Medicine- GORD + IBS + Gallstones Flashcards
What is GORD?
a) Increased vomiting with fresh blood
b) Abnormal growth of cells in the oesophagus
c) Gastric contents refluxing back into oesophagus
d) Substernal chest pain which is worse on exertion
c) Gastric contents refluxing back into oesophagus
What does a barium swallow assess?
a) pH levels in stomach and oesophagus
b) Pressure of lower oesophageal sphincter
c) Defects and anomalies in oesophagus
d) Where a gastric bleed may be occurring
c) Defects and anomalies in oesophagus
Which test isn’t recommended in GORD
a) H pylori testing
b) Endoscopy
c) 24 hour pH monitoring
d) Barium swallow
a) H pylori testing
The test which isn’t recommended for GORD is useful in gastric ulcers
What is ‘GORD’
A common chronic condition
• Stomach contents such as acid, bile and pepsin reflux back into the oesophagus and irritates the lining
Complications for GORD?
• Complications include oesophagitis, oesophageal ulcer, oesophageal stricture, Barrett’s oesophagus and oesophageal cancer
What do you see with GORD in endoscope?
- Oesophagitis- oesophageal inflammation and mucosal erosions seen
- If endoscope normal but symptoms of GORD present it is known as endoscopy-negative reflux disease (non-erosive reflux disease)
Causes of GORD?
Caused by many mechanisms including weakening of lower oesophageal sphincter, increased intra-gastric pressure (e.g. straining and coughing), delayed gastric emptying and impaired oesophageal clearance of acid
Symptoms of GORD
- Predominantly heartburn and acid reflux
- Heartburn- burning chest pain below breastbone spreading to throat and worse after eating, bending over or lying down
- Acid reflux- stomach contents brought back up so unpleasant, sour taste at back of mouth
- Nausea and vomiting
- Bad breath
- Bloating
- Belching
- Dysphagia (food stuck low down throat)
- Sore throat
- Hoarseness • Pain when swallowing
- Persistent cough or wheezing (worse at night)
- Tooth decay
- Gum disease
Questions to ask in suspected GORD?
- Where does the chest pain radiate to? Helps differentiate respiratory and cardiac chest pain causes from GORD
- Any difficulty swallowing, fever or weight loss? Red flag symptoms for malignancy
- Is the pain worse after a few hours of eating food? Differentiate from gastric ulcer disease
- Any lower gastrointestinal symptoms, like bowel movement? To see if abnormalities in lower gastrointestinal tract too, Crohn’s is a condition affecting entire gastrointestinal trac
Epidemiology of GORD
- Prevalence in Europe of 8.8-25.9%
- Prevalence increased with age
- More common in women overall
- Woman are more likely to have endoscopy-negative reflux disease while men are more likely to have severe oesophagitis
Ix for GORD?
- Endoscopy
- Barium swallow or barium meal test
- Manometry
Lower oesophageal sphincter pressure, Oesophageal motility disorders, GORD more likely if abnormal results
- 24 hour pH monitoring
- Blood tests
Differentials DIagnosis?
Management for GORD?
CLinical examination findings for GORD?
- Look out for signs in hand like tar staining (smoker) which is a risk factor for GORD • Pain around retrosternal area
- Extra oesophageal signs:
- Cough or wheeze- aspiration gastric contents into trachea or from vagal reflex arc producing bronchoconstriction
- Hoarseness from vocal cord irritation by gastric reflux (morning usually)
OSCE Tips for GORD
- You could be asked to explain GORD to a parent
- GORD history taking is more likely than examining a patient with GORD so know how to take a chest pain history!
- Possible questions relating to GORD would be complications, investigations and management plan
What criteria do you use to diagnose IBS?
a) Glasgow-Blatchford
b) Rome IV
c) Rockall
d) Rome III
b) Rome IV
What can be mistaken for IBS?
a) Colorectal cancer
b) Inflammatory bowel disease
c) Coeliac disease
d) Gastroenteritis
ALL
Is there any histological changes in IBS?
a) Yes b) No
b) No
What is ‘IBS’
A functional disorder of the GI tract characterized by chronic abdominal pain and altered bowel habits
