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Gastroenterology > Gastro-oesophageal Conditions > Flashcards

Gastro-oesophageal Conditions Flashcards

1
Q

Risk factors for GORD

A

Obesity, alcohol, smoking, specific foods such as coffee, citrus, spicy foods

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2
Q

Management of GORD

A

Lifestyle changes, PPI therapy, antacids, anti-reflux surgery

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3
Q

Complications of GORD

A

Ulcers, Barrett’s oesophagus, strictures, adenocarcinoma

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4
Q

Drug management of GORD

A

Antacids, gel formers, PPIs, H2 inhibitors

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5
Q

How long are PPIs given for in GORD

A

2-4 months

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6
Q

Diagnosis of GORD

A

Clinical based on symptoms that there is a defective lower oesophageal sphincter

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7
Q

Typical symptoms of GORD

A

Dyspepsia, acid regurgitation

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8
Q

Atypical symptoms of GORD

A

Epigastric/chest pain, nausea, bloating, belching, laryngitis, tooth decay

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9
Q

Warning signs of GORD

A

Weight loss, anaemia, dysphagia, haematemesis, melaena and persistent vomiting

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10
Q

Investigations into GORD

A

Trial of standard PPI, OGD if there are alarm features or atypical, or if relapsing

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11
Q

Type types of peptic ulcers

A

Duodenal and gastric

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12
Q

Presence of duodenal to gastric ulcers

A

4x more duodenal (4:1)

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13
Q

Risk factors and causes of peptic ulcers

A

H.pylori (90%), NSAIDs, SSRIs, smoking, stress, type O blood, Zolliger-Ellison Syndrome, improper/irregular meals

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14
Q

Symptoms of duodenal ulcer

A

Weight gain, dyspepsia, upper GI pain, nausea and bloating

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15
Q

What makes a duodenal ulcer symptoms improve

A

pain relieved by eating, and foods such as milk, and also rest and antacids.

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16
Q

Symptoms of gastric ulcer

A

Upper GI pain, heartburn, appetitie loss, weight loss, anaemia, dyspepsia, nausea, belching

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17
Q

The aims and goals of therapy for ulcers

A

Relieve symptoms, repair damage and eradicate bacteria

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18
Q

How are symptoms relieved in peptic ulcers

A

Antacids, prostaglandins and gel formers

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19
Q

How is damage repaired in peptic ulcers

A

PPIs and H2 antagonists

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20
Q

Treatment if patients with ulcers are H.pylori negative

A

4-8 weeks of full dose PPI treatment and lifestyle advice. Can give H2 antagonists

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21
Q

Lifestyle advice for peptic ulcers

A

Stop smoking and drinking alcohol, avoid acidic foods, coffee, fatty and spicy foods, weight loss, avoid NSAIDs, steroids, bisphosphonates and SSRIs

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22
Q

Follow up of patients with peptic ulcers

A

Repeat endoscopy 6-8 weeks after to ensure healing

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23
Q

Treatment if patients are H.pylori positive

A

‘Triple therapy’. PPI, H2 antagonist, OTC antacids

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24
Q

Eg of antacids and their use

A

Al hydroxide, Mg trisillicate, Ca and Na bicarbonates. Symptomatic relief

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25
Q

Side effects of antacids

A

Al can cause constipation, Mg can cause diarrhoea, risks of malabsorption with other drugs and hypercalcaemia over long time

26
Q

Eg of prostaglandin analogues and use

A

Misprostol, PGE2, protects mucosa - not used in pregnancy

27
Q

Eg of gel formers and use

A

Sucralfate, alginate. Forms gel at low pH to protect mucosa

28
Q

Eg of PPIs

A

Omeprazole, lansoprazole

29
Q

Role of PPIs and H2 antagonists

A

Inhibit stomach acid secretion

30
Q

What is cautioned in use of PPI

A

Warfarin interaction, liver disease, can mask gastric cancer

31
Q

Eg of H2 antagonist

A

Cimetidine, Ranitidine

32
Q

Side effects and cautions of H2 antagonists

A

Used in caution with those who have renal failure and can mask gastric cancer. Cimetidine inhibits P450 enzyme

33
Q

What is H.pylori

A

Gram negative bacteria which buries itself into gastric epithelium, releases urease which neuralises pH of stomach and damages epithelium

34
Q

What does H.pylori cause

A

Approximately 90% of duodenal ulcers

35
Q

Diagnosis of H.pylori

A

Endoscopy using rapid urease test on gastric biopsy

36
Q

Triple therapy to eradiate H.pylori

A

Treatment using amoxicillin, clarithromycin, and PPI twice a day for 7 days

37
Q

What happens after the first course of treatment for H.pylori

A

After 4-8 week retest for H.pylori, if present second course of triple therapy with metronidazole instead of amoxicillin

38
Q

Bacteria causes of gastroenteritis

A

Staph aureus
Bacillus cereus
Clostridium perfingens
E.coli
Campylobacter
Salmonella
Shigella

39
Q

Viral causes of gastroenteritis

A

Rotavirus (infantile) norovirus (most common), adenovirus

40
Q

Parasitic causes of gastroenteritis

A

Cryptosporidium, entamoebahistolytica, giardia intestinalis

41
Q

Management of gastroenteritis

A

Conservatively with fluid replacement, or oral hydration sachets

42
Q

What are the indications to give antibiotics

A

If patient is systemically unwell, immunosurpressed or elderly

43
Q

Antibiotic treatments for salmonella and shigella causes of gastroenteritis

A

Ciprofloxacin

44
Q

Antibiotic treatments for campylobacter causes of gastroenteritis

A

Macrolide (erythromycin)

45
Q

Antibiotic treatments for cholera causing gastroenteritis

A

tetracycline

46
Q

Features of norovirus

A

Abrupt onset, short lived. GI symptoms 24-48 hours after contact

47
Q

What is the cause of Barretts oesophagus

A

Long standing GORD where chronic acid exposure leads to change in the distal oesophagus to metastatic columnar

48
Q

Low grade dysplasia treatment in BO

A

High dose PPI, endoscopies every 6 months

49
Q

High grade dysplasia treatment in BO

A

Endoscopic resection of areas - radiofrequency ablation, photodynamic ablation or laser. If they are fit enough then oesophagectomy.

50
Q

Complications of Barretts oesophagus

A

Progression to adenocarcinoma

51
Q

What is achalasia

A

Failure of lower oesophageal sphincter to relax - unknown cause

52
Q

Presentation of achalasia

A

Gradual onset dysphagia, regurgitation, aspiration, chest pain/heart burn, mild weight loss

53
Q

Endoscope view of achalasia

A

Dilated oesophagus, residual material

54
Q

Oesophageal manometry achalasia

A

High pressure and incomplete lower oesophageal sphincter relax

55
Q

What does a barium swallow show of achalasia

A

Birds beak appearance in advanced disease

56
Q

Management of achalasia

A

Botulinum toxin injections, calcium channel blockers/nitrates trialled, or surgical Heller’s myotomy

57
Q

Causes of variceal bleedings

A

Most commonly portal hypertension secondary to cirrhosis

58
Q

Management of variceal bleeding

A

Blood transfusion, vit K, FEP and platelet transfusion, Terlipressin (vasopressin analogue - vasoconstriction), broad spec antibiotics

59
Q

Endoscopic management

A

Variceal band ligation

60
Q

Signs of variceal bleeding

A

Dark stools in blood, haematemesis

Gastroenterology (19 decks)

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