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Gastrointestinal > Gastro-Oesophageal Reflux Disease (GORD) > Flashcards

Gastro-Oesophageal Reflux Disease (GORD) Flashcards

1
Q

What is GORD. (3)

A

It develops when the oesophageal mucosa is exposed to gastroduodenal contents for prolonged periods of time.
It is caused by the reflux of the stomach causing symptoms >2 episodes/ week.

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2
Q

What are the causes of GORD. (10)

A 
Usually no obvious cause. 
Secondary causes include:
Alcohol.
Smoking. 
Pregnancy. 
Scleroderma. 
Drugs (tricyclics, anticholinergics, nitrates). 
Trauma. 
Obesity. 
H. Pylori. 
Surgery (for achalasia).
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3
Q

What are the symptoms of GORD divided into.

A

Oesophageal.

Exta-oesophageal.

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4
Q

What percentage of the general population is affected by GORD.

A

30%

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5
Q

What can GORD cause in a proportion of cases. (5)

A 
Oesophagitis. 
Barrett's Oesophagus. 
Benign oesophageal stricture. 
Iron deficiency. 
Gastric volvulus.
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6
Q

What factors are involved in the development of GORD. (7)

A 
Abdominal obesity. 
Dietary factors. 
Defective oesophageal clearance. 
Abnormal lower oesophageal sphincter (reduced tone, inappropriate relaxation).
Hiatus hernia.  
Delayed gastric emptying. 
Increased intra-abdominal pressure.
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7
Q

What is heartburn. (2)

A

Burning, retrosternal discomfort after meals, lying stooping or straining.

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8
Q

What is heartburn usually relieved by.

A

Antacids.

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9
Q

What is acid brash. (2)

A

Acid or bile regurgitation.

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10
Q

What is waterbrash.

A

Increased salivation.

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11
Q

What is odynophagia.

A

Painful swallowing.

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12
Q

What is odynophagia caused by in GORD. (2)

A

Oesophagitis.

Ulceration.

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13
Q

What are the oesophageal symptoms of GORD. (5)

A 
Heartburn. 
Belching. 
Acid brash.
Waterbrash. 
Odynophagia.
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14
Q

What are the extra-oesophageal symptoms of GORD. (4)

A

Nocturnal asthma.
Chronic cough.
Laryngitis (hoarseness, throat clearing).
Sinusitis.

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15
Q

What drug classes can predispose to the development of GORD. (3)

A

Tricyclics.
Anticholinergics.
Nitrates.

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16
Q

What surgery can lead to the development of GORD.

A

Surgery for achalasia.

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17
Q

How is GORD classified.

A

Los Angeles Classification.

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18
Q

How many grades are in the Los Angeles Classification of GORD.

A

4.

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19
Q

What is the Los Angeles Classification used to grade.

A

GORD.

20
Q

What is grade 1 of the Los Angeles classification of GORD. (3)

A

> 1 mucosal break(s).

21
Q

What is grade 2 of the Los Angeles classification of GORD. (3)

A 
Mucosal break(s). 
>5mm long.
Limited between two mucosal fold tops.
22
Q

What is grade 3 of the Los Angeles classification of GORD. (3)

A

Continuous mucosal break(s).
Between beyond two or more mucosal fold tops.
Involving

23
Q

What is grade 4 of the Los Angeles classification of GORD. (2)

A

Continuous mucosal break(s).

Involving >75% of the oesophageal circumference.

24
Q

What does the reflux of GORD consist of. (2)

A

Acide.

Bile.

25
Q

What is the state of the LOS under normal circumstances.

A

Tonically contracted.

26
Q

When does the LOS relax.

A

During swallowing.

27
Q

What are the two LOS abnormalities that may cause GORD.

A

Reduced LOS tone (permits reflux when intra-abdominal pressure rises).
Inappropriate sphincter relaxation.

28
Q

Why does a hiatus hernia cause GORD.

A

Because the pressure gradient between the abdominal and thoracic cavities is lost.

29
Q

What angle is lost in a hiatus hernia.

A

The oblique angle between the cardia and oesophagus.

30
Q

Who is defective oesophageal peristaltic activity normally found in.

A

Patients with oesophagitis.

31
Q

Is loss of oesophageal peristaltic activity a primary or secondary abnormality.

A

Primary.

Because it persists after oesophagitis has been healed by acid-suppressing drug therapy.

32
Q

What is the consequence of loss of oesophageal peristaltic activity.

A

Poor oesophageal clearance leads to increased acid exposure time.

33
Q

What contributes to mucosal injury of the oesophagus in GORD. (3)

A

Gastric acid.
Pepsin.
Bile may contribute as well.

34
Q

What may be a conservative first line set in managing GORD in an overweight patient.

A

Weight loss.

35
Q

What causes waterbrash.

A

It is salivation due to reflex salivary gland stimulation, as acid enters the gullet.

36
Q

Why might a patient with GORD develop iron defiency anaemia.

A

It can occur as a consequence of occult blood loss from long standing oesophagitis.

37
Q

What is a name given to subtile erosions in the neck of the sac of the hiatus hernia, that bleeds.

A

Cameron lesions.

38
Q

What are benign oesophageal strictures.

A

Fibrous bands that develop as a consequence of long-standing oesophagitis.

39
Q

Who are benign oesophageal strictures common in. (2)

A

The elderly.

Those with poor oesophageal peristaltic activity.

40
Q

What is a common presentation for a benign oesophageal stricture.

A

Dysphagia that is worse for solids than for liquids.

41
Q

What is a gastric volvulus.

A

It is rare, and occurs when a massive intrathoracic hiatus hernia twists upon itself.

42
Q

What is a consequence of a gastric volvulus.

A

Complete oesophageal or gastric obstruction.

43
Q

What does a patient with a gastric volvulus present with. (3)

A

Severe chest pain.
Vomiting.
Dysphagia.

44
Q

How is the diagnosis for a gastric volvulus made. (2)

A

CXR (air bubble in the chest).

Barium swallow.

45
Q

What are some features of GORD in the elderly. (4)

A

Prevalence is higher.
Severity of symptoms does not correlate with the degree of mucosal inflammation.
Complications are more common (eg peptic strictures or bleeding from oesophagitis)
Recurrent pneumonias f(consider aspiration from occult GORD).

46
Q

What percentage of cases admitted to CCU are actually related to GORD.

A

20%

47
Q

What are the characteristics of reflux pain and cardiac ischaemic pain. (8)

A

Reflux: seldom radiates to the arms.
Cardiac: radiates to neck or left arm.

Reflux: worse with hot drinks or alcohol.
Cardiac: worse with exercise.

Reflux: Relieved by antacids.

Reflux: burning, worse on bending, stooping or lying down.
Cardiac: gripping or crushing pain.

Cardiac: Accompanied by dyspnoea.

Gastrointestinal (35 decks)

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