GORD

Question 1

Anat

Answer 1

Oes 25cm. Striated to smooth musc. Squam epith.
UOS striated musc, close at rest.
LOS smooth musc, 3-4cm, high rest press, diaph contribs.

Question 2

Peristalsis

Answer 2

Prim peristalsis- induced by swallow, 2-4cm/s, clear and neuts rfluxed acid.
Secondary- stubborn bolus or refluxed food.
Teritary contrac- non peristaltic waves, abn but comm in eld.

Question 3

Px

Answer 3

HB
Epig pain
Regurg
NV
Dental eros
Dysphagia
Odynophagia
Globus
CP
Resp symps
ENT symps
Rumination

Question 4

Mx

Answer 4

Medical. PPI 1st line. Poo rev for motil modif drugs.
Surg. Indics- choice, high vol reflux, PPI intol, fail drugs. Risks- death, fail, s/e (dysphagia, gas, flatus). Us laparoscopic- fundoplication wrap stom rnd oes. Linx new mag beads.
Endosc- suturing tx to form valve, uncomm.
Radio freq tx- stretta, musc hypert.

Question 5

Causes

Answer 5

Impaired clearance- saliva, distal oes motil.
Impaired intrinsic LOS
Impaired ext LOS of diaph crural fibres eg hiatus hernia
Acid and pepsin
Delayed gastric emptying
Duodenogastric reflux- PPI not help

Question 6

RF

Answer 6

Western popn
Obese
Smoking
Alc
Coffee
Choc
Genetic

Question 7

defin

Answer 7

Reflux gastric conts to oes causing oesophagitis, reflux symps suffic to impair qol or risk LT complics.

Question 8

Hiatus hernia

Answer 8

Gastric mucosa folds over 3cm above diaph
Most dont have GORD but most oesophagitis pts have one.
Hernia alone us asymp
T1- sliding, GO junc to chest, lax hiatus
T2- true paraoes (rolling)- fundus rolls up nest to oes, GO junc might be correct place.
T3 mixed.

Question 9

Ix

Answer 9

Endosc if mucosal inj ev
24hr ph study of acid reflux symps
Oes manometry if motil disorder
NICE- endosc if alarm symps, and if malig concern over 555 new onset dyspepsia. Actually do more often than that.

Question 10

Complics

Answer 10

Oesophagitis
Stricture
Barretts metaplasia squam to col