GORD Flashcards

1
Q

What is GORD?

A

where acid from the stomach flows through the lower oesophageal sphincter and into the oesophagus where it irritates the lining and causes heartburn symptoms

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2
Q

What is the cardinal clinical presentation of GORD?

A

heartburn

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3
Q

What cells line the oesophagus?

A

squamous epithelium

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4
Q

What cells line the stomach?

A

columnar epithelium

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5
Q

Describe the pathophysiology of GORD:

A

transient lower oesophageal sphincter relaxations (which occur as part of normal physiology) occur more frequently causing gastric flow back into the oesophagus

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6
Q

Give 9 risk factors for GORD:

A

1) pregnancy
2) obesity
3) cigarette smoking
4) alcohol
5) coffee intake
6) large or fatty meals
7) spicy food intake
8) hiatus hernias
9) stress

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7
Q

Give 3 drugs that predispose to GORD:

A

1) antimuscarinics
2) calcium-channel blockers
3) nitrates

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8
Q

Give 6 clinical features of GORD:

A

1) heartburn (which is worse when bending, stooping or lying down)
2) acid regurgitation
3) bloating
4) nocturnal cough
5) hoarse voice
6) retrosternal/epigastric pain

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9
Q

True or false: GORD is mostly a clinical diagnosis that doesn’t require further investigation

A

true

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10
Q

Name two investigations for GORD:

A

1) endoscopy
2) intraluminal monitoring

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11
Q

How can endoscopy help diagnose GORD?

A

it can visualise visible breaks in the oesophagus mucosa, indicating oesophagitis

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12
Q

Describe how intraluminal monitoring can be used to investigate GORD:

A

a nasogastric tube with a pH probe is passed down the oesophagus for 24 hours

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13
Q

What action is taken if a GORD patient has any red flags, particularly dysphagia?

A

2 week wait referral for direct access endoscopy

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14
Q

What is the key red flag in GORD?

A

dysphagia

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15
Q

Name 8 red flags associated with GORD:

A

1) dysphagia
2) weight loss
3) abdominal mass
4) resistant to treatment
5) upper abdominal pain
6) nausea and vomiting
7) raised platelet count
8) anaemia

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16
Q

Name 3 lifestyle changes used to manage GORD:

A

1) weight loss
2) raising the head of the bed at night
3) reduction in alcohol and coffee consumption

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17
Q

What medication may exacerbate gastritis/ GORD symptoms?

A

NSAIDs

18
Q

Give 3 examples of over the counter antacids:

A

1) Gaviscon
2) pepto-bismol
3) rennie

19
Q

What compound found in antacids reduces reflux?

A

alginate

20
Q

Give two examples of proton pump inhibitors:

A

1) omeprazole
2) lansoprazole

21
Q

Describe how PPIs reduce reflux symptoms:

A

they inhibit gastric H+/K+ ATPase, reducing gastric acid secretion

22
Q

Give 4 examples of histamine H2-receptor antagonists:

A

1) famotidine
2) ranitidine
3) cimetidine
4) nizatidine

23
Q

When are histamine H2-receptor antagonists used in the treatment of GORD?

A

1) if antacid use is unsuccessful
2) used with PPIs for patients with more severe GORD

24
Q

How do histamine H2-receptor antagonists relieve reflux symptoms?

A

they block the action of histamine on parietal cells in the stomach, decreasing production of gastric acid

25
Q

Name the surgical intervention used to treat GORD:

A

laparoscopic fundoplication

26
Q

Describe laparoscopic fundoplication:

A

tying the fundus of the stomach around the lower oesophagus to narrow the lower oesophageal sphincter

27
Q

Which bacterial should be ruled out when investigating GORD?

A

H. pylori

28
Q

Name 3 investigations for H. pylori infection:

A

1) stool antigen test
2) urea breath test (radio labelled carbon-13)
3) rapid urease test

29
Q

What compound does H. pylori produce that allows it to neutralise stomach acid?

A

ammonium hydroxide

30
Q

What 3 drugs are used in H. pylori triple therapy?

A

1) PPI
2) two antibiotics (amoxicillin and clarithromycin)

31
Q

What is Barrett’s oesophagus?

A

where the lower oesophageal epithelium changes from squamous to columnar epithelium via metaplasia caused by chronic acid reflux

32
Q

Name the premalignant condition caused by chronic reflux and is a leading risk factor for oesophageal adenocarcinoma:

A

Barrett’s oesophagus

33
Q

What endoscopy finding indicates Barrett’s oesophagus?

A

proximal displacement of the sqaumocolumnar mucosal junction

34
Q

What biopsy finding indicates Barrett’s oesophagus?

A

columnar epithelium in the oesophagus

35
Q

What are the two main investigations for Barrett’s oesophagus?

A

1) endoscopy
2) biopsy and histology

36
Q

Give 3 treatments for Barrett’s oesophagus:

A

1) endoscopic monitoring for progression to adenocarcinoma
2) PPIs
3) endoscopic ablation

37
Q

Describe how endoscopic ablation treats Barrett’s oesophagus:

A

it destroys columnar epithelial cells which are then replaced with normal squamous epithelial cells

38
Q

What is the name of the rare condition characterised by neuroendocrine tumours producing excessive gastrin?

A

Zollinger-Ellison Syndrome

39
Q

What is Zollinger-Ellison Syndrome?

A

a rare condition where a duodenal or pancreatic neuroendocrine tumour produces excessive gastrin which stimulates acid secretion in the stomach, resulting in severe dyspepsia

40
Q

What genetic condition is associated with Zollinger-Ellison Syndrome?

A

multiple endocrine neoplasia type 1 (MEN1)

41
Q

Is MEN1 an autosomal dominant or recessive condition?

A

autosomal dominant

42
Q

What is multiple endocrine neoplasia?

A

an autosomal condition characterised by endocrine tumours, particularly of the pancreas, parathyroid glands, duodenum and pituitary gland