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Tim CP3 @ UoN - Medicine & Surgery > 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

Herniae allowing part of the stomach into the thoracic cavity

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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

Gastro-oesophageal junction slides through hiatus to lie above diaphragm

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7
Q

Describe the anatomical change in a para-oesophageal hiatus herniae

A

Fundus rolls up through herniae alongside oesophagus but sphincter remains competent below diaphragm

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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 
Raised IAP
Large meals/late at night
Smoking
High caffeine intake
High fatty food intake
Drugs (anticholinergic, nitrates, tricyclics, CCBs)
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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 
Dyspepsia
Regurgitation of food/acid
Waterbrash
Odynophagia
Atypical chest pain
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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
Relieve by antacids

17
Q

What is waterbrash?

A

Sudden filling of mouth w/ dilute saliva

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

Clinically (generally)

20
Q

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

A

ALARMS 55

  • anaemia (Fe deficient)
  • loss of wt
  • anorexia
  • recent onset
  • melaena/haematemesis
  • swallowing difficulties
  • > 55yrs
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 
Wt loss
Smoking cessation
Eat small/regular meals >3h before bed
Avoid hot drinks/alcohol
Raised head of bed at night
Avoid exacerbating drugs/mucosa damaging drugs (NSAIDs, K salts)
24
Q

What medical options are used to manage GORD?

A

Antacids +/- alginates
H2RAs/PPIs
Prokinetic drugs (metoclopramide/domperidone)
Antibiotics

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)

28
Q

When should H. pylori ‘test & treat’ be offered?

A

If sx return after 2wks of PPI treatment

29
Q

What is the main side effect of prokinetic drugs?

A

ESPEs in pts w/ Parkinson’s

30
Q

What are the long term complications of GORD?

A

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

31
Q

How common is Barratt’s Oesophagus?

A

2% of adults in UK

32
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

33
Q

How does Barratt’s Oesophagus present?

A

Asymptomatic

Pt will have sx of GORD

34
Q

How is Barratt’s Oesophagus confirmed?

A

Upper GI endoscopy & biopsy

35
Q

What are the potential complications of Barratt’s Oesophagus?

A

Dysplasia/malignant change

-adenocarcinoma of lower 1/3 of oesophagus

36
Q

What are the management options for Barratt’s Oesophagus?

A

Regular endoscopic surveillance w/ biopsies

Dysplasia/carcinoma in situ treated w/ endoscopic resection

37
Q

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

A

0.5%/pt/yr

Tim CP3 @ UoN - Medicine & Surgery (136 decks)

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