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gastrointestinal pathology > GI reflux > Flashcards

GI reflux Flashcards

1
Q

What is Gastro-oesophageal reflux disease?

A

Reflux of the stomach contents (acid +- bile) into the oesophagus causes symptoms of >2 heartburn episodes per week and/or complications.

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2
Q

what causes GORD?

A
  1. Lower esophageal sphincter hypo tension
  2. Hiatus hernia
  3. Loss of oesophageal peristaltic function
  4. Gastric acid hyper-secretion
  5. Slow gastric emptying
  6. Abdominal obesity
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3
Q

What factors predispose GORD?

A
  1. Over eating
  2. Pregnancy
  3. smoking
  4. Drugs -> tricyclics, anti-cholinergic, nitrates.
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4
Q

What are the main symptoms?

A
  1. Heart burn
  2. Acid or bile regurgitation
  3. water brush (increase salivation in mouth)
  4. Belching
  5. odynophagia
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5
Q

what is heart burn?

A

Burning, retro-sternal discomfort after meals, lying down, stooping or straining. It is relived by antacids.

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6
Q

What is odynophagia?

A

painful swallowing due to oesophagitis or ulceration

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7
Q

what are extra-oesophgeal symptoms?

A
  1. nocturnal asthma
  2. chronic cough
  3. laryngitis (hoarseness, clearing)
  4. sinusitis
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8
Q

Why can you sometimes get nocturnal asthma and cough?

A

They occur when the gastric contents have been aspirated into the lungs.

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9
Q

what are the complications of GORD?

A
  1. oesophagitis
  2. ulcers
  3. benign stricture
  4. iron deficiency
  5. Barrett’s oesophagus
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10
Q

what is a benign stricture?

A

It is the narrowing/ tightening of the oesophagus that causes swallowing difficulties. It presents with gradually worsening dysphagia. It is treated with endoscopic dilation and PPI therapy

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11
Q

What is Barrett;s oesophagus?

A

Abnormal columnar epithelium (red colored) replace the squamous epithelium (pale, glossy) that line the distal oesophagus. It is diagnose by endoscopic appearance and biopsies. It is pre-malignant. It is treated with PPI and oesophagus surveillance every 2 years with multiple biopsies.

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12
Q

Differential diagnosis?

A
  1. oesophagitis from corrosives, NSAID’s, herpes.
  2. duodenal/ Gastric ulcers.
  3. non-ulcer dyspepsia
  4. sphincter of oddi malfunction.
    5, cardiac disease
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13
Q

How to diagnose GORD?

A

Diagnosis is clinical and most people are treated without investigations.

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14
Q

When should an endoscopy be done?

A
  1. if have symptoms ? 4wks
  2. persistent vomiting
  3. GI bleeding
  4. palpable mass.
  5. age >55
  6. dysphagia
  7. symptoms despite treatment
  8. relapsing symptoms.
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15
Q

If endoscopy is normal, what other investigation can confirm GORD as a diagnosis?

A

pH monitoring +- manometry

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16
Q

What lifestyle changes can be made to treat GORD?

A
  1. raising bed head +- weight loss
  2. smoking cessation
  3. small regular meals.
  4. Avoid hot drinks, alcohol, spicy foods etc.
  5. Avoid drugs like nitrates, anti-cholinergics etc.
17
Q

How and which drugs affect esophageal motility?

A

Nitrates, anti-cholinergics, and Ca+ channel blockers relax the lower esophageal sphincter.

NAID’s, K+ salts, bisphosphonates damage mucosa

18
Q

What is the first line drug treatment?

A

Alginate containing antacids for symptomatic relief of heart burn.

19
Q

Mechanism is antacids?

A

it buffers stomach acid

20
Q

mechanism of alginates?

A

it increases the viscosity of the stomach contents, which reduces the reflux of stomach acid into the oesphagus. after reacting with stomach acid, they from a floating raft that separates the gastric contents from the gastro-oesphgeal junction to prevent mucosal damage.

21
Q

What treatment is given for mild symptoms?

A

life style changes and antacids.

22
Q

what treatment is given for severe symptoms or complications?

A

PPI’s provide symptomatic relief of dyspepsia and GORD

23
Q

mechanism of PPI’s?

A

Reduce gastric acid secretion. They act by irreversible binding to H+/K+-ATPase in gastric parietal cells, which is the proton pump that secrets H+ and produces gastric acid.

24
Q

Why are PPI’s so effective?

A

They target the final stage of gastric acid production, thus are able to suppress gastric acid production completely.

25
Q

what treatment is given for patients who continue to have symptoms after having medical treatment?

A

Surgery

26
Q

What is the aim for surgery?

A

Aims to increase resting lower oesophgeal sphincter pressure.

27
Q

Name a surgical procedure?

A

Nissen fundoplication. The fundus of stomach is sutured around the lower oesphagus and anti reflux valve is inserted. Complication are dysphagia and bloating.

gastrointestinal pathology (1 decks)

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