GORD & Ulcers Flashcards
What are red flags to assess for ulcers or malignancyt
Dysphasia (2 week wait) >55 Weight loss Reflux/upper abdo pain Treatment resistant dyspepsia Nausea and vomit Low Hb Raised platelets
What are non medical management for GOR?
Reduce caffeine Weight loss Stop smoking Small ,light meals Upright after eating
What is medical management of GOR?
Antacids- Gaviscon or Rennie
PPI- Omeprazole, Lasoprazole
H2 receptor antagonist- Ranitidine
What is surgical procedure in GOR?
Laparoscopic fundoplication
How long must you be off PPIs to test for H pylori?
2 weeks
How does H pylori cause disease?
Burrows in breaking up epithelial protection
Produces ammonia
How is H pylori tested for?
Urea breath test
Stool antigen test
Rapid urea test (CLO test) during endoscopy
How is H pylori managed?
Triple therapy for 7 days then urea breath test to check clearance
PPI
Amox
Clarithro
What is Barrett’s Oesophagus?
Squamous cell metaplasia- premalignant
Does Barretts Oesophagus improve or worsen symptoms?
improve
How is Barrett’s Oesophagus managed?
PPIs
Aspirin
What is done in high grade dypsplasia in Barretts?
Ablation on endoscopy
What are causes of increased acid
Alcohol Spicy food Stress Smoking Caffeine
What medications increae risk of ulcers?
NSAIDs
Steroids
How do gastric ulcers present?
Epigastric pain N and Vomit Dyspepsia Haematemesis Melaena Fe deficient anaemia
What is the difference between gastric and duodenal ulcers?
Gastric are worsened by eating
Duodenal are improved by eating
How do you investigate ulcers?
Endoscopy and CLO test
How do you treat ulcers?
PPIs
What are complications of ulcers?
Perforation
Scarring and stricture
Pyloric stenosis
Distention
What is the scoring used for upper GI bleeds?
Blatchford Glasgow scale
What is the Rockall Score used for?
Rebleeding risk in those who have had endoscopy and mortality
What should you always do for patients with Upper GI bleeds?
Get a group and save so units of blood ready to go in case
