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Medicine - Finals > GI > Flashcards

GI Flashcards

1
Q

What is GORD?

A

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

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2
Q

What are the causes of GORD?

A

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)

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3
Q

Give the 5 key oesophageal symptoms of GORD

A

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

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4
Q

Give the 4 key extra-oesophageal symptoms of GORD

A

Nocturnal asthma
Chronic cough
Laryngitis
Sinusitis

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5
Q

Give some complications of GORD

A 
Oesophagitis
Ulcers
Benign strictures
Iron deficiency
Metaplasia (Barrett's oesophagus)
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6
Q

Give 8 DDx for GORD

A 
Oesophagitis from corrosives
NSAIDs
Herpes
Candida
Duodenal/gastric ulcers or cancers
Non-ulcer dyspepsia
Sphincter of Oddi malfunction
Cardiac disease
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7
Q

How is GORD investigated?

A

Trial of PPIs

Endoscopy if symptoms persisting >4wks, or other concerning features, e.g. persistent vomiting

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8
Q

What lifestyle measures can be used to manage GORD?

A 
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)
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9
Q

What medications can be used to treat GORD?

A

GORD

Gaviscon (antacid)
Omeprazole (PPI)
Ranitidine (H2R antag)
Domperidone (pro kinetic)

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10
Q

Give an example of a surgical measure that could be used to manage GORD

Give 2 complications

A

Nissen fundoplication

Dysphagia
Bloating

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11
Q

What is the grading system for GORD?

A

Los Angeles classification
Depends on mucosal breaks
1 = mild; 4 = severe

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12
Q

What are the two types of hiatus hernia? Which is more common?

A

Sliding hiatus hernia (80%)

Rolling hiatus hernia

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13
Q

What is a sliding hiatus hernia?

A

Gastro-oesophageal junction slides up into the chest

LOS often becomes incompetent, so reflux is common

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14
Q

What is a rolling hiatus hernia?

A

Gastro-oesophageal junction remains in abdomen but a bulge of stomach herniates up into chest alongside oesophagus

Reflux is common as LOS remains intact

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15
Q

Key Ix for hiatus hernia?

A

Barium swallow

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16
Q

Treatment for hiatus hernia?

A

Lose weight
Treat reflux symptoms
Repair rolling hiatus hernia prophylactically as may strangulate

17
Q

Side effect of alginate-containing antacids?

1) magnesium-containing
2) aluminium-containing

A

1) Diarrhoea

2) Constipation

18
Q

What is a Mallory-Weiss tear?

What causes it?

A

Linear mucosal tear occurring at oesophageal-gastric junction

Caused by sudden increase in intra-abdominal pressure - e.g. after bout of coughing/retching

19
Q

Give 3 RFs for Mallory-Weiss tear

A

Excess ETOH ingestion
Hiatus hernia
Gallstones/cholecystitis

20
Q

How do Mallory-Weiss tears present?

A

Acute upper GI bleeding - haematemesis

21
Q

How are Mallory-Weiss tears managed?

A

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

22
Q

Give 5 differentials for an acute upper GI bleed

A 
Reflux oesophagitis
Varices
Haemorrhagic gastropathy and erosions
Gastric or duodenal ulcers
Gastric cancer
23
Q

What is a peptic ulcer?

A

Breach in membrane of mucosa in/adjacent to an acid-bearing area

24
Q

Most common sites for peptic ulcers?

A

Duodenum (more common)

Stomach - mostly on lesser curvature

25
Q

Give 4 ways the stomach normally protects itself against gastric acid

A

1) Mucus production by goblet cells
2) High turnover of cells
3) Feedback loops
4) Tight junctions between cells

Medicine - Finals (13 decks)

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