Upper GI disease Flashcards
Describe the presentation of GORD
- Heartburn occurring after meals/nighttime: central chest discomfort, burning character
- Regurgitation
- Bad taste in the mouth
- Chronic dry cough
- Hoarseness
Describe the signs of GORD
Usually no signs
-Dental erosion
Describe the investigations for GORD
Dx is clinical, no need for further Ix unless red flag symptoms
- FIT test
- Bloods: FBC, CRP, B12
- OGD for alarm/atypical/relapsing
- Oesophageal pH monitoring: rarely used
What are some red flag features in GORD?
Alarm symptoms:
- Weight loss
- Anaemia
- Dysphagia
- GI bleeding: melaena, haematemesis
- Persistent vomiting
Describe the management of GORD
Conservative:
- Lifestyle: weight loss, smoking and alcohol cessation
- Dietary advice: avoidance, meal size etc
Medical:
-PPIs 1st line. 8 week trial is Dx -> H2R antagonists
Surgical:
-Laparoscopic Nissen fundoplication
Describe the complications of GORD
Short term:
-Oesophagitis
Long term:
- Barrett’s oesophagus
- Strictures
- Carcinoma
- Dental erosion
Define peptic ulcers
Breach in the lining of the stomach or duodenum to the depth of the muscularis mucosa
Describe the aetiology of peptic ulcer disease
Top causes are NSAIDs and H pylori infection Also: -Smoking -Alcohol -Stress ulcers e.g ITU patients -Zollinger-Ellison syndrome -Medications: bisphosphonates, steroids -Inflammation: Crohn's
Which are more common, gastric or duodenal ulcers?
Duodenal
Describe the presentation of peptic ulcers
Dyspepsia: intermittent dull aching epigastric pain
-Gastric: pain worse before and during meals
-Duodenal: relieved by eating
+ nausea, vomiting, early satiety rarely
Possible sudden onset in erosions:
-Haematemesis
-Shock
-Peritonitis
Describe the signs of peptic ulcer disease
Usually normal exam
Some mild epigastric tenderness
Describe the investigations for peptic ulcer disease
History and exam
Stool antigen test/urease breath test for H pylori
Bloods: FBC, iron studies if needed
OGD: gold standard for diagnosis
-2WW: for any pt with weight loss over 55 yrs + dyspepsia, epigastric pain, reflux
Describe the management of peptic ulcer disease
Conservative:
- Avoid trigger: stop NSAIDs where possible
- Lifestyle: stop smoking, alcohol, dietary modification
Medical:
- H pylori eradication: triple therapy (amox + clari/metro + PPI)
- PPI/H2RA: 8 week trial
What are the considerations for H pylori testing?
- No PPI for 2 weeks
- No Abx for 4 weeks
- Confirm eradication after 6-8 weeks from treatment
What are the standard doses of common PPIs?
Omeprazole: 20mg OD
Lansoprazole: 30 mg OD
Pantoprazole: 40 mg OD
What are the common side effects and interactions of PPIs?
GI upset: diarrhoea, constipation, nausea
Headaches
Hypomagnesaemia
Increased risk of osteoporosis
Interactions: don’t give omeprazole with clopi
What are the common side effects and interactions of H2RA?
Usually v well tolerated
- GI upset
- Headaches
- no interactions
Describe the aetiology of gastritis
Acute vs chronic gastritis
Acute: Same as peptic ulcer disease
-NSAIDs, H pylori
-Alcohol
Chronic:
- Autoimmune
- H pylori
Describe the presentation of acute gastritis
Essentially the same as peptic ulcer disease
- Dyspepsia: dull aching epigastric pain
- Nausea and vomiting
- Loss of appetite
Describe the investigations for gastritis
The same as for peptic ulcer disease
- H pylori testing: breath test or stool Ag test
- Consider bloods: FBC, B12, antibodies
- OGD: in >55s with weight loss + dyspepsia/reflux/ epigastric pain
Describe the management of gastritis
As for peptic ulcer disease
Describe the complications of peptic ulcer disease + gastritis
Acute:
- Perforation
- Erosion + haemorrhage
Chronic:
- Carcinoma, lymphoma
- Strictures
Define achalasia
Oesophageal motor disorder caused by aperistalsis and impaired relaxation of the oesophageal sphincter -> narrowing of the distal oesophagus
Describe the presentation of achalasia
- Progressive dysphagia to solids + liquids, with posturing to aide swallowing
- Regurgitation
- Weight loss
- Recurrent infections
