GORD and hiatus hernia

Question 1

Briefly describe the pathophysiology of GORD

Answer 1

Lower oesophageal sphincter dysfunction → reflux of gastric contents →
oesophagitis

Question 2

Three risk factors for GORD?

Answer 2

hiatus hernia
smoking
alcohol
obesity
pregnancy
drugs

Question 3

Name two drugs that can induce GORD

Answer 3

CCB, TCAs, anti-ACh, nitrates

Question 4

Describe two oesophageal symptoms of GORD

Answer 4

Heartburn
Belching
Odonophagia- painful swallowing
Hypersalivation

Question 5

Describe two extra-oesophageal symptoms of GORD

Answer 5

Nocturnal asthma (lying down)
chronic cough
laryingitis, sinusitis

Question 6

List two complications of GORD

Answer 6

  Oesophagitis: heartburn 
  Ulceration: rarely → haematemesis, melaena, ↓Fe 
  Benign stricture: dysphagia 
  Barrett’s oesophagus 
  Oesophageal adenocarcinoma

Question 7

Two differential diagnoses for GORD?

Answer 7

Peptic ulcer disease
Oesophagitis (infection, IBD)
Oesophageal carcinoma

Question 8

Three investigations for suspected GORD?

Answer 8

Bloods: FBC
CXR: hiatus hernia
Ba swallow
24 hr pH testing

Question 9

When would an oesophago- gastro-duodenoscopy (OGD) be indicated?

Answer 9

  >55yrs 
  Symptoms >4wks 
  Dysphagia 
  Persistent symptoms despite Rx 
  Wt. loss

Question 10

Discuss two conservative options for GORD treatment

Answer 10

Small regular meals >3 hr before bed
Stop smoking and alcohol
Avoid hot drinks and spicy food
Stop drugs: NSAIDs, steroids, CCBs

Question 11

Name two drugs to treat GORD

Answer 11

PPI- lansoprazole
H2RA- ranitidine
OTC antacids: gaviscon

Question 12

What are the two types of hiatus hernia?

Answer 12

sliding and rolling

Question 13

Which hiatus hernia is the most common?

Answer 13

sliding (80%)

Question 14

Describe the structural abnormality of sliding hernia

Answer 14

Gastro-oesophageal junction slides up into chest

Question 15

Describe rolling hiatus hernia

Answer 15

Gastro-oesophageal junction remains in abdomen but a
bulge of stomach rolls into chest alongside the
oesophagus

Question 16

Is GORD more common in sliding or rolling hiatus hernia?

Answer 16

LOS remains intact in rolling hernia, therefore GORD uncommon. Sliding is associated with GORD

Question 17

List three investigations for GORD

Answer 17

CXR
Ba swallow
OGD
24 hr pH + manometry

Question 18

Which test is diagnostic of hiatus hernia?

Answer 18

Ba swallow

Question 19

If patient has hiatus hernia, what would you observe on their CXR?

Answer 19

gas bubble and fluid level in chest

Question 20

What is manometry?

Answer 20

Manometry measures the strength and muscle coordination of your esophagus when you swallow. During the manometry test, a thin, pressure-sensitive tube is passed through the nose, along the back of the throat, down the esophagus, and into the stomach

Question 21

What is the management of hiatus hernia?

Answer 21

lose weight, treat for reflux, surgery

Question 22

Strangulation is a risk of which hernia?

Answer 22

rolling hernia, therefore always perform surgery

Question 23

Name two organisms that cause infection in the oesophagus

Answer 23

candida albicans (fungus) and HSV (immunocompromised)

Question 24

Name two cancers of the oesophagus. What are the risk factors associated with these two cancers

Answer 24

squamous carcinoma and adenocarcinoma

SCC- smoking and drinking, adenocarcinoma- GERD and obesity

Question 25

What histological change arises in Barrett’s oesophagus?

Answer 25

squamous cells become glandular with goblet cells