Gastrointestinal disease

Question 1

How common is GORD

Answer 1

10-20 % prevalence. 60% have symptoms. 20-30 percent have weekly symptoms.

Question 2

What causes GORD

Answer 2

1. A transient relaxation of the lower oesophageal sphincter.
2. Increased abdominal pressure
3. decreased gastric emptying
4. reduced LOS tone
5. impaired esophageal clearance

Question 3

Risk Factors - GORD

Answer 3

1. High BMI (obesity). 2. Fatty foods delay gastric emptying. 3. Alcohol, smoking and coffee reduced LOS tone. 4. stress. 5. drugs that decrease LOS pressure e.g. calcium channels, theophylline.
2. pregnancy 6 hiatus hernia. benzodiazepine. 7.

Question 4

Presentation - GORD

Answer 4

retrosternal chest pain, fullness or bloating - often leads to anorexia

Question 5

Investigations - GORD

Answer 5

Full blood count - rule out anaemia
Iron levels in blood
Endoscopy - esophagitis and barretts

Question 6

Complications of GORD

Answer 6

esophagitis, barrett’s esophagus, esophageal carcinoma, Anaemia.

Question 7

Treatment/Management - GORD

Answer 7

Lifestyle changes - Smoking cessation, Alcohol, reduced caffeine. Smaller meals, lose weight. 3-4 hours before bed. If required can take antacid or PPI.

Question 8

Differentials - GORD

Answer 8

Peptic ulcer, duodenitis, gastritis, hiatus hernia.

Question 9

What is the name of the grading system for esophagitis

Answer 9

Savory-Miller - Grade 1-5. Grade 5 = Barretts esophagus.

Question 10

Barretts esophagus is a risk factor for ___ . Patients are likely to develop this within _____ years

Answer 10

Oesophageal cancer. 10-20 years.

Question 11

Why is reflux of duodenal contents more serious than that of gastric contents alone

Answer 11

Bile is a very caustic substance.

Question 12

What is dyspepsia

Answer 12

General gastrointestinal discomfort which can present as: Pain, bloating, fullness, distension, nausea, burping.

Question 13

How common are peptic ulcers

Answer 13

Estimated 1/10 people will have one at some point in their life

Question 14

Dyspepsia is a common presenting complaint, what are the main diagnoses.

Answer 14

40% - Functional - non ulcerative dyspepsia
40% - Gord
13%- Peptic ulcers
2%- Gastric cancer
1% esophageal cancer

Question 15

What are the symptoms of peptic ulcers

Answer 15

Non specific - need more for diagnosis
Epigastric pain - 1 to 3 hours post prandial.
Nausea
Sometimes oral flatulence and bloating.
Pain my radiate to back if ulcer is on posterior wall of stomach.
Intolerance for fatty foods.
Relieved by antacids.

Question 16

Signs - Peptic ulcer

Answer 16

Epigastric tenderness,

Succussion splash - (delayed gastric emptying)

Question 17

Investigations - peptic ulcer

Answer 17

Full blood count- anaemia, H pylori, Carbon 13 test. Only do endoscopy if over 55 and this is their first time presenting with such symptoms or if patient has family history gastric carcinoma, if there is weight loss, blood loss, dysphagia, iron deficiency or palpable mass.

Question 18

What are the two main causes of peptic ulcers

Answer 18

H Pylori (80% of gastric and 95% duodenal ulcers)
NSAIDs (20% of gastric, 5 % duodenal)

Question 19

Other risk factors/ aetiologies

Answer 19

Smoking - Reduced wound healing, H2 receptor antagonist.
Pepsin
Bile acids.

Question 20

Management

Answer 20

Lifestyle changes - Smoking cessation.
PPI - esomeprazole usually 40 mg.
7 day course of amoxicillin with inhibitor or (clarithromycin/ metronidazole.)

Question 21

complications

Answer 21

haematemesis, malaena, perforation, pyloric stenosis