GORD Flashcards

1
Q

What is GORD?

A

Chronic condition where reflux of gastric contents - bile, acid and pepsin - back into oesophagus -> heartburn and acid regurg symptoms

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2
Q

What symptoms are atypical but present in GORD?

A

Hoarseness
Cough
Asthma
Dental erosions

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3
Q

What are the diagnosis of GORD on endoscopy?

A

Oesophagitis - orophageal inglammation and erosions seen
Endoscopy negatie reflux disease - symptoms of GORD but normal endoscopy

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4
Q

Pathology of GORD

A

transient relaxation (reduced tone) of the lower oesophageal sphincter, increased intra-gastric pressure (for example straining and coughing), delayed gastric emptying, and impaired oesophageal clearance of acid

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5
Q

GORD risk factors

A

Stress and anxiety
Smoking and alcohol
Trigger foods - coffee, chocolate, fatty foods
Obestiy
Drugs that decrease LOS pressure
Preganancy
Hiatus hernia
FH

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6
Q

How do coffee + chocolate vs fatty foods worsen GORD?

A

c+c -> lowered LOS tone,
Fatty foods - delay gastric emptying

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7
Q

Drugs that increase risk of GORD

A

Alpha blockers
Anticholinergucs
benzos
Beta blockers
Bisphosphonates
CCBs
Corticosteroids
NSAIDs
Theophyllines
Tricyclic antidepressnts

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8
Q

Risk factors for developing barretts oeophagus

A

Male
Long duration and increased frequency of GORD symptoms
Prev oesophagitis or hiatus hernia, stricutre or ulcers

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9
Q

Complications of GORD

A

Oesophageal ulcers
Oesophageal haemorrhage
Anaemia - chronic blood losss - severe oesophagitis
Oesophageal structure - fibrosis narrows lumen
Aspiration pneumonia
Barretts
Oral problems - gingivitis, eroisions, halitosis

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10
Q

What is barretss oesophagus?

A

Columnar metaplasia of distal oesophagus
Malginant potential + risk oeophageal adenocarcinoma

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11
Q

Lifestyle advice for GORD

A

Lose weight if overwieight
Avoid trigger foods - coffe, chocolate, tomatos, fatty, spicy
Smaller meals and eat evening meals 3-4 hours before going to bed
Stop smoking
Reduce alcohol consumption

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12
Q

Mananging GORD

A

Raised head of bed, not additional pillows
Assess for stress and anxiety
Ask about OTCs
Offer lifestyle advice
Review meds + consider stopping exacerbatinig

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13
Q

Medication management for proven GORD

A

Full dose PPI for 4 weeks to aid healing

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14
Q

Severe oesophagitis medicaiton

A

Full dose for 8 weeks to aid healing and as long term maintenance treatment

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15
Q

When are PPIs given in the day?

A

30 mins before breakfast and evening meal

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16
Q

Contraindications PPIs

A

-alarm symptoms before endoscopy - mask symtpoms
- stop 2 weeks before endoscopy
-at risk of osteoporosis
-at risk of hypomagnesaemia

17
Q

Common Adverse effects of PPIs

A

Headahce, diarrhoea, nausea, vomitting, abdo pain, constipation, dizziness

18
Q

Long term PPI risks serious adverse effects

A

hypomagnesaemia
Increased fracture risk
C difficile
Rebound hypersecretion syndrome

19
Q

What else can be used to treat GORD?

A

H2 receptor agonists
Antacids

20
Q

Antacid examples

A

Aluminium hydroxide, sodium bicarb, calcoium carbonate

21
Q

H2 receptor antagonists examples

A

Ranitidne, cimetidine

22
Q

Surgeries for GORD

A

Fundoplication - strengthen LOS by wrapping gastric fundus around it
Laprascopic insertion of magnetic bead band

23
Q

Investigations GORD

A

FBC
Endoscopy
CXR
Barium swallow
Oeophageal pH monitoring

24
Q

Why do FBC in GORD

A

Exclude anaemia

25
What is investgiation of choice GORD
Endoscopy
26
What can diagnose a hiatus hernia?
CXR Barium swallow
27
What causes GORD?
Incompetenve of atirefluc barriers at oesophagetic juntion Lower oesophageal sphinctre and crural diaphragm Causes refluc of acid and irritatnts into oesophagus froms tomach
28
What causes severe oesophagitis?
Loss of mucosal defence mechanisms on prolonged exposure to acid
29
Risk factors for GORD
Stress and anxiety Smoking Alcohol excess Fatty foods and coffee Drugs that decrease LOS pressure Pregnancy Hiatus hernia FH
30
What drugs decrease LOS pressure
Tricyclic antidepressants, anticholinergics, nitrates and CCBs
31
Clinical features of GORD
Heartburn - lying, stooping, straingin trosternal discomfort Acid brash Water brash Odynophagia Chest pain/epigastric pain Bloating Chronic hoarseness, cough and asthmatic sym,ptoms
32
Acid vs water brash
Regurg of acid or bile Excessive salivation
33
What does being ashkenazi jewish descent make you more likely to have?
UC
34
When do you get hypoalbuminaemia in UC?
Severe disease
35
Biologics that can be used in UC
Anti-TNFa (e.g. Infliximab) Anti-IL-12/23 (e.g. Ustekinumab) Anti a4b7 (e.g. Vedolizumab)
36
What does barretts oesophagus increase the risk of?
Oesophageal carcinoma
37
What does epithelium change from to in Barretts?
From squamous to columnar intestinal epithelium
38
What is seen on endoscopy with barretts?
Slamon coloured columnar epithelium above the gastro-oeophageal junction - at least 1 cm
39
What determines severity of barretts
Prague C+M classification