GORD and PUD Flashcards
Symptoms of Gerd
Heartburn Acid reflex oesophagitis Halitosis Bloating and belching Nausea and/or vomiting Pain when swallowing (odynophagia) and/or difficulty swallowing (dysphagia)
Risk factors of Gerd
Obesity Hernia pregnancy Connective tissue disorders such as scleroderma Delayed stomach emptying
Two main types of hiatus hernia
Which has a risk of strangulation and what does this present as
Sliding- entire stomach moves upwards
Rolling - out pouching of stomach (possibility of strangulation)
–>Pain, unable to swallow because of gastric obstruction and feeling very bloated
Complications of GORD and symptoms
Oesophageal ulcers- bleeding, pain, odynophagia
Oesophageal stricture- dysphagia, odynophagia
Barretts oesophagus- normal stratified squamous to simple columnar
Oesophageal cancer- dysphagia, weight loss, persistent indigestion, hoarseness, persistent cough, haemoptysis, vomiting
Investigations to confirm gord
Refer if :
- Unsure of good diagnosis
- Symptoms are persistent, severe or unusual
- Not controlled by prescribed medication
- May benefit from surgery
- Signs of a potentially more severe condition, such as difficulty swallowing or unexplained weight loss
When to refer tor endoscopy same day
Presenting with dyspepsia with significant acute GI bleeding, refer on same day
Specialist investigations for GORD
oesophageal manometry and ambulatory 24h oesophageal pH monitoring (to quantify reflux and asses relationship between reflux episodes and person’s symptoms
Barium swallow meal to help exclude structural disorders such as hiatus hernia or motility disorders such as achalasia
Interventions for GORD
Offer full dose PPI for 8 weeks. Offer a full-dose PPI long term as maintenance treatment for people with severe oesophagitis
What are peptic ulcers
Defects in the gastric or duodenal mucosa that extend through the muscular mucosa
Duodenal ulcer symptom
May improve with food (delay gastric emptying)
May present with bleeding (posterior ulcer) or perforation (anterior)
Gastric ulcer symptom
May be more painful immediately after food
May present with small bleed (iron deficiency anaemia) or major haemorrhage (haematemesis)
causes of PUD
H.pylori
Long term used of NSAIDs, or high dose corticosteroids
What makes PUD worse
Stress
spicy food
Alcohol
Smoking
common symptoms of PUD
burning stomach pain Feeling of fullness, bloating or belching Fatty food intolerance Heartburn Nausea
Severe signs of ulcers
Vomiting or vomiting blood (red or black) Dark blood in stools or stools that are black or tarry trouble breathing Feeling faint N&V Unexplained weight loss Appetite changes Severe abdo pain (perforation)
How does stoking affect GI tract
Disrupts mucus renewal (which normally protects lining of stomach)
Disrupts proliferation of mucosal cells
Causes issues with blood flow, decrease immunity and protection imbalance
How do NSAIDs affect GI tract
Inhibit arachidonic acid pathway which inhibits COX1+2 pathway. Decreased prostaglandin production and therefore decrease platelet aggregation, vasodilation, inflammation response and increase gastric secretions
What gram is h.pylori
Gram -ve
How does h.pylori affect stomach
Produce urease enzyme that will hydrolyse urea –>ammonia
Ammonia neutralises gastric acid and damages mucosal wall
Those with peptic ulcers are commonly found to have H.pylori infections
Risks of H.pylori
Duodenal ulcer
Chronic gastritis
Gastric cancer
gastric ulcer
Testing for h.pylori
carbon 13 urea breath test or a stool antigen test
Lab based serology
When should urgent referrals for endoscopy be done
With dysphagia or Aged 55 and over with weight loss and any of the following: -Upper abdo pain -Reflux -Dyspepsia
When to repeat endoscopy
ppl with gastric ulcer and pylori repeat endoscopy 6-8 weeks after beginning treatment, depending on size of lesion
Offer people with peptic ulcers and pylori retesting for h.pylori 6-8 weeks after beginning treatme, depending on the size of the lesion
Perform -retesting for h.pylori using a carbon13 urea breath test. Don’t use stool anitigen test
