Reflux and GORD

Question 1

Vomiting

Answer 1

active forceful of gastric contents through mouth or nose

Question 2

Regurgitation

Answer 2

effortless gastric contents via oesophagus to oropharynx

Question 3

GOR

Answer 3

effortless passing of gastric contents to oesophagus

does not have to present at mouth

Question 4

Anti-reflux mechanisms

Answer 4

extrinsic - crura and angle of his

intrinsic - LES, increased tone 10-40mm, fluctuations in normal reflux

Question 5

Predisposition of reflux

Answer 5

CP
tubes in seriously ill
sliding hiatus hernia

Question 6

Complications

Answer 6

oesophagitis 
bleeding 
anaemia
dysphagia 
stricture formation

Question 7

Diagnosis

Answer 7

HISTORY
examination
focused diagnostic testing
barium swallow - not specific or sensitive for GOR
oesophageal pH monitoring - GOLD STANDARD FOR DOCUMENTING REFLUX
Radionucleotide scintigraphy - milk scan
Endoscopy

Question 8

Management of GOR

Answer 8

feeding and post feeding position - prone and elevate
change feeding pattern- frequent small feeds, thicken feeds, nestargel, gelatine
H2RA, PPI, Antacid, reduce acid and heal oesophagitis
Prokinetic agents - cisapride, domperidone, metoclopramide before meals, erythromycin
Surgery: Nissen fundoplication