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Gastro > Gastro-Oesophageal Reflux Disease > Flashcards

Gastro-Oesophageal Reflux Disease Flashcards

1
Q

What is the oesophageal hiatus?

A

Oval apeture in right crus of diaphragm at T10

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2
Q

What structures pass through the oesophageal hiatus?

A

Oesophagus
Vagal nerve trunks
Oesophageal branches of L. gastric vessels/lymphatics

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3
Q

What is a hiatus herniae?

A

Protrusion of the stomach through oesophageal opening of the diaphragm

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4
Q

How do hiatus herniae typically present?

A

Asymptomatic

Occasionally reflux causing pain

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5
Q

What are the two anatomical types of hiatus herniae?

A

Sliding hiatus herniae

Para-oesophageal herniae (rolling)

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6
Q

Describe the anatomical change in a sliding hiatus herniae

A

Entire stomach slides up through opening next to oesophagus

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7
Q

Describe the anatomical change in a para-oesophageal hiatus herniae

A

Outpouching of the stomach rolls up

High risk of strangulation

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8
Q

What are the anatomical risk factors for gastro-oesophageal disease?

A

Hiatus hernia

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9
Q

What are the physiological risk factors for gastro-oesophageal disease?

A 
Obesity
High fatty food intake
Pregnancy
Alcohol and caffeine intake
Smoking
Connective tissue disorders e.g. scleroderma
Delayed gastric emptying (diabetes)
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10
Q

How do sliding hiatus herniae present?

A

30% of adults >50
Typically insignificant
Sx may occur due to associated reflux

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11
Q

How do para-oesophageal herniae present?

A

Severe pain

Gastric volvulus/strangulus (requires surgical intervention)

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12
Q

What is Dyspepsia?

A

Chronic upper abdominal pain/discomfort

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13
Q

What are the subtypes of dyspepsia?

A

Reflux (heartburn/regurgitation eg. GORD)
Ulcer (epigastric pain)
Dysmotility (bloating/nausea)

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14
Q

When do sx of GORD occur?

A

When there is prolonged contact of gastric contents w/ oesophageal mucosa –> oesophagitis

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15
Q

What are the common features of GORD?

A

Heartburn
-epigastric or retrosternal pain

Acid regurgitation
Nocturnal cough
Hoarse voice
Bloating

Odynophagia
Waterbrash

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16
Q

What are the features of the dyspepsia present in GORD?

A

Worse on bending/lying down
Hot liquids/alcohol make it worse
Relieve by antacids

17
Q

What is waterbrash?

A

Filling of mouth with excessive saliva and acid

18
Q

What are the features of the atypical chest pain present in GORD?

A

Nocturnal cough/wheeze

Due to distal oesophageal muscle spasm

19
Q

How is GORD diagnosed?

A

Normally a clinical diagnosis

Unless ALARM 55 sx or symptoms of bleeding

20
Q

What are the red flag sx indicating a need for endoscopy?

A

ALARMS 55

  • anaemia (Fe deficient)
  • loss of wt
  • anorexia
  • not responding to treatment
  • N&V
    • melaena/haematemesis
    • dysphagia
    • > 55yrs
  • high platelets
21
Q

What is the empirical treatment of GORD?

A

PPI

-unless ALARMS 55 sx

22
Q

What further investigations may be appropriate in GORD?

A 
Barium swallow (?hiatus herniae)
24hr luminal pH monitoring/manometry
23
Q

What lifestyle measures are used to manage GORD?

A 
Weight loss
Stop smoking
Decrease alcohol and caffeine
Smaller meals
Eat at least 2 hours before bed
Stay upright after meals

Gaviscon and rennies prn

24
Q

What medical options are used to manage GORD?

A

Antacids +/- alginates
PPIs
H2 receptor antagonists

25
Q

What are the common types of antacids/alginates?

A

Magnesium Hydroxide
Aluminium Hydroxide
Gaviscon

26
Q

What are the side effects of antacids?

A

Aluminium salts - constipation

Magnesium salts - diarrhoea

27
Q

What is the main side effect of PPIs?

A

Achlorrhydia
-increased risk of food poisoning (campylobacter)

Hyponatramia
Hypomagnesia
Increased risk of c diff
Osteoporosis

28
Q

What are the long term complications of GORD?

A

Oesophagitis/ulcers
Benign strictures
Barrett’s oesophagus/oesophageal adenocarcinoma

29
Q

How common is Barratt’s Oesophagus?

A

2% of adults in UK

30
Q

What is the underlying pathophysiology of Barratt’s Oesophagus?

A

In pts w/ long standing reflux normal stratified squamous epithelium undergoes metaplasia to glandular columnar epithelium

31
Q

How does Barratt’s Oesophagus present?

A

Asymptomatic

Pt with history of GORD may have improvement of symptoms

32
Q

How is Barratt’s Oesophagus confirmed?

A

Upper GI endoscopy & biopsy

33
Q

What are the potential complications of Barratt’s Oesophagus?

A

Dysplasia/malignant change

-adenocarcinoma of lower 1/3 of oesophagus

34
Q

What are the management options for Barratt’s Oesophagus?

A

Regular endoscopic surveillance w/ biopsies

Dysplasia/carcinoma in situ treated w/ endoscopic ablation

35
Q

What is the risk of malignant change in Barratt’s Oesophagus?

A

0.5%/pt/yr

Gastro (8 decks)

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