Gastro-oesophageal reflux disease and dysmobility of oesophagus Flashcards

1
Q

what type of medication is used for reflux?

A

proton pump inhibitor (PPI)

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2
Q

what does reflux quality of life compare to?

A

acute coronary syndrome

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3
Q

what is GORD?

A

gastro-oesophageal-reflux disease

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4
Q

what does GORD cause?

A

incompetent lower oesophageal sphincter
poor oesophageal clearance
Barrier function/visceral sensitivity

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5
Q

what are the symptoms of GORD?

A
heart burn/acid reflux
waterbrash
dysphagia
odynophagia
weight loss
chest pain
hoarseness
coughing
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6
Q

how is GORD investigated?

A

endoscopy
Ba swallow
oesophageal manometry and pH studies
nuclear studies

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7
Q

what symptoms of reflux would cause alarm?

A
dysphagia
weight loss
anaemia
vomiting
F/H UGI cancer
Barrets oesophagus
pernicious anaemia
PUD surgery >20 years
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8
Q

what can be done for oesophageal carcinoma?

A

radiotherapy
surgery
palliation

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9
Q

what is the prognosis of oesophageal adenocarcinoma?

A

perioperative = 5-10% mortality
5 year survival = 5-10%
subclinical = 80-90%

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10
Q

what is the trend in oesophageal adenocarcinoma incidence?

A

increasing

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11
Q

what is the trend in squamous cell carcinoma incidence?

A

decreasing

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12
Q

what is the pathogenesis of adenocarcinoma?

A

normal > oesophagitis (reversible) > barrets (irreversible) > adenocarcinoma (too late)

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13
Q

how is GORD managed?

A

symptom relief
heal oesophagitis
Prevent complications

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14
Q

what lifestyle modifications can improve GORD?

A

stop smoking
loose weight
prop up bed head
avoid provoking factors

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15
Q

what do antacids do?

A

symptomatic relief for majority of reflux patients

no healing/preventative effects

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16
Q

what is cimetidine?

A

H2 antagonist

rapid symptom relief

17
Q

what is ranitidine?

A

H2 antagonist
reduces stomach acid
tolerance after 4 weeks

18
Q

what is omeprazole?

A

proton pump inhibitor

effective symptom relief and healing of oesophagitis

19
Q

what is nissen fundoplication?

A

surgery which controls symptoms and heals oesophagitis in young patients and severe/unresponsive disease

20
Q

how common is barrets oesophagus?

A

10% of GORD patients

21
Q

what is Barrets oesophagus?

A

irreversible intestinal metaplasia

22
Q

barrets oesophagus increases risk of adenocarcinoma, true or false?

A

true

23
Q

how is dysplasia managed?

A
frequent surveillance
optimise PPI dose
endoscopic mucosal resection (EMR)
radiofrequency ablation (HALO)
Argon
24
Q

what 2 types of hiatus hernia exist?

A

sliding hiatus hernia = hernia from stomach up into oesophagus
Paraoesophageal hiatus hernia = hernia from stomach pushes up beside oesophagus

25
Q

what is gastroparesis?

A

delayed gastric emptying

no physical obstruction

26
Q

what are the symptoms of gastroparesis?

A
feeling of fullness
nausea
vomiting
weight loss
upper abdominal pain
27
Q

what can cause gastroparesis?

A
idiopathic
diabetes mellitus
cannabis
medication opiates, anticholinergics)
systemic diseases (eg. sarcoidosis)
28
Q

how is gastroparesis investigated?

A

gastric emptying studies

29
Q

how is gastroparesis managed?

A
remove precipitating factors (eg. drugs)
liquid/sloppy diet
eat little and often
promotility agents
gastric pacemaker
30
Q

which dose of lansoprazole is best, 15mg or 30mg?

A

30mg

31
Q

which drug is best, ranitidine or omeprazole?

A

omeprazole