Oesophagus

Question 1

Define Hiatus Hernia with regard to anatomical type

Answer 1

Herniation of stomach through the oesophageal hiatus of the diaphragm

Sliding - 95%. The gastro-oesophageal junction herniates through the diaphragm. No symptoms unless there’s reflux

Para-oseophgeal - Fundus herniates through, but the GO junction remains below the hiatus. Risk of volvulus formation, bleeding and respiratory complications. Treated surgically

Question 2

Anatomical and physiological factors predisposing to gastro oesophageal reflux disease

Answer 2

Lower Oesophageal Sphincter (LOS) weakening 
Increased intra-abdominal pressure 
Large meals 
Obesity, Smoking, Alcohol, Fat, Coffee 
Hiatus Hernia 
Tight Clothes 
Drugs

Question 3

Typical symptoms of GORD

Answer 3

Chest Pain - Ascending Heart Burn (usually after eating)
Epigastric Pain
Bloating
Regurgitation
Odynophagia
Chronic Cough, Nocturnal Asthma (Aspiration)

Question 4

Investigations of GORD

Answer 4

Endoscopy
FBC - (anaemia)
Barium Swallow (Hiatus Hernia)
ph monitoring