GORD Flashcards
1
Q
GORD
A
Lower oesophageal sphincter dysfunction → reflux of gastric contents →
oesophagitis.
2
Q
Risk factors
A
Hiatus hernia Smoking EtOH Obesity Pregnancy Drugs: anti-AChM, nitrates, CCB, TCAs
3
Q
Symptoms
A
Heartburn - related to meals Worse lying down Relieved by antacids Belching Odonophagia
4
Q
Barrett’s oesophagus
A
Intestinal metaplasia of squamous epithelium to stratified columnar
Metaplasia → dysplasia → adenocarcinoma
5
Q
Ix of GORD
A
Isolated symptoms don’t need Ix
Bloods: FBC
CXR: hiatus hernia may be seen
OGD
If OGD is negative consider pH testing
Ba swallow: hiatus hernia, dysmotility
6
Q
OGD indications
A
>55yrs Symptoms >4wks Dysphagia Persistent symptoms despite Rx Wt. loss
7
Q
Mx
A
Conservative: Lose wt. Raise head of bed Small regular meals ≥ 3h before bed Stop smoking and ↓ EtOH Avoid hot drinks and spicy food Stop drugs: NSAIDs
Medical:
OTC antacids: Gaviscon
1: Full-dose PPI for 1-2mo
2: No response → double dose PPI
3: No response: add an H2RA
Ranitidine
8
Q
Haematemesis Differential
VINTAGE
A
Varices - oesophageal from chronic liver disease Inflammation - PUD Neoplasm - oesophageal or gastric Ca Trauma - Mallory Weiss tear Angiodysplasia General bleeding - warfarin Epistaxis
9
Q
Rectal bleeding causes (DRIPING)
A
Diverticulitis Rectal- haemorrhoids Infections - campy, salmonella, E.coli, Shigella, C. diff Polyps IBD Neoplasia Gastric or upper bowel bleeding
10
Q
Complications
A
Oesophagitis Ulcers Anaemia Benign structures Bretts oesophagus Oesophageal carcinoma
