Oesophageal disorders and GORD Flashcards
physiological mechanisms to prevent reflux?
LOS
acute angle of entry of oesophagus into stomach
mucosal folds act like a valve
R crus of diaphragm acts as a pinch cock
+ve IA pressure which compresses walls of oesophagus
most important factor considered in genesis of GORD?
reduced lower oesophageal sphincter pressure
aggravating factors for GORD?
rich, fatty or spicy meals- precipitate it
lying down- makes it worse
landmark for diagnosis of a hiatus hernia with endoscopy?
the diaphragm
this is indicated by the indentation of R crus of diaphragm
how is Barrett’s oesophagus identified with endoscopy?
squamo-columnar junction (Z-line) is at least 3 cm higher than GOJ.
Biopsies must be taken to confirm, and exclude dysplasia- pre-neoplastic change which is reversible but there is poor differentiation.
investigation essential for diagnosis of significant GORD, espec. in symptomatic ptnts with no oesophagitis (seen with erythema, strictures, ulceration etc.) at endoscopy?
24 hr ambulatory pH oesophageal recording and static manometry for motility disorder detection
what can barium swallow demonstrate in relation to GORD?
reflux directly
hiatus herniae
strictures
achalasia
why is a barium swallow often done prior to an endoscopy in suspected oesophageal malignancy?
malignancy easily perforated with endoscope
define achalasia
disorder of motility of the lower oesophageal or cardiac sphincter. The smooth muscle layer of the oesophagus has impaired peristalsis and failure of the sphincter to relax causes a functional stenosis or functional oesophageal stricture.
name of score calculated from pH oesophageal recording which if elevated may mean surgery offered to patient?
De Meester score
mainstay of anti-reflux surgery?
fundoplication
nissen fundoplication= most common- mobilisation of distal oesophagus, crural approx. and wrapping of mobilized fundus poster. around oesophagus through 360degrees.
if made floppy, can diminish gas bloat and dysphagia.
indications for nissen fundoplication?
symptomatic reflux and elevated De Meester scores in those not controlled by PPIs
young asymptomatic ptnts to avoid PPI therapy for the rest of their lives.
commonest reflux symptoms?
heartburn
regurgitation
may be chest pain mimicking angina
general tment of GORD?
weight reduction
head of bed elevation for nocturnal symtpoms
avoid fatty foods, coffee= these relax sphincter, reduce its pressure
avoid meals just before bed-time
stop smoking
milk- despite relief as alkaline, milk fats promote more acid secretion
medical tment of GORD?
antacids e.g. gaviscon
H2 anatagonist e.g. ranitidine, espec. if oesophagitis
PPIs- used in tment of benign strictures
