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Gastrointestinal Conditions (JBR) > GORD, Barrett's Oesophagus, Oesophagitis > Flashcards

GORD, Barrett's Oesophagus, Oesophagitis Flashcards

1
Q

What does GORD stand for?

A

Gastro-oesophageal Reflux Disease

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2
Q

What are causes of GORD?

A 
Incompetent LOS
Poor oesophageal clearance or barrier function
Visceral sesntivity
Increased abdominal pressure 
Gastric acid hypersecretion
Slow gastric emptying 
Overating 
Surgery in achalasia 
Drugs 
Systemic sclerosis
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3
Q

What are causes of increased abdominal pressure increasing risk of GORD?

A

Obesity

Pregnancy

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4
Q

What are the major risk factors for GORD?

A

Smoking
Alcohol
Weight

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5
Q

Which drugs can cause GORD?

A

Tricyclics
Anticholinergics
Nitrates

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6
Q

What is associated with systemic sclerosis in the GORD context?

A

H. pylori

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7
Q

What is the pathological mechanism behind GORD?

A

Ulceration due to exposure

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8
Q

GORD is graded according to?

A

Erosion

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9
Q

What are the 4 grades of GORD?

A

Tiny erosion
> 5 mm
<75% affected
All affected

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10
Q

How does GORD present?

A 
Heartburn
Acid reflux 
Water brash (hyper-salivation) 
Dysphagia 
Odynophagia (pain on swallowing) 
Weight loss
Epigastric pain (mimic cardiac) 
Hoarseness
Cough 
Reflux bronchitis lying flat
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11
Q

How do you investigate GORD?

A 
Endoscopy
Barium swallow 
Oesophageal manometry
pH studies
Nuclear studies
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12
Q

Where are possible complications of GORD?

A 
Barrett's -> Oesophageal carinoma
Benign oesophageal stricture (Schatzki's rink)
Oesophagitis
Gastroparesis 
Achalasia
Hiatus hernia
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13
Q

What is gastroparesis?

A

Delayed gastric emptying without physical obstruction

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14
Q

What are symptoms of gastroparesis?

A 
Feeling full / bloated
Nausea
Vomiting (food fear) 
Weight loss
Epigastric pain
Feeling bloated
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15
Q

What are causes of gastroparesis?

A 
Idiopathic 
DM
Cannabis
Medication
Systemic disease (systemic sclerosis)
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16
Q

Which medications can cause gastroparesis?

A

Opiates

Anticholinergics

17
Q

How do you investigate gastroparesis?

A

Gastric emptying studies

18
Q

How do you manage gastroparesis?

A 
Remove provokers
Liquid/sloppy diet
Eat little and often
Pro-motility agents
Gastric pacemaker
19
Q

How do you manage GORD?

A 
If no erosion manage symptoms 
Lifestyle 
Antacid 
PPI
Surgery
20
Q

Which antacids can be given for GORD?

A

Magnesium trisillicate mixture

Gaviscon

21
Q

Which PPIs could be given for GORD?

A

Omeprazole

Lansoprozole

22
Q

How are PPIs like omeprazole absorbed?

A

Become active in acidic environment

Absorbed from GIT and delivered to secretory cancel of stomach where activated to sulferamide

23
Q

What is the mechanism of PPIs?

A

Modify membrane-inserted proton pumps

Inhibit acid secretion for 10-14 hours

24
Q

What is important for the timing of PPIs?

A

At least 40 minutes before meal

25
Q

PPIs only give full effect after?

A

Repeated dosing

26
Q

What are PPIs used for?

A

Peptic ulcers
GORD
Zollinger-Ellison Syndrome

27
Q

What is the surgical option for GORD?

A

Nissen Fundoplication
Tighten valve to prevent oesophagitis
(unlikely to be effective in severe/unresponsive disease)

28
Q

What is Barrett’s Oesophagus?

A

Irreversible (unless ablated) metabplastic change from stratified squamous to columnar epithelium as a protective response to persistent reflux of acid/bile

29
Q

Barrett’s oesophagus moves the _______ more proximal

A

squamo-columnar junction (Z-line)

30
Q

What are the risk factors for Barrett’s oesophagus?

A 
GORD
Hiatus hernia
Obesity
Smoking 
Alcohol
31
Q

What is the pathological pathway to Barrett’s oesophagus and possible complication?

A

Norma
Oesophagitis
Barrett’s Oesophagus
Adenocarcinoma

32
Q

How do you manage Barrett’s?

A

Lifestyle advice
Radiofrequency ablation
PPIs
Oesophagectomy

33
Q

What causes acute oesophagi’s?

A

Chemical ingestion (bleach, caustic substances) or infectious agent (candidiasis, herpes, CMV) in immunocompromised patients)

34
Q

What type of inflammation occurs with allergic oesophagi’s?

A

Eosinophilic

35
Q

What are risk factors for allergic oesophagitis?

A

Personal or FHx of atopy
Asthma
being young

36
Q

What are investigations for allergic oesophagitis?

A

pH probe negative for reflux
Increased eosinophils in blood
Corrugated ‘feline’ or ‘spotty’ oesophagus

37
Q

How do you treat allergic oesophagitis?

A

Steroids

Cromoglycate +/- Montelukast

Gastrointestinal Conditions (JBR) (33 decks)

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