GORD Flashcards
What is GORD?
Reflux of gastric acid into oesophagus
Physiologically, what does GORD do to the oesophagus and stomach?
Thickening of squamous epithelium
Ulceration of epithelium when severe
Loss of oesophageal sphincter
Herniation of proximal part of stomach through diaphragm and into chest
Fibrosis of tissue=no peristalsis=food/liquid may accumulate
GORD can lead to Barrett’s oesophagus, what is this?
Type of metaplasia
- transformation of normal squamous to glandular epithelium
- protective mechanism
- higher risk of malignancy
S+S of GORD?
Heartburn
Cough
Waterbrash
Sleep disturbance
Risk factors for GORD?
Pregnancy Obesity Drugs lowering LOS pressure Smoking Alcoholism Hypomobility Men Caucasian>black>Asian
Endoscopy for GORD Ix?
No
Poor diagnostic test
Must be done of alarm features present for malignancy (dysphagia, vomiting, weight loss)
Aetiology
Transient relaxations of LOS Hypotension of LOS Delayed gastric emptying Delayed oesophageal emptying Slower oesophageal acid clearance Decreased tissue resistance to acid/bile
Hiatus hernia=2 types
- sliding
- paraoesophagheal
Lead to mucosa exposed to acid (pepsin and bile)
Increased cell loss and regenerative activity (inflammation)
Erosive oesophagitis
Complications of GORD
Ulceration Stricture Glandular metaplasia Erosive oesophagitis Carcinoma
Tx for Barrett’s oesophagus
Endoscopic mucosal resection
Radio-frequency ablation
Tx for GORD
Lifestyle measures Alginates -gaviscon H2RA -randitine PPI -omeprazole Anti-reflux surgery -fundoplication
Describe the S+S dyspepsia
Pain or discomfort in the upper abdomen Retrosternal pain Anorexia Nausea Vomiting Bloating Fullness Early satiety Heartburn
Ix for dyspepsia
FBC Ferritin LFT U+E Calcium Gallstones Coeliac serology
Tx for dyspepsia
NSAIDs Steroids Bisphosphates Ca antagonists Lifestyle -alcohol -diet -smoking -excercise -weight reduction
