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
Who is anti-reflux surgery for?
not responded to medical management
cannot tolerate medications due to side effects
those who do not want to be on medications lifelong
What surgery is done for reflux?
Nissen fundoplication surgery
fundus of stomach is wrapped around oesophagus to reinforce sphincter
What are the tiers for obesity management?
Tier 1 = universal interventions
Tier 2 = lifestyle interventions, diets, pharmacotherapy
Tier 3 = specialist services
Tier 4 = surgery
What is a sleeve gastrectomy?
part (sleeve) of stomach removed
contraindicated in patients with GORD
Roux en Y gastric bypass complications
anastomotic leak
internal herniation
Someone had a gastric band placed 5y ago. Now vomiting + epigastric pain. Diagnosis + management?
slipped band
distal stomach herniates upward through the band causing proximal band dilatation
can result in ischaemia and necrosis of stomach
band needs urgent deflation
