Hiatus hernias, reflux + bariatric surgery Flashcards
What substances can be refluxed?
gas
bile
acid
What is a hiatus hernia?
When part of the stomach is in the chest
bulges through diaphragm
CXR sign of hiatus hernia
retrocardiac air fluid level
Typical reflux symptoms
heartburn
chest pain
regurgitation
sensitivity to certain foods (esp cold)
acid brash (taste of acid at back of mouth)
worse with leaning forwards
worse at night time
Atypical reflux symptoms
cough
throat clearing
dental issues
When won’t PPIs work for reflux?
when reflux is mostly bile (PPIs work against acid)
What are some concerning reflux symptoms that suggest something more sinister may be going on?
anaemia
weight loss
haematemesis
melaena
vomiting
Name the 2 functional oesophageal disorders
reflux hypersensitivity
functional heartburn
Reflux complications
erosive oesophagitis
aspiration
Barrett’s oesophagus
peptic stricture
Lifestyle management of reflux
weight loss
adjusting head of bed
dietary adjustment (reducing alcohol, fizzy drinks, spicy food)
smoking cessation
reducing stress
eating 3 hours before bedtime
reducing caffeine (lower LOS pressure)
Pharmacological treatment of reflux
OTC - Gaviscon, Peptac
PPIs
H2 antagonists
Prokinetics (eg. domperidone)
baclofen
amitriptyline
Why does Rabeprazole work better for some people than other PPIs?
metabolised by different enzymes
if not responsive to other PPIs, might be responsive to Rabeprazole
How should PPIs be taken?
30-45mins before food
When should H2 antagonists be taken?
at bedtime
PPI adverse effects
diarrhoea
acute interstitial nephritis
hypomagnesaemia
