GI and liver Flashcards
what is gastrointestinal reflux disease GORD
Caused by reflux of stomach contents into the oesophagus
causes of GORD
- lower oesophageal sphincter hypotension
- Hiatus hernia
- Oesophageal dysmotility
- Obesity
- Gastric acid hypersecretion
- Delayed gastric emptying
- Smoking, alcohol, pregnancy, drugs
oesophageal manifestations of GORD
- Heartburn (burning, retrosternal discomfort after meals)
- Belching
- Acid brash (acid regurgitation)
- Waterbrash
- Odynophagia (swallowing pain)
extra-oesophageal manifestations of GORD
- Nocturnal asthma
- Chronic cough
- Laryngitis
- Sinusitis
investigations for GORD
- Endoscopy if dysphagia
- 24h oesophageal pH monitoring
- Manometry help diagnose GORD when endoscopy is normal
management of GORD
- Lifestyle = weight loss, stop smoking, small meals, reduce hot drinks and alcohol, avoid acidic food
- antacids
- ranitidine ( H2 receptor antagonist)
- lansoprazole ( proton pump inhibitor)
- surgery
what is peptic ulceration
A break in the inner lining of the stomach, first part of the small intestine or sometimes the lower oesophagus
pathology of peptic ulceration
- Inflammation caused by the bacteria H.pylori
- Erosion from stomach acids
clinical manifestations of peptic ulceration
- Epigastric pain often related to hunger, specific foods, or time of day
-Fullness, Heart burn, Tender epigastrium
ALARM symptoms (Anaemia, Loss of weight, Anorexia, Recent onset, Melaena/haematemesis)
-Swallowing difficulty
H.pylori and peptic ulceration
- Test and treat for H.pylori, if positive give appropriate Proton Pump Inhibitor and 2 antibiotic combination.
- Lansoprazole with clarithromycin and metronidazole
duodenal ulcer
- H.pyori, drugs, increased gastric acid, blood group O
- epigastric pain and weight loss
- upper GI endoscopy, test for H.pylori
- differentials = non-ulcer dyspepsia, duodenal crohn’s
gastric ulcers
- elderly
- h.pylori, smoking, NSAIDs
- upper GI endoscopy to exclude malignancy
proton pump inhibitors
what is oesophago-gastric varices
- Submucosal venous dilatations secondary to high portal pressures.
- Bleeding can be brisk, particularly if underlying coagulopathy secondary to loss of hepatic synthesis of clotting factors
cause of oesophago-gastric varices
Cirrhosis
Thrombosis
Parasitic infection
portal hypertension
causes of portal hypertension
- Pre-hepatic: thrombosis (portal or splenic vein)
- Intra-hepatic: cirrhosis, schistosomiasis, sarcoid, myeloproliferative diseases, congenital hepatic fibrosis
- Post-hepatic: Budd-Chiari syndrome, right heart failure, constrictive pericarditis, veno-occlusive disease
risk factors for variceal bleeds
High portal pressure
Variceal size
Endoscopic features of the variceal wall and advanced liver disease
symptoms of OG varices
- Only symptomatic if they bleed;
- Vomiting large amounts of blood
- Black, tarry or bloody stools
- Light headedness
- Loss of consciousness in severe cases
management of OG varices
Endoscopic banding or sclerotherapy
upper GI bleeding
- Haematemesis: vomiting of blood. It may be bright red or look like coffee grounds.
- Melaena: black motions, often like tar, and has a characteristic smell of altered blood
Mallory-Weiss tear
- a tear in the mucous membrane where the oesophagus meets the stomach
- Persistent vomiting/retching
- endoscopy (clips, cautery, adrenaline)
what is gastritis
Inflammation of the lining of the stomach
causes of gastritis
- excessive alcohol use, chronic vomiting, stress, aspirin.
- Helicobacter pylori: a bacteria that lives in the mucous lining
- Bile reflux
- Infections
- risk factors = alcohol, h.pylori, NSAIDs, reflux hernia
symptoms of gastritis
- Epigastric pain
- Vomiting
- Indigestion (dyspepsia)
- Abdominal bloating
investigations for gastritis
- upper gi endoscopy
- test for anaemia and h.pylori
- test stool for blood