GORD and Hiatus Hernia Flashcards
What are the risk factors for GORD?
Obesity Alcohol Smoking Fhx GORD Increasing age Asthma Psychological stress Intake of specific foods e.g. coffee, mints, citrus fruits or fats
How can GORD result in asthma?
Vagal stimulation caused by acid in the lower oesophagus may cause chronic coughing and throat clearing. Reflux induced asthma may be caused by chronic aspiration of the reflux contents and vasovagal bronchoconstriction
Describe the. typical presentation of GORD?
Heartburn and regurgitation are the most reliable symptoms
These often occur after meals, especially large or fatty meals
Atypical symptoms include cough, laryngitis, asthma or dental erosion
Symptoms may be worse when the patient is lying down or bending over
Relief with antacids is typical
What are alarm symptoms in the presentation of GORD?
Anaemia Dysphagia Haematemesis Malaena Persistent vomiting Involuntary weight loss
Routine testing for h.pylori infection is recommended by guidelines in GORD. T/F?
True
Other than endoscopy, what investigations may be done for patients with GORD, particularly if symptoms are persistent?
Mannometry
Ambulatory 24-hour oesophageal pH
What lifestyle measures should be used to treat GORD?
Weight loss
Smoking cessation
Avoidance of late-night eating
What is the standard pharmacotherapy for GORD?
8 week treatment with PPIs - omeprazole
or H2 receptor antagonists
What type of surgery is used for GORD?
Fundoplication
Give an example of a H2 receptor antagonist?
Cimetidine and ranitidine
List some of the complications of GORD?
Oesophagitis Oesophageal ulcer Oesophageal stricture Barrett's oesophagus Adenocarcinoma of the oesophagus Iron deficiency anaemia
What is Barrett’s oesophagus?
Metaplasia of the oesophageal epithelium which is considered to. be a premalignant lesion
What is a hiatus hernia?
The protrusion of intra-abdominal contents through an enlarged oesophageal hiatus of the diaphragm
What are the risk factors for a hiatus hernia?
Obesity Male sex Advanced age Elevated intra-abdominal pressure Structural abnormalities of the oesophagus
Describe the difference between sliding and rolling hiatus hernia?
Sliding - the whole fundus of the stomach slides through the diaphragm and the lower oesophageal sphincter is no longer in contact with the diaphragm
Rolling - the fundus is pushed up through the gap in the diaphragm but the lower oesophageal sphincter remains in contact with the diaphragm
Which type of hiatus hernia is more likely to cause symptoms?
Sliding hiatus hernia because the disruption of the lower oesophageal sphincter
Which type of hiatus hernia is more likely to become strangulated?
Rolling hiatus hernia
What are the symptoms of hiatus hernia?
Often asymptomatic
Same symptoms as GORD - heartburn, regurgitation
May also be: dysphagia, odynophagia, vomiting, GI bleeding, early satiety, bloating, hoarseness, wheeze
How is hiatus hernia investigated?
CXR
Contrast upper GI series
Oesophago-gastroduodenoscopy
CT
The Nissen fundoplication is the surgery used to treat hiatus hernia. Describe the principle of how this works/
The fundus is wrapped around the distal oesophagus which encourages the lower oesophageal sphincter to assume its correct position and also acts as an artificial sphincter
What are the complications of surgery to repair hiatus hernia?
Gas bloat syndrome Dysphagia Dumping syndrome Excessive scarring Vagus nerve injury Achalasia
What findings would be seen on CXR when there is a hiatus hernia?
Retrocardiac air bubble
Describe the management of hiatus hernia
Strangulation / obstruction -> emergency surgical repair
Symptomatic GORD -> PPI and lifestyle changes
Rolling hernia -> surgical repair +/- anti-reflux procedure
What are the potential complications of hiatus hernia?
GI bleeding
Barrett’s oesophagus -> adenocarcinoma
Obstruction / strangulation
Gastric volvulus
