Gastrointenstinal (medicine) Flashcards
1
Q
Gastroenteritis causes (common)
A
Viral
Campylobacter spp.
Salmonella spp.
Cholera (developing countries)
2
Q
Gastroenteritis causes (rare but important)
A
E. coli O157
Staphylococcus aureus
Clostridium botulinum
Vibrio para-haemolyticus
3
Q
Management of gastroenteritis
A
Oral rehydration
Abx if septicaemia (ciprofloxacin)
Colonoscopy if lasts >3 weeks
4
Q
Chronic gastrointestinal infections
A
Giardiasis:
Treat with tinidazole or metronidazole
TB:
Treat as if for pulmonary TB
Amoebiasis:
Metronidazole + diloxanide furoate
5
Q
GORD
A
Caused by laxity of the lower sphincter leading to episodic reflux into the oesophagus
6
Q
What exacerbates GORD
A
Lifestyle factors:
Obesity (higher intra abdominal pressure)
Smoking
Stress
Dietary factors (fatty foods, pastry, alcohol, chocolate)
Postural (e.g. eating at night)
7
Q
Features of GORD
A
Marked postural element to symptoms Chest pain (reflux precipitated oesophageal spasm) Heartburn and nausea Belching Effortless regurgitation Transient dysphagia
8
Q
GORD management
A
Can have an upper GI endoscopy
Lifestyle management
Antacids (over the counter) - gaviscon etc
PPI for 1-2 months
Pro-kinetics (domperidone) - if more regurgitation
Surgery - Nissen’s fundoplication
9
Q
Barrett’s oesophagus
A
Barrett’s epithelium is present in 15% of GORD sufferers
Metaplasia of the lower oesophageal mucosea from squamous epithelium to columnar epithelium
Potentially a premalignant condition (lower third oesophageal adenocarcinoma risk)
10
Q
Barrett’s oesophagus treatment
A
PPI, high dose
11
Q
What other condition do you sometimes get with GORD
A
Hiatus hernia
12
Q
Peptic ulcer disease types
A
Duodenal ulcer
Gastric ulcer
13
Q
Features of peptic ulcer disease
A
GI haemorrhage
Dyspepsia
Vomiting
Perforation (with peritonitis)
14
Q
Ix in duodenal ulcer
A
Endoscopy (first-line)
H. pylori testing
15
Q
H. pylori tests
A
Serology - IgG
Urease breath test
CLO test (campylobacter-like-organism test)
Faecal antigen testing
16
Q
Duodenal ulcers
A
Where gastric acid production exceeds the buffering capacity of the alkali
Strong association with H. pylori
Pain relieved by eating
17
Q
H. pylori
A
Gram negative bacteria associated with 95% of duodenal ulcers, 75% of gastric ulcers)
18
Q
Gastric ulcer
A
Epigastric pain worse after eating
19
Q
Management of peptic ulcer disease
A
If gastric - endoscopy and biopsy (to ensure not malignant), you probably also do this in duodenal but these are less likely to be malignant
Treatment:
PPIs only if H. pylori negative (4-6 weeks)
H. pyolori positive - triple therapy (PPI, amoxicillin, clarithromycin)
Note - metronidazole can replace amoxicillin in H. pylori eradication
20
Q
Complications of peptic ulcer disease
A
Vomiting
Bleeding (haematemesis/malaena)
Perforation
Pyloric stenosis
21
Q
Diverticular disease
A
Herniation of colonic mucosa through the muscular wall of the colon (forming out pouches)
22
Q
Prevalence of diverticular disease
A
5% at 40 y.o
50% at 80 y.o
23
Q
Diverticulitis
A
Impacted faeces within a diverticulum causing inflammation
May evolve into an abscess
24
Q
Where are diverticula found
A
Almost always in sigmoid colon
25
Symptoms of diverticular disease
Intermittent abdominal pain (LLQ)
Bloating
Constipation/diarrhoea
26
Diverticulitis symptoms
Severe abdominal pain in LLQ
Nausea and vomiting
Change in bowel habit (const > diarrhoea)
Urinary frequency
PR bleeding
Pneumaturia/faecaluria - colovesical fistula
27
Diverticulitis signs
Pyrexia
Tachycardia
Tender LIF (20% have a mass)
Guarding/rigidity if perforation
28
Ix findings in diverticulitis
Raised WCC
Raised CRP
Erect CXR - pneumoperitoneum if perforation
AXR - dilated bowel loops/obstruction/abscesses
Colonoscopy - don't perform initially - high risk of perforation
29
Management of diverticulitis
Oral abx
Liquid diet
Analgesia
If symptoms don't resolve <72hrs or if symptoms sever: hospital admission for IV abx
30
Diverticulosis
Presence of diverticula without symptoms
31
Where is iron absorbed
Proximal small intestine
32
Causes of iron deficiency
Reduced absorption
- Coeliac disease
- Duodenal bypass
Chronic blood loss
- Menstrual bleeding
- GI neoplasia
- Intestinal angiodysplasia
33
Blood tests in iron deficient anaemia
```
FBC
Haemotinics
TTG
Faecal occult blood
Colonoscopy
```
34
Management of iron deficiency anaemia
```
Treat cause
Iron replacement (oral)
```
35
Virchow's node
Supplied by lymph vessels in the abdominal cavity and there is swollen in abdominal cancers
36
Ulcerative colitis
Always present in the rectum
Extends proximally
Continuous, limited to the mucosa (superficial, one layer)
37
Ulcerative colitis features
```
Bloody diarrhoea
Urgency
Tenesmus
Abdominal pain, LLQ
Extra-intestinal features
```
38
What is tenesmus
Feeling of incomplete rectal emptying
39
Extra-intestinal features of UC
```
Arthritis (most common feature)
Erythema nodosum
Episcleritis
Uveitis
Primary sclerosing cholangitis
Pyoderma gangrenosum
Osteoporosis
```
40
What is the scoring system for UC
Truelove-Witt's criteria
41
Ix in UC
```
Rectal biopsy
Flexible sigmoidosocopy/colonoscopy
Abdo x-ray (toxic dilation)
Stool culture (to exclude infective causes)
```
42
Management of UC flare
Either topical (rectal) aminosalicylate (e.g. mesalazine) or add oral corticosteroid
IV steroids if severe
IV ciclosporin can be used if steroids contraindicated
43
Maintaining remission in UC
Topical or oral aminosalicylates
Can then move onto azathioprine or mercaptopurine
Infliximab
Surgery
44
Crohn's disease
Affects entire GI tract - mouth to anus
Inflammation has skip lesions
Deep and transmural (involves all layers)
45
Clinical features of Crohn's disease
```
Weight loss
Lethargy
Diarrhoea (bloody if colitis)
Abdominal pain
Skin tags/ulcers
Extra intestinal features
```
46
Extra-intestinal features of Crohn's
Arthritis
Erythema nodosum
Episcleritis
Pyoderma gangrenosum
47
Ix in Crohn's
ESR/CRP
Colonoscopy (ulcers, skip lesions, abscesses)
Small bowel enema
48
Management of Crohn's flares
```
Steroids (first line)
Enteral feeding
Mesalazine/other 5-ASAs
Inflixmab
Metronidazole
```
49
Maintaining remission in Crohn's
Stop smoking
Azathioprine or mercaptopurine first line
Methotrexate second line
Mesalazine if they have had previous surgery
50
Complications of Crohn's
Strictures
Abscesses
Fistulae
Small bowel cancer risk increased 40 times
Colorectal cancer increased by 2
Osteoporosis (guessing from the steroids)
51
Coeliac's disease
```
Most common cause of small bowel malabsorption
Peak incidence at 20-40 y.o
Immune reaction to gluten
Villous atrophy
HLA-DQ2 and DQ8 associations
```
52
Features of coeliac's disease
```
Iron deficiency
Malabsorption symptoms - diarrhoea, weight loss, oedema
Dermatitis herpetiformis (characteristic bleeding eruption)
```
53
Investigations in coeliac's disease
```
Endoscopy and distal duodenal biops
Tissue-transglutaminase (TTG)
Endomyseal antibody (IgA)
```
54
Findings on biopsy in coeliac's disease
Usually in distal duodenum:
Villous atrophy
Crypt hyperplasia
Increase in intrapeithelial lymphocytes
Lamina propria infiltration with lymphocytes
55
Management of coeliac's
Gluten-free diet
Vitamin and iron replacement
Osteopenia
56
Pancreatitis causes
Alcohol (40%)
Gallstones (50%)
Idiopathic (10%)
57
Features of pancreatitis
Abdominal pain (sudden, epigastric, radiates to the back)
Hypovolaemia/shock
Vomiting
Jaundice
58
Jaundice in pancreatitis
Suggests the presence of an associated cholangitis
59
Scoring system in pancreatitis
```
Modified glasgow score
PaO2 <8kPa
Age >55
WBC >15
Calcium <2mmol
Urea >16mmol
AST >200 or LDH >600
Albumin <32g
Blood glucose >10
```
60
Mneumonic for glasgow score
```
PANCREAS
P PaO2
A Age
N Neutrophils
C Calcium
R Renal - Urea
E Enzymes AST/LDH
A Albumin
S Sugar
```
61
Ix for pancreatitis
```
Raised amylase (75% of patients)
Investigate for underlying cause (ultrasound)
```
62
Chronic pancreatitis causes
Recurrent acute pancreatitis
Alcohol
Idiopathic
63
Features of pancreatitis
Pain
Exocrine pancreatic insufficiency (steatorrhoea/weight loss)
Endocrine pancreatic insufficiency (diabetes)
64
Ix in chronic pancreatitis
```
Faecal elastase (chrymotrypsin)
Abdominal CT (pancreatic calcification)
MRCP (demonstrates pancreatic duct irregularity)
```
65
Management in chronic pancreatitis
Pancreatic enzyme replacement (creon/pancrex)
May need insulin for the pancreatic exocrine insufficient
Opioid pain management
66
Pancreatic cancer risk factors
Smoking
High fat meat diet
Afro/Caribbean
Male gender
67
Ix in pancreatic cancer
Abdo CT
MRCP
Endoscopic US
ERCP
68
What is first line for painless jaundice?
MRCP
69
Pancreatic cancer symptoms
```
Painless jaundice (due to biliary tree obstruction)
Abdominal pain
Weight loss
```
70
Most likely place for pancreatic cancer
Tumour of the head of the pancreas
71
What type of cancer is common in the pancreas
Adenocarcinoma
72
Management of pancreatic cancer
90% die within a year, 98% within 5 years
Surgery - Whipple's resection (pancreaticoduodenectomy) for head of pancreas cancers
Chemotherapy
Palliative - ERCP with stenting
73
Gallstone disease
From precipitation of cholesterol crystals in supersaturated bile
Stones ultimately contain calcium salts
74
Risk factors for gallstone disease
```
4 F's:
Fat - obesity (cholesterol synthesis)
Female - 2/3 times more likely due to oestrogen increasing HMG-CoA
Fertile - pregnancy
Forty
```
DM
Crohn's
Rapid weight loss
Drugs - fibrates/COCP
75
Pathophysiology of biliary colic
Increase in cholesterol
Decrease in bile salts
Biliary stasis
Pain is due to contracting of the gall bladder against a stone lodged in the cystic duct
76
Features of biliary colic
```
Colicky pain in the RUQ
Worse postprandially
Worse after fatty foods
Nausea and vomiting common
Can radiate to right shoulder/interscapular region
```
77
Acute cholecystitis
Describes inflammation of the gallbladder
| Develops secondary to gallstones in 90%, or alcalculous cholecystitis
78
Features of cholecystitis
RUQ pain (may radiate to right shoulder)
Fever and signs of systemic upset
Murphy's sign on examination
Mildly deranged LFT's
79
Murphy's sign
Ask the patient to breathe out
Place hand below costal margin on right side (where gallbladder is)
Breathe in
If the patient winces/catches breath, the test is positive
80
Investigating cholecystitis
US
| If not found on US, do a cholescintigraphy (HIDA) scan
81
Treating cholecystitis
IV abx
| Laparoscopic cholecystectomy
82
Where is the stone in cholestatic jaundice or ascending cholangitis
The common bile duct
83
What is ascending cholangitis
A bacterial infection (typically by e. coli) of the biliary tree
Usually gallstones is a cause
84
What is Charcot's triad
A triad of symptoms for ascending cholangitis:
Fever
RUQ pain
Jaundice
85
Management of ascending cholangitis
IV abx
| Endoscopic retrograde cholangiopancreatography (ERCP)
86
What is Mirizzi syndrome
Common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or gallbladder
87
Mirizzi syndrome symptoms/treatment
Jaundice
Pain etc.
Cholecystectomy
88
Hepatitis A
Common cause of transient hepatitis
| Faecal-oral transmission
89
Features of hep A
2-4 week incubation period
Flu-like prodome
```
Acute hepatitis
Fatigue
Malaise
Anorexia
Nausea
Cholestatic phase - jaundice
```
90
Investigations in viral hepatitis A
AST rise (most marked)
Bilirubin rise
ALP rise
HAV IgM serology (diagnostic of acute infection)
91
Management of hepatitis A
Usually symptomatic
Evidence of liver failure requires admission (encephalopathy, coagulopathy)
Rare to have complications
92
Immunisation in hep A
Initial dose should be followed by a booster dose 6-12 months later
```
Vaccinations should be for:
Haemophiliacs
Chronic liver disease
MSM
IVDU
HIV patients
```
93
Hep B
Most common cause of chronic liver disease and hepatoma
Double-stranded DNA hepadnavirus
More common in IVDU, sex workers and
94
Clinical features of hep B
Fever
Jaundice
Elevated liver transaminases
95
Complications of hep B
```
Chronic hepatitis
Fulminant liver failure
Hepatocellular carcinoma
Glomerulonephritis
Polyarteritis nodosa
Cryoglobulinaemia
```
96
Hep B serology
```
HBsAg - ongoing infection
HbeAg - active viral replication (able to spread, ie infectious)
HBsAb and HBcAb - previous infection
HBsAb alone - vaccine induced immunity
HBV DNA - continued infectious state
```
97
Tests for liver fibrosis
Hepatic elastography
Procollagen II
N-peptide
TIMP-1
Hydraluronidase
98
Management of hep B
Pegylated interferon-alpha acutely
Antivirals:
Tenofovir
Entecavir
Screening for HCC
Transplant if decompensated liver cirrhosis
99
Hepatitis C
RNA Flavivirus
Incubation period 6-9 weeks
Transmission risk:
IVDU
Vertical
Sex
100
Symptoms in hep c
Only 30% get symptoms
Serum aminotransferases rise
Jaundice
Fatigue
Arthralgia
101
Ix in hep C
```
HCV RNA (acute infection)
Anti-HCV (have cleared the virus)
```
102
Outcomes of acute hep C
Develops into chronic hep C in >50% of cases
103
Chronic hep C
Defined as having HCV RNA in your blood for 6 months
104
Complications of chronic hep C
Rheum:
Arthralgia/arthritis
Sjogren's
Hepatocellular cancer
Cryoglobulinaemia
Porphyria cutanea tarda
Membraneous glomerulonephritis
105
How to manage chronic hep C
Depends on genotype
Protease inhibitors
Antivirals
Liver transplants
106
Autoimmune hepatitis
90% are women
ANA or SMA positive
Elevated globulins + IgG
May present with amenorrhoea
107
Autoimmune hepatitis treatment
Steroids
Azathioprine
Liver transplant
108
Does c difficile cause bloody diarrhoea
No
109
Primary biliary cholangitis (primary biliary cirrhosis)
Chronic liver disorder
Typically seen in middle age females (9:1)
Interlobular bile ductrs become damaged by a chronic inflammatory process
Can lead to cholestasis and eventually cirrhosis
110
Features of PBC
Pruritis
Lethargy
Fatigue
Later:
Steatorrhoea
Fat soluble vitamin deficiency (A, D, K)
111
Conditions associated with PBC
Sjogren's (80%)
RA
Systemic sclerosis
Thyroid disease
112
Diagnosis of PBC
AMA positive
Cholestatic liver panel
Biopsy shows granuloma
113
Treatment of PBC
Ursodeoxycholic acid
Fat soluble vitamin supplementation
Cholestyramine (for itching)
Liver transplant if bilirubin high (>100)
114
Complications of PBC
Cirrhosis
Osteomalacia
Ostoporosis
Increased risk of HCC
115
Primary sclerosing cholangitis
Inflammation of the intra AND extra hepatic bile ducts
116
PSC associations
Male gender
UC (80% of people with PSC have UC)
Crohn's (less-so)
HIV
117
Features of PSC
Cholestasis (jaundice, pruritus)
RUQ pain
Fatigue
118
Ix in PSC
ERCP or MRCP
ANCA positive
Liver biopsy (onion skin)
119
Complications
Small increase in cholangiocarcinoma and colorectal cancer
Can give ursodeoxycholic acid to help with itching
No specific therapy
120
Non-alcoholic fatty liver disease
Most common cause of liver disease in the developed world
Largely associated with metabolic syndrome: T2DM, obesity, HTN, elevated TG
Insulin resistance is underlying mechanism
US shows fatty liver
121
Fulminant liver failure
Progression from normal liver to liver failure (ie hepatic encephalopathy) within 8 weeks
122
NAFLD features
Usually asymptomatic
Hepatomegaly
ALT > AST
Increased echogenicity
123
Management of NAFLD
Lifestyle
| Potentially metformin, gastric banding, pioglitazone (not licensed yet I think?)
124
Hepatic encephalopathy
```
Occurs in liver failure
Features:
Progressive deterioration in cognitive function
Shortened attention span
Metabolic flap (asterixis)
```
125
Alcoholic liver disease
Occurs due to a:
Fatty liver
Acute alcoholic hepatitis
Cirrhosis
126
Clinical features of alcoholic liver disease
If decompensated:
GI bleeding
Ascites
If acute hepatitis:
Sudden jaundice, anorexia, nausea, coagulopathy etc. in a chronic drinker
127
Ix of alcoholic liver disease
Clinical history mainly
128
Treatment of alcoholic hepatitis
Pentoxifylline
| Prednisolone
129
Management of alcoholic liver disease chronically
Alcohol cessation
Biopsy for fibrosis
HCC risk so can do surveillance
130
Haemochromatosis
Autosomal recessive disorder of iron absorption and metabolism
Results in iron accumulation
131
Precipitating causes of hepatic encephalopathy
```
Constipation
Diuretics
Infection
Sedatives
GI bleed
```
132
Ix in hepatic encephalopathy
Elevated ammonia (liver can't remove toxins causing brain damage)
133
Gene in haemochromatosis
HFE C282Y
| Common in Celtics
134
Features of haemochromatosis
```
Fatigue
ED
Bronzed skin
Arthralgia (particularly hands)
DM
Liver - stigmata of chronic liver disease (cirrhosis, HCC)
Cardiac
```
135
Ix in haemochromatosis
Raised ALT, though non-specific picture
Iron studies:
Transferrin saturation >80%
Ferritin levels VERY high
136
Treatment of haemochromatosis
Venesection (lifelong)
Surveillance for hepatoma
Screen releatives
137
Wilson's disease
Autosomal recessive disorder
Excessive copper deposition in tissues due to failure of biliary excretion
Chromosome 13 ATP7B gene
138
What can be seen in the eyes of patients with Wilson's
Kayser Fleischer rings
139
Presentations of Wilson's
Hepatitis/cirrhosis
Extrapyramidal disturbances/psychosis
Acute intravascular haemolysis
Blue nails
140
How to diagnose Wilson's
Reduced serum caeruloplasmin
Reduced serum copper
Increased 24 hour urinary excretion
141
Management of Wilson's
Penicillamine
| Trientine hydrochloride
142
Causes of liver cirrhosis
Alcohol
NAFLD
Viral hep B/C
143
How do we investigate for liver cirrhosis
Fibroscan (transient elastography)
| Measures the 'stiffness' of the liver (proxy for fibrosis)
144
What is the worry with liver cirrhosis
Progressive scarring can lead to non-function and thus eventually liver failure
145
Symptoms of liver cirrhosis
Nausea
Loss of appetite
Loss of sex drive
Tired/weak
```
Eventually:
Yellowing
Vomiting blood
Itchy skin
Dark tarry stool
Oedema
```
146
Causes of acute liver failure
Paracetamol overdose
Alcohol
Viral hep (A or B)
Acute fatty liver of pregnancy
147
Features of liver failure
```
Jaundice
Coagulopathy (raised PT time)
Hypoalbuminaemia
Hepatic encephalopathy
Renal failure is common (tubular necrosis)
```
148
Treatment of fulminant liver failure
Airway management
Fluid resus if needed
Nac if paracetamol
149
Portal hypertension features
Ascites (free fluid in the peritoneal cavity)
Splenomegaly
Thrombocytopenia
Varices
150
Treatment of portal hypertension
Portosystemic shunts
| - splenic vein to the left renal vein
151
Ascites groups
Serum-ascites albumin gradient (SAAG) <11g/L
Serum-ascites albumin gradient (SAAG) >11g/L
152
SAAG >11g
| Exudate
Indicates portal HTN:
Cirrhosis
Hepatitis
Cardiac ascites
Budd-chiari etc.
153
SAAG <11g
| Transudate
Peritoneal carcinomatosis
TB peritonitis
Pancreatic ascites
Bowel obstruction
154
Management of ascites
Reduce dietary sodium
Fluid restrict
Aldosterone antagonists: (e.g. spironolactone)
Drainage if tense ascites (therapeutic abdominal paracentesis)
Prophylactic abx for spontaneous bacterial peritonitis
155
Spontaneous bacterial peritonitis
Form of peritonitis
| Usually seen in patients with ascites secondary to liver cirrhosis
156
Features of SBP
Ascites
Abdo pain
Fever
157
SBP investigations
Paracentesis: neutrophil count > 250 cells
| E. coli often found on ascitic fluid culture
158
Treatment of SBP
IV cefotaxime
159
Budd-Chiari syndrome
```
Hepatic vein thrombosis caused by:
Haematological disease such as PRV
Thrombophilia
Pregnancy
COCP
```
160
Triad in Budd-Chiari
Abdominal pain (sudden, severe)
Ascites
Tender hepatomegaly
161
Ix in Budd-Chiari
Doppler US
162
Treatment of Budd-Chiari
Surgical shunts (e.g. TIPS)
163
Alpha-1 antitrypsin deficiency (A1AT)
Common inherited condition (autosomal recessive)causing lack of protease inhibitor (Pi), which is normally produced by the liver and usually protects cells from enzymes such as neutrophil elastase
164
Features of alpha-1 antitrypsin deficiency
COPD (if young, non-smoker, often affects lower lobes most) - by causing emphysema
Liver cirrhosis
Hepatocellular carcinoma
Cholestasis in children
165
Ix in A1AT
A1AT concentrations
| Spirometry - obstructive picture
166
Management in A1AT
No smoking
Supportive
IV A1AT protein concentrates
Surgery - lung transplant
167
C difficile gram
Gram positive rod
168
Clostridium difficile
Develops in response to broad-spectrum abx (C abx). PPIs a risk factor as well
Causes pseudomembranous colitis
169
Features of C diff infection
Diarrhoea
Abdominal pain
Raised WCC (characteristic)
Toxic megacolon can develop
170
Diagnosis of C diff
C diff toxin in stool (CDT)
171
Management of C diff
```
Oral metronidazole (10-14 days)
Vancomycin
```
172
Achalasia features
Dysphagia of both solids and liquids at the same time
Heartburn
Regurgitation of food - may lead to cough, aspiration pneumonia etc
173
Achalasia
Failure of oesophageal peristalsis and failure of relaxation of lower oesophageal sphincter (LOS)
Due to degenerative loss of ganglia from Auerbach's plexus
174
Achalasia Ix
Oesophageal manometry - excessive LOS tone which doesn't relax on swallowing
Barium swallow - grossly expanded oesphagus
CXR - wide mediastinum, fluid level
175
Treatment of achalasia
Intra-sphincteric injection of botulinum toxin
Heller cardiomyotomy
Pneumatic (balloon) dilation
176
What is the cardiac sphincter
A sphincter between the oesophagus and stomach
177
Peptic stricture
Longer history of dysphagia
Usually has symptoms of GORD
Lack of systemic features seen with malignancy
Usually non-progressive
Often caused by GORD
178
Peptic strictures pathophysiology
GORD
Causes inflammation (oesophagitis)
Causes peptic strictures
179
Oesophageal carcinoma pathology
Two types:
SCC (middle 1/3rd)
Adenocarcinoma (lower 1/3rd)
180
Management of oesophageal carcinoma
Surgical resection
Ivor-Lewis type oesophagectomy
Adjuvant chemotherapy/radiotherapy
181
Peptic stricture management
Surgical
Treat underlying cause:
H2 antagonists (ranitidine)
PPIs
182
Hiatus hernia
This is where the stomach pushes up into the lower chest through a weakness in the diaghram. Two types:
Sliding:
95% of hiatus hernias
Gastroesophageal junction moves above the diaghram
Rolling (paraoesophageal):
Top of the stomach does not pass through, a different part of the stomach does
183
Features of hiatus hernia
No symptoms itself
| Can cause problems with sphincter and thus cause reflux
184
Management of hiatus hernia
Lifestyle (lose weight, stop drinking, stop smoking etc.)
PPIs/ranitidine/antacids
Surgery
185
How do we diagnose hiatus hernia
Barium swallow
| Endoscopy
