upper GI conditions (week 3) Flashcards
what causes acid reflux in oesophageal disease and what can reduce LOS pressure?
lower oesophageal sphincter pressure loss
certain drugs and foods can cause it to lower (e.g. alcohol, nicotine, dietary xanthines)
what is important to ask about in patients presenting with dysphagia?
type of food they struggle swallowing
pattern (if it is progressive, can indicate malignancy)
associated factors (cough, weight loss, regurgitation)
what investigations do we use for oesophageal disease?
oesophago-gastro-dueonscopy
upper GI endoscopy
constrast radiology (rarely used)
pH measurement
manometry (patient given food to swallow and pressure changes monitored by tube sensor down the throat)
hypermotility disorders - what is most common disorder of this kind and what can patients present with?
diffuse oesophageal spasm
‘corkscrew appearance, on barium swallow, as well as chest pain (can be confused for angina/MI)
treated with smooth muscle relaxants (e.g, nitrates and Calcium channel antag.)
what is hypomotility associated with and what is the most common type?
connective tissue disorders, diabetes, neuropathy
achalasia (functional loss of myenteric plexus ganglion), caused by failure of LOS to relax
what are the symptoms of achalasia?
progressive dysphagia for solids and liquids
weight loss
chest pain
regurgitation and chest infection (due to stasis of food contents)
describe the treatment options for achalasia and what of these is the most effective?
drugs - nitrates + CCB
endoscopic - botox balloon dilatation
surgical - myotomy (BEST RESULT)
what is the most oesophageal disorder?
gastro-oesophageal reflux disease
what causes GORD and what are its symptoms and risk factors?
recurrent acid in lower oesophagus
heart burn, sleep disturbance, water brash (lots of saliva production), cough
pregnancy, certain drugs which lower pressure, alcoholism, obesity
CAN BE DIAGNOSED JUST OFF SYMPTOMS
what are the two types of GORD aetiology?
non-abnormal anatomy - tissues less resistant to acid (others as well)
hiatus hernia
what are the common treatments for GORD?
alginates - Gaviscon
H2RA - ranitidine
PPI - omeprazole
LIFESTYLE MEASURES
what investigations do we use to diagnose H.Pylori infection?
IgG against HP
urea breath test
stool antigen test
endoscopy - gastric biopsies , rapid slide urease test
what are symptoms associated with peptic ulcers?
epigastric pain and tenderness, hunger pain, nausea and occasionally vomiting, weight loss
how do we get rid of H. pylori infection?
triple therapy for 7 days
clarithromycin, amoxicillin, and PPI
