamous epithelial lining making it more sensitive to the acid
Stomach produces mucus to help stop the acid affect the lining
Causes of GERD?
Greasy or spicy food
Coffee or tea
Alcohol
NSAIDs
Stress
Obesity
Smoking
Hiatus Hernia
Sx of GERD
Dyspepsia (indigestion) is a term used to cover the symptoms of GERD
Sx include:
Heartburn
Acid regurgitation
Retrosternal or epigastric pain
Bloating
Nocturnal cough (laying flat at night induces cough)
Hoarse voice
Red flags of GERD Sx:
Dysphagia
age over 55
Weight loss
Upper abdo pain
Reflux
Treatment resistant dyspepsia
Nausea vomiting
Upper abdo mass on palpation
Low hemoglobin (anemia)
Raised platelet count (thrombocytosis)
Pt can be given a 2 week wait referral (urgent) or routine referral for direct access endoscopy? What warrants urgent and what are you looking for?
Dysphagia at any age warrants a referral but over 55 would be urgent vs routine
upper abdo mass
Feeling of food getting stuck in throat (globus sensation)
doing this to clear out cancer especially esophageal cancer
Dx of GERD:
Biopsy: if sx > 4weeks, persistent vomiting, GI bleed, anemia, weight loss
Barium swallow for hiatus hernia
Endoscopy
DDx of GERD:
Endoscopy (OGD) can help rule out other causes of sx such as:
Gastritis
Peptic ulcer
Upper GI bleed
Oesophageal varices
Barrett’s esophagus
Esophageal stricture
Malignancy of esophagus or stomach
Tx of GERD?
Lifestyle changes: weight loss, stop smoking, reduce alcohol, eat smaller healthier meals, avoid eating 3 hrs before bed.
(short term) Antacids: Gaviscon, Pepto-Bismol
PPI: omeprazole, lansoprazole
Histamine H2- receptor antagonists: famotidine, cimetidine (reduce stomach acid)
Surgery: laparoscopic fundoplication
wraps fundus around L-esophageal sphincter.
Complications of this is dysphagia, gas bloat syndrome and diarrhoea.
What are antacids? Examples? Side effects?
Meds that neutralise stomach acid to relieve indigestion.
Gaviscon, Pepto-Bismol they often contain aluminium or magnesium salts.
Gaviscon contains aluminium hydroxide and magnesium trisilicate.
Aluminium can cause constipation while magnesium can cause diarrhoea
Hiatal Hernia Def?
Herniation of stomach up through the diaphragm.
What does the normal diaphragmatic opening look like, how does this typically prevent acid reflux?
The diaphragm opening should be at the level of the lower esophageal sphincter and fixed in place.
The opening is narrow which helps stop stomach contents from refluxing
Types of Hital hernia
Type 1: sliding - stomach slides up through diaphragm with gastro-esophageal junction passing into thorax.
Type 2: rolling – fundus of stomach folds around and enters diaphragm opening.
Type 3: combo of 1 and 2
Type 4: Large opening with additional abdominal organs entering the thorax (bowel, pancreas, omentum)
Dx of hiatus hernia?
Can’t always be seen as they are intermittent. Can be Dx using:
Xray
CT
Endoscopy
Barium swallow
Pathophysiology of H. Pylori infection?
Forces its way into gastric mucosa using flagella and creates gaps in the mucosa exposing underlying epithelial cells to damage from stomach acid.
H. pylori produces ammonium hydroxide which neutralises the acid surrounding the bacteria. Can also produce toxins which combined with the ammonia cause gastric mucosal damage.
