GI Flashcards
What is GORD?
Oesophagitis secondary to refluxed gastric contents
Reflux of gastric contents into the oesophagus is normal - clinical symptoms only occur when there is prolonged contact of gastric contents with oesophageal mucosa
What are the causes of GORD?
Anything that causes:
1) Increased intra-abdominal pressure
2) Weakness of LOS
e.g. Pregnancy, Obesity, Smoking, ETOH, Fatty/large meals, Coffee, Achalasia, Hiatus hernia, Drugs (TCAs, anticholinergics, nitrates, CCBs, bisphosphonates, NSAIDs)
Give the 5 key oesophageal symptoms of GORD
Heartburn - aggravated by bending/lying down (promotes acid exposure)
May be relieved by oral antacids
Pain on drinking hot liquids/alcohol
Belching
Acid brash
Water brash (^^salivation)
Odynophagia
Give the 4 key extra-oesophageal symptoms of GORD
Nocturnal asthma
Chronic cough
Laryngitis
Sinusitis
Give some complications of GORD
Oesophagitis Ulcers Benign strictures Iron deficiency Metaplasia (Barrett's oesophagus)
Give 8 DDx for GORD
Oesophagitis from corrosives NSAIDs Herpes Candida Duodenal/gastric ulcers or cancers Non-ulcer dyspepsia Sphincter of Oddi malfunction Cardiac disease
How is GORD investigated?
Trial of PPIs
Endoscopy if symptoms persisting >4wks, or other concerning features, e.g. persistent vomiting
What lifestyle measures can be used to manage GORD?
Raise head of bed Weight loss Smoking cessation Small, regular meals Avoid triggering foods Avoid drugs affecting oesophageal motility (nitrates, anticholinergics, etc) and that damage the mucosa (NSAIDs, K+ salts, bisphosphonates)
What medications can be used to treat GORD?
GORD
Gaviscon (antacid)
Omeprazole (PPI)
Ranitidine (H2R antag)
Domperidone (pro kinetic)
Give an example of a surgical measure that could be used to manage GORD
Give 2 complications
Nissen fundoplication
Dysphagia
Bloating
What is the grading system for GORD?
Los Angeles classification
Depends on mucosal breaks
1 = mild; 4 = severe
What are the two types of hiatus hernia? Which is more common?
Sliding hiatus hernia (80%)
Rolling hiatus hernia
What is a sliding hiatus hernia?
Gastro-oesophageal junction slides up into the chest
LOS often becomes incompetent, so reflux is common
What is a rolling hiatus hernia?
Gastro-oesophageal junction remains in abdomen but a bulge of stomach herniates up into chest alongside oesophagus
Reflux is common as LOS remains intact
Key Ix for hiatus hernia?
Barium swallow
Treatment for hiatus hernia?
Lose weight
Treat reflux symptoms
Repair rolling hiatus hernia prophylactically as may strangulate
Side effect of alginate-containing antacids?
1) magnesium-containing
2) aluminium-containing
1) Diarrhoea
2) Constipation
What is a Mallory-Weiss tear?
What causes it?
Linear mucosal tear occurring at oesophageal-gastric junction
Caused by sudden increase in intra-abdominal pressure - e.g. after bout of coughing/retching
Give 3 RFs for Mallory-Weiss tear
Excess ETOH ingestion
Hiatus hernia
Gallstones/cholecystitis
How do Mallory-Weiss tears present?
Acute upper GI bleeding - haematemesis
How are Mallory-Weiss tears managed?
Most bleeds are minor - patient discharged within 24h
Haemorrhage may be large but most stop spontaneously
Early endoscopy confirms diagnosis and allows therapy if necessary
Give 5 differentials for an acute upper GI bleed
Reflux oesophagitis Varices Haemorrhagic gastropathy and erosions Gastric or duodenal ulcers Gastric cancer
What is a peptic ulcer?
Breach in membrane of mucosa in/adjacent to an acid-bearing area
Most common sites for peptic ulcers?
Duodenum (more common)
Stomach - mostly on lesser curvature
Give 4 ways the stomach normally protects itself against gastric acid
1) Mucus production by goblet cells
2) High turnover of cells
3) Feedback loops
4) Tight junctions between cells
