GORD Flashcards

1
Q

What is GORD?

A

Reflux of stomach acid back through the LOS, iritating the oesophageal lining.

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2
Q

Why is the oesophagus affected by the acid and not the stomach?

A

Oesophagus has a squamous epithelial lining.

Stomach has columnar epithelial lining and bicarbonate-rich mucus.

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3
Q

What causes the reflux to occur?

A

Transient relaxation of the LOS

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4
Q

How does GORD present?

A

Burning retrosternal chest pain:

  • Worse when flat
  • Worse with certain foods
  • Hoarse voice
  • Acid brash (acid in throat, salivate more- water brash)
  • Cough
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5
Q

When should you do an OGD in GORD?

A

Concerning Features/Red Flags

  • Dysphagia
  • Age 55+
  • Weight Loss
  • Bleeds
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6
Q

When should you admit urgently?

A

Bleeds:

  • Melaena
  • Coffee ground
  • Low Hb
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7
Q

How is GORD conservatively managed?

A
  • Reduce caffeine and citrus
  • Smaller, lighter meals
  • Don’t eat before bed
  • Weight loss
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8
Q

What OTC medication should be tried first?

A
  • Gaviscon

- Rennie

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9
Q

How do Gaviscon and Rennie work?

A

Antacids

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10
Q

What drug should be prescribed first hand?

A

PPIs

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11
Q

What else may be prescribed for GORD?

A

Ranitidine

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12
Q

How does Ranitidine work?

A

H2 antagonist

- Blocks parietal cell stimulation

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13
Q

What surgery is used for GORD?

A

Fundoplication

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14
Q

How does fundoplication work?

A

Narrows the LOS

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15
Q

What can predispose to GORD and gastritis?

A

H.pylori

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16
Q

What is H.pylori

A

Gram negative helical bacteria

17
Q

Is H.pylori aerobic or anaerobic?

A

Aerobic

18
Q

How does H.pylori avoid the gastric acid?

A

Sits in the gastric mucosa

19
Q

How does H.pylori cause epithelial damage?

A

Breaks the gastric mucosa, exposing the epithelial lining underneath to the acid

20
Q

What does H.pylori produce?

A

Ammonia (neutralises HCl)

21
Q

Who gets a H.pylori test?

A

Anyone with dyspepsia

22
Q

What are the H.pylori tests?

A
  • Urea breath test using radiolabelled C-13
  • Stool antigen test
  • Rapid urease test (on endoscopy)
23
Q

What is the rapid urease test?

A

CLO Test

  • Biopsy on endoscopy
  • Add urea to the sample
  • H.pylori will use urease to turn the urea to ammonia
  • Sample turns alkaline
24
Q

How is H.pylori treated?

A

Triple eradication

25
Q

What is triple eradication?

A
  • Lansoprazole
  • Clarithromycin
  • Amoxicillin
26
Q

How does lansoprazole work?

A

PPI

27
Q

How does clarithromycin work?

A

Protein synthesis inhibition

Think Clarithromyprotein

28
Q

How does amoxicillin work?

A

Beta-lactam- inhibits peptidoglycan cell wall

29
Q

What is Barrett’s Oesophagus?

A

Metaplasia

- Squamous to columnar epithelium

30
Q

What happens to the symptoms with Barrett’s?

A

Symptoms tend to improve

31
Q

What is the lifetime risk of malignancy with Barrett’s?

A

5%

32
Q

What cancer can Barrett’s cause?

A

Adenocarcinoma

33
Q

How is Barrett’s treated?

A

PPI

34
Q

What else is useful to prevent adenocarcinoma in Barrett’s?

A

Regular aspirin

35
Q

How might Barrett’s be resolved?

A

Destruction of the epithelium so it can regenerate:

  • Cryotherapy
  • Radiotherapy