Oesophagus + Stomach Flashcards
What is the pathophysiology of GORD?
Reflux of gastric contents through the lower oesophageal sphincter into the oesophagus
Repeat episodes leads to inflammation of the mucosa of the lower oesophagus
What are some risk factors for GORD?
Male
Obesity
Pregnant
Smoking
Alcohol
Hiatus hernia
What is a common presentation of GORD?
Retrosternal burning pain after meals
No weight loss
No Dysphagia
No alcohol
No smoking
What are some differentials for a presentation that is GORD?
Peptic ulcer disease
Gastric cancer
Oesophageal cancer
MI
What important anatomical features prevent reflux of gastric contents?
Lower oesophageal sphincter
Right crus of diaphragm
Acute angle of entry of oesophagus into stomach
Gastric emptying time
Pressure difference
What is the steps in approaching managing GORD?
Clinical diagnosis so doesn’t require imaging
Advise conservative/lifestyle changes and then medication
Only image if this doesn’t work or they have red flag symptoms
What are the lifestyle changes advised for GORD?
Weight loss
Exercise
Smoking cessation
Reduce fatty/spicy foods
Reduce alcohol intake
What medications are given for GORD?
PPIs like lansoprazole or omeprazole
What are some red flag symptoms that would warrant imaging for?
Progressive Dysphagia
Weight loss
Early satiety
Persistent symptoms despite PPI treatment
What imaging/investigations are done for patients with red flag symtpoms or non resolving GORD with PPIs?
Urgent OGD (2wk wait)
ECG (rules out cardiac cause of pain)
24hr pH monitoring
H-pylori test (CLO test)
What are some complications of GORD?
Barrett’s oesophagus
Oesophageal cancer
Oesophageal strictures
Aspiration pneumonia
What is Barrett’s oesophagus?
Metaplastic changes of the lower 1/3 of the oesophagus from stratified squamous cells to columnar epithelial cells (glandular cells of the stomach)
What are some pre surgical investigations that are done for GORD?
Barium oesophagus
Oesophageal manometry
24hr pH monitoring
What are the 2 surgical procedures for GORD?
Fundoplication
Cruroplasty
What is a fundoplication?
Where the fundus of the stomach is wrapped around the gastro-oesphogeal junction acting like another lower oesophageal sphincter
What is a hernia?
When an organ or tissue protrudes through the confines of the cavity it should be in into another cavity
What is the definition of a hiatus hernia?
Protrusion of an abdominal organ from the abdominal cavity into the thorax from the oesophageal hiatus
What are the 3 types of Hiatus hernia?
Sliding
Rolling
Mixed
What is a sliding hiatus hernia?
When the stomach follows the oesophagus upwards
What is a rolling hiatus hernia?
Stomach appears next to oesophagus
What vertebral level is the oesophageal hiatus?
T10
What are the risk factors for hiatus hernia?
Age
Chronic cough
Larger diaphragmatic hiatus
Pregnancy
Obesity
Ascites
Previous oesphageal or stomach surgery
How do hiatus hernia present?
Typically asymptomatic
GORD
Mild Epigastric pain
May get swallowing difficulties
How is hiatus hernia managed?
Same as GORD
Lifestyle (weight loss, smoking cessation, cease alcohol)
PPIs
Surgery (fundoplication, cruroplasty)