gastro oesophageal reflux disease * Flashcards
what is the montreal definition of GERD
it is a chronic disease
more than two heartburn episode in a week and other symptoms and complication
developed from the reflux of stomach contents such as acid , pepsin and bile
it interferes with the PATIENTS LIFESTYLE
what are the oesophageal syndromes of gastroesophageal reflux ? and symptoms
SYNDROMES reflux esophagitis oesophageal strictures barretts esophagus oesophageal adenocarcinoma
Symptoms
regurgitation
chest pain - angina pain worst after meal and lying down
dysphagia - ‘red flag’’ symptom, potentially caused by a tumor
upper gastrointestinal bleeding - red flag
what are the extraesophageal syndrome of GERD?
syndrome reflex cough syndrome = , hoarseness, sore throat reflux pharyngitis reflux laryngitis syndrome reflux dental erosion reflux asthma syndrome
symptom
epigastric pain
reflux esophagitis in GERD is classified according to what system ?
LA (loa angeles ) ENDOSCOPIC classification system for assessment of reflux esophagitis
what are the LA endoscopic classification o reflux esophagitis ?
grade a - where there is mucosal erosion however it not more than 5mm in width and it is not between the superior margins of oesophageal mucosal folds
grade b - more than 5 mm long and does not extend between the superior margins of the mucosal folds
grade c- where it extends between the superior margin of two or more mucosal folds however effects less than 75 recent of the oesophageal circumference o
grade d - involves atleast 75 percent or more of the oesophageal circumference
what is NERD?
non erosive reflux disease
there are reflux symptoms which do not involve the abrasions of the mucosal surface of the oesophagus in endoscopy
what are the DD of GERD ?
oesophageal infections
and eosinophilic esophagitis
functional dyspepsia
irritable bowel syndrome
what stimulates the acid production in the stomach ?
PGE2 and its agonist
gastrin
acetylcholine
histamine 2
all of this activates protein kinases to active the proton pumps in the stomach
where is the chief cells located and what are their function in the stomach ?
deep in stomach lining
pepsinogen
where is the g cells located and what ia their function in the stomach ?
antrum
gastrin
where are the parietal cells located and what are their function?
fundus and cardia
produce acid and INTRINSIC FACTOR
which parasympathetic nerve stimulates acid secretion (from the partial cells) and stomach peristalsis ?
vagus nerve - ACH
what are the treatment options for GERD?
proton pump inhibitors - PRIMARY histamine 2 receptor antagonist anticholinergic drugs prostaglandin inhibitors antacids pro kinetic - promote gastric emptying
frequent and light meals avoid
lying down within 3 h after eating
weight loss
avoid meals before sleep
elevate head for bed
what are some PPI ‘s?
omeprazole
esomeprazole
lansoprazole
usually given before meals
when are injectable PPI’s given ?
in bleeding ulcer and patients in ICU
which PPI is prevered to be given IV ?
omeprazole in 80mg bolus
what are the antacids?
Aluminum hydroxide gel - alternagel
calcium carbonate
milk of magnesia - magnesia hydroxide
what causes GERD?
hiatal hernia
chronic coughing
obesity
delayed gastric emptying,
antroduodenal motility disorders
pyloric incompetence
incompetence of the lower esophageal sphincter (LES) - due to alcohol and TCA (trycyclic antidepressants) , surgeries
and scleroderma
impaired oesophageal mucosa
what is the indication for surgical therapy with GERD?
Patients with continuous ,
per- sistent troublesome symptoms,
progression of disease DESPITE adequate PPI therapy
best available surgical techniques to treat severe GERD?
Nissen Laparoscopic partial and total fundoplications - the gastric fundus is wrapped around the esophagus
first line for type 2 hiatal hernia
the intra-abdominal - below diaphragm segment of the esophagus is how long ?
2–3 cm long, depending on the body’s lengt
patient with long-standing GERD and persistent or recurrent esophagitis, the esophagus can be?
shortened
when the oesophagus is shortened for normal surgical procedure what should be done ?
Collis gastroplasty -A Collis gastroplasty is a surgical procedure performed when the surgeon desires to create a Nissen fundoplication, but the portion of esophagus inferior to the diaphragm is too shor
what is barett esophagus ?
he presence of columnar mucosa and intestinal metaplasia mostly in the distal esophagus
what needs to be present for barett esophagus to be diagnosed ?
goblet cells -intestinal metaplasia is the only type of esophageal columnar epithelium clearly predisposed to malignancy
therapy for BE
Barrett’s esophagus the past two endoscopy and biopsy examinations have confirmed the absence of dysplasia, then the patient should not have another endoscopy within three years
PPI
Antireflux surgery/ nissen fundoplication
what can aggravate GERD
caffeine
fatty and spicy food
pregnancy
diagnostic tests for GERD
barium swallow - dysphagia - show stricture , mass , hiatal hernia
endoscopy - red flag
fail medication
long term treatment
24hr ph monitoring
