Oesophageal and gastric disease Flashcards
what is GORD
acid reflux due to incompetent LOS and poor oesophageal clearance
lifestyle management of GORD
smoking cessation
weight loss
trigger avoidance
why are antacids not the best for treating GORD
only provide symptomatic treatment, do not give stomach and oesophagus time to heal
true/false - ranitidine has tolerance after 8 weeks
false - after 4
best treatment of GORD
30mg lansoprazole - PPI
where would surgery for GORD be indicated
young patients with severe disease
what is a complication of barretts oesophagus
adenocarcinoma
what is gastroparesis
delayed gastric emptying with no physical obstruction
cause of gastroparesis
idiopathic diabetes cannabis anticholinergics/opiates systemic disease
investigation of gastroparesis
gastric emptying studies
management of gastroparesis
liquid diet
eat little and often
remove cause eg drug
gastric pacemaker
describe dyspepsia by the rome III criteria
epigastric pain/burning
postprandial fullness
early satiety
dyspepsia is more common with ___ and ____
H.pylori
NSAIDs
how would uncomplicated dyspepsia present on examination
epigastric tenderness
how would complicated dyspepsia present on examination
cachexia, mass, peritonism, gastric outflow obstruction
common causes of PUD
h pylori
NSAIDs
complications of h pylori infection
PUD - duodenal ulcer
non-cardia gastric adenocarcinoma
low grade gastric lymphoma
management of h pylori ulcer
triple therapy - amoxicillin/metronidazole and clarithromycin with PPI for 1 week
if NSAID induced ulcer what is the treatment
PPI
remove NSAIDs
complications of PUD
anaemia
bleeding
perforation
fibrosis so gastric outlet/duodenal obstruction
cause of acute upper GI bleed
duodenal/gastric ulcer
gastric erosion
oesophagitis
neoplasia
how do you identify a poor prognostic group in acute upper GI bleed
Systolic <100mmHg
pulse>100
Hb<100g/L
age>60
treatment of bleeding peptic ulcers
injection of adrenaline heat probe coagulation clips haemospray IV omeprazole - acid suppression
risk factors for bleeding varices
portal pressure >12mmHg
varices >25% oesophageal lumen
red signs
liver failure
mortality of bleeding varices
25-50%
treatment of acute variceal bleed
terlipressin endoscopic variceal ligation scleropathy balloon TIPS
