Gastro - GORD Flashcards
What are the oesophagus and stomach lined with?
Oesophagus
Squamous epithelial
Stomach
Columnar epithelial
What can cause GORD?
Hiatus hernia
Greasy and spicy foods
Alcohol
NSAIDs
Coffee and tea
Stress
Smoking
Obesity
What term is used to describe indigestion?
Dyspepsia
What are the symptoms of GORD?
Heartburn
Acid regurgitation
Retrosternal or epigastric pain
Bloating
Nocturnal cough
Hoarse voice
Halitosis
What are the red flag features of GORD?
Dysphagia
Over 55
Weight loss
Upper abdominal pain
Reflux
Treatment-resistant dyspepsia
Nausea and vomiting
Upper abdominal mass
Low Hb
Raised platelet count
What do the red flag features of GORD suggest?
Suspected cancer
Two week wait referral
What is an OGD?
Oesophago-gastro-duodenoscopy
Camera inserted through mouth down to duodenum
What is an OGD used for?
Assess for :
- Gastritis
- Peptic ulcers
- Upper GI bleeding
- Oesophageal varices
- Barrett’s oesophagus
- Oesophageal stricture
- Malignancy of the oesophagus
If patients have evidence of upper GI bleeding what should be done?
Admission
Urgent endoscopy
Melaena
Coffee ground vomiting
What are the 4 types of hiatus hernia?
Type 1
Sliding
Type 2
Rolling
Type 3
Sliding and rolling
Type 4
Large opening with additional abdominal organs entering thorax
What may hiatus hernia be seen on?
CXR
CT scan
Endoscopy
Barium swallow test
What is the management of GORD?
Lifestyle changes
Medication review
Antacids
PPIs
Histamine H2-receptor antagonists
Surgery
What lifestyle changes are indicated in GORD?
Reduce tea, coffee and alcohol
Weight loss
Avoid smoking
Smaller, lighter meals
Avoid heavy meals before bedtime
Stay upright
What surgery is done for GORD?
Laparoscopic reverse fundoplication
What type of bacteria is Helicobacter pylori?
Gram-negative aerobic bacteria
What does Helicobacter pylori do in the stomach?
Damages epithelial lining resulting in gastritis, ulcers and increased risk of stomach cancer
Avoids acidic environment by forcing its way into the gastric mucosa using flagella to propel itself
Creates a gap in the mucosa exposing the epithelial cells to damage from stomach acid
What does Helicobacter pylori produce?
Ammonium hydroxide, neutralising stomach acid
Toxins
Both damage gastric mucosa
What investigations are done for Helicobacter pylori?
Stool antigen test
Urease breath test
Pylori antibody test
Rapid urease test
What does a rapid urease test involve?
Taking a biopsy of stomach mucosa
Added to liquid medium containing urea
Pylori produce urease enzymes converting urea to ammonia
Ammonia makes the solution more alkaline
pH indicator used to indicate change if Pylori are there
How is Helicobacter pylori treated?
Triple therapy with a PPI
Omeprazole
Amoxicillin
Clarithromycin
For 7 days
What is Barrett’s oesophagus?
Premalignant condition
Metaplasia of the lower oesophageal epithelium
Changes from squamous to columnar epithelium
Patients may notice improved reflux symptoms after they develop Barrett’s oesophagus
What is Barrett’s oesophagus a risk factor for?
Developing oesophageal adenocarcinoma
Can be stepwise progression from no dysplasia to low-grade, high-grade and adenocarcinoma
What is treatment of Barrett’s oesophagus with?
Endoscopic monitoring (for progression to adenocarcinoma)
PPIs
Endoscopic ablation
What is endoscopic ablation used for?
Destroy abnormal columnar epithelial cells, then replaced with normal squamous epithelial cells
Reduces cancer risk
What is Zollinger-Ellison syndrome?
Rare condition where duodenal or pancreatic tumour secretes excessive gastrin
Gastrin stimulates acid secretion
Excess production of stomach acid causing severe dyspepsia, diarrhoea and peptic ulcers
What are gastrinomas associated with?
MEN-1
Autosomal dominant condition
Parathyroids
Pituitary
