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Gastro > Gastrointestinal Title:Gastro-oesophageal reflux disease, Barretts & Dysmotility of oesophagus & stomach > Flashcards

Gastrointestinal Title:Gastro-oesophageal reflux disease, Barretts & Dysmotility of oesophagus & stomach Flashcards

1
Q

What happens to the quality of life for patients with refluc

A

It decreases and can be similar to quality of life of a patient with an acute coronary event

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2
Q

Why does reflux occur

A

Incompetent Lower Oesophageal sphincter
Poor oesophageal clearance
Barrier/ function / Visceral senstitivity (some mucus for protection but if changed, an ulcer can form)

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3
Q

What are the symptoms of reflux

A 
Heartburn
Acid reflux 
Waterbrash
Dysphagia
Odynophagia
Weight loss
Chest pain
Hoarseness
Coughing
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4
Q

What investigations are carried out for reflux

A

Endoscopy
Ba swallow
Oesophageal manometry (measures pressure) & pH studies (probe and leave down for 24-48 hours - they will confirm with a diary)
Nuclear studies

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5
Q

How much of the population get reflux symptoms

A

40%

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6
Q

Who should we investigate

A 
Weight loss
Anaemia
Vomiting 
F/H UGI cancer
Barrett's (10% of patients reflux patients)
Pernicious Anaemia (association with cancer)
PUD surgery >20 years 
Dysphagia
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7
Q

What are the grades for oesophagitis

A

Grade A -
Grade B =
Grade C
Grade D -

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8
Q

What is achatsies ring?

A

Caused by acid reflux

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9
Q

Who is most likely to get oesophageal carcinoma?

A

Males

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10
Q

What are the treatment options for oesophageal carcinoma?

A

Radiotherapy
Surgery
Palliation (treat symptoms only)

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11
Q

What is the 5 year survival rate?

A

5-10%

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12
Q

What causes an increase in oesophageal adenocarcinoma?

A

More reflux

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13
Q

What causes a decrease in squamous cell carcinoma?

A

I dont know

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14
Q

What is the pathogenesis of adenocarcinoma

A

Normal
Oesophagitis (reversible)
Barrett’s (Irresversible?)
Adenocarcinoma (too late)

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15
Q

What is the management of GORD

A

Doubling the dose of PPI therapy
Adding an H2RA at bedtime
Extending the length of treatment
Surgery

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16
Q

What lifestyle modifications can be made for reflux?

A

Stop smoking
Lose weight if obese
Prop up the bed head
Avoid provoking factors

17
Q

GIve two types of H2 antagonists

A

Cinetidine

Ranitidine

18
Q

How does cinetidine work?

A

Rapid symptom relief

Less effective at healing than placebo

19
Q

How does ranitidine work?

A

Tolerance after 4 week therapy

Poor in preventing ….

20
Q

What are Proton pump inhibitors (PPI)

A

Block the hydrogen pump that makes the acid in the first place. It is irreversibly bound to it.

21
Q

What happens after 8 hours of taking a PPI

A

only half of the proton pumps remain blocked

22
Q

What do the proton pumps do?

A

Heal the mucosa

Relieve the symptoms

23
Q

What is the correct dose of Lansoprazole for healing and maintenance?

A

20mg or 30mg for healing and maintenance

24
Q

What are the benefits of surgery in GORD

A

Controls symptoms
Heals oesophagitis
Cost effective for Young patients (dont need to have them on PPI for a long period of time)
Severe / unresponsive disease

25
Q

What define’s Barratts oesophagitus

A

Intestinal Metaplasia
Irreversible
Increased risk of adenocarcinoma

26
Q

How can we manage dysplasia

A 
More frequent surveillance 
Optimise PPI (if on suboptimal dose)
Endoscopic mucosal resection
Radiofrequency abalation (HALO) to abalate the rest of the mucus. 
Argon
27
Q

What can a Hiatus hernia do?

A

Can be sliding or just push the oeophagus upwards causing reflex

28
Q

What is gastroparesis

A

Delayed gastric emptying with no physical obstruction

29
Q

What are the symptoms of gastroparesis

A 
Feeling of fullness / bloating 
Nausea
Vomiting
Weight loss
Upper abdominal pain
30
Q

What are the causes of gastroparesis

A

Idiopathic
Diabetes mellitus
Cannabis
Medication e.g. opiates, anticholinergics
Systemic diseases e.g. systemic sclerosis

31
Q

What investigations are done for gastroparesis

A

Gastric emptying studies (images of stomach using isotopes to calculate how long it takes to empty)

32
Q

WHat can we do to manage gastroparesis

A

Removal of precipitating factor se.g. drugs
Liquid / slopy diet
Eat little and often
Promotility

33
Q

What is achalasia?

A

Relatively uncommon condition
Lower OS is in spasm
requires surgery
cut longitudinally through sphincter, separate the fibres and pull them back
Now can be dilated with a balloon but can be dangerous

34
Q

How do we manage achalasia ?

A

Use of Botulinum toxin

Gastro (67 decks)

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