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Ch. 3 - Upper GI Surgery > GORD > Flashcards

GORD Flashcards

1
Q

What is heartburn?

A

Retrosternal discomfort

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2
Q

With dysphagia comes pulmonary aspiration. What are the sequelae of pulmonary aspiration

A

1) Recurrent infection (pneumonia +/-sepsis) -> Bronchiectasis
2) Nocturnal coughing
3) Hoarse voice

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3
Q

Whatre the symptoms of GORD

A

Symptoms:
Retrosternal discomfort/heartburn
Acid reflux
Globus sensation
Dysphagia and chronic cough
Pulmonary aspiration (leading to recurrent infection, nocturnal coughing, hoarse voice)

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4
Q

What is the sequelae of mucosal injury caused by GORD

A

Ulceration causing pain
Strictures causing dysphagia, cough, and aspiration

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5
Q

What is GORD? Define it

A

Excessive reflux of gastric contents into the oesophagus, !through a defective lower oesophageal sphincter (LOS) !leading to
sx and/or mucosal injury

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6
Q

A 66 yo patient presents to the GP with the following symptoms:
Retrosternal discomfort/heartburn
Acid reflux
Globus sensation
Dysphagia and chronic cough
Pulmonary aspiration
Weight loss

How should the GP manage this patient?

A

Refer for urgent OGD

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7
Q

What foods cause gastric irritation?

A

Spicy food, coffee, chocolate

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8
Q

What are the RFs for GORD?

A

Modifiable:
Obesity,
pregnancy,
smoking and alcohol abuse,
ingestion of gastric irritants (coffee, chocolate, spicy food)

Non-modifiable:
Hiatus hernia
Family history of GORD
H.pylori inf

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9
Q

What are the 3 most important diagnostic investigations to perform for GORD?

A

1) De Meester Score
2) Oesophageal Manometry
3) OGD

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10
Q

What pH is significant for the DeMeester score?

A

pH<4

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11
Q

What is a De Meester score?
What is it used for? What are you looking for?

A

24-hour continuous pH monitoring assessing for peaks of pH change corresponding to symptoms along with number and duration of episodes where pH<4

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12
Q

What is oesophageal manometry? How is it conducted?
What is its use in the context of dysphagia/GORD

A

It is a diagnostic test used to assess the function of the lower oesophageal sphincter (LOS) and the muscles of the esophagus (peristalsis) to evaluate how well they work when swallowing.

Patient is fasting and medications affecting peristalsis (CCB, antacids) are stopped. A catheter is passed down the nose into the esophagus to measure the pH at different areas and different angles (position). The patient is asked to drink sips of water and pressures are measures.

It is used to diagnose achalasia or rule it out in the case of GORD or dysphagia

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13
Q

What is the role of OGD in GORD?

A

It is performed in all cases to rule out malignancy and pharyngeal pouch!, webs, Plummer Vinson

+ complications of GORD (strictures and ulcers)

Also determines if GORD is erosive vs. non-erosive AND short vs long segment

Done also to perform biopsy for Barrett’s esophagus

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14
Q

How can you ask about heartburn (indirectly) or increased stomach acidity when taking a history?

A

Does it feel better after drinking milk?

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15
Q

How would you determine if GORD is erosive or not erosive?

A

OGD

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16
Q

How many units of alcohol is the recommended amount according to NICE guidelines for men and women?

A

14 units for both men and women

17
Q

A person presents to the GP complaining of heartburn. What lifestyle advice will you give them?

A

Dietician for:
1) Smaller meals at regular intervals
2) Avoid late night food intake
3) Avoid gastric irritants (caffeine, chocolate, spicy food)
4) Weight loss (RF)

Quit.ie = Smoking cessation

AAA, education, limit to 14U => Alcohol control

Speech and language therapy (for severe cases)

18
Q

If PPIs arent sufficient or not tolerated what is the alternative medication for GORD?
Give an example

A

H2 receptor antagonist - Ranitidine

19
Q

Give a medication used for mucosal protection

Give an example of an antacid

A

Mucosal protection: Sucralfate
Ant-acid: Gaviscon

20
Q

What is the medical management for GORD?

A

PPI - Pentroprazole, omeprazole (+ calcium and vitamin. D supplements) +/- vit b12 supplements
H2 blockers - Ranitidine

Mucosal protection: Sucralfate
Ant-acid: Gaviscon

Pro-kinetic: Metoclopramide
+/- eradication of H-Pylori (PAC 500, PMC 250)

21
Q

Metoclopramide is used both as an antiemetic and a prokinetic. When should it be avoided

A

In patients with a first generation antipsychotic and those with parkinsons as it is a D2 antagonist

22
Q

What are the complications of GORD?

A

1) Oesophagitis
2) Ulceration
3) Strictures
4) Barret’s Oesophagus
5) Recurrent chest infections -> pneumonia

mucosal injury causing oesophagitis, ulceration and strictures + Reflux causing recurrent chest infections => pneumonia and barret’s oesophagus -> Adenocarcinoma

23
Q

What are the indications for surgical management of GORD?

What is the surgical management of GORD?

A

Indications:
1) Failed medical therapy (despite maximal dosage)
2) Large volume of reflux with increased risk of aspiration/multiple admissions
3) Complications of GORD (Barret’s, stricture, ulceration, oesophagitis)

Surgical management: Nissen’s, Dor’s/Anterior, Toupet/posterior Fundoplication

24
Q

The surgical management of GORD is Nissen’s, Dor’s, Toupet Fundoplication. What is fundoplication and whatre the differences between each?

A

Fundoplication is a surgical procedure in which the upper part of the stomach (the fundus) is wrapped around the lower end of the esophagus to reinforce the lower esophageal sphincter, preventing acid reflux

Nissen: Wrapping of fundus around the intraabdominal oesophagus
Dor: Anterior wrapping of fundus around cardia
Toupet: Posterior wrapping of fundus around cardia

25
Q

What is the full management plan for GORD?

A

1) Preventative/lifestyle:
Dietician for:
1) Smaller meals at regular intervals
2) Avoid late night food intake
3) Avoid gastric irritants (caffeine, chocolate, spicy food)
4) Weight loss (RF)

Quit.ie = Smoking cessation

AAA, education, limit to 14U => Alcohol control

Speech and language therapy (for severe cases)

2) Medical:
PPI - Pentroprazole, omeprazole
H2 blockers - Ranitidine

Mucosal protection: Sucralfate
Ant-acid: Gaviscon

Pro-kinetic: Metoclopramide
+/- eradication of H-Pylori (PAC 500, PMC 250)

3) Surgical: Nissen’s, Dor’s/Anterior, Toupet/posterior Fundoplication

26
Q

With pulmonary aspiration (e.g GORD), which lung is affected more often?
Why?

A

Right lung
that is because of the anatomical differences
At the bifurcation at the carina, the right main bronchus is shorter and more vertically oriented than the left

Ch. 3 - Upper GI Surgery (7 decks)

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