Upper GI surgery learning objectives:

Question 1

GORD: Learning objective 1:

What are the symptoms of GORD?

Aetiology
?

Answer 1

1) Burning retrosternal pain (heartburn)
2) Water brash - regurgitation of of contents into mouth

Aetiology:

1) Overeating and subsequent obestiy +western diet
2) Alcohol
3) Smoking

Patho: - Include:

1) Loss of LOS tone, or decreased tone over time leading to reflux of acid
2) oesophageal peristaltic activity - Disordered motility in the oesophagus
3) hiatus hernia and loss of normal anatomy: Strong association:
4) Acid being the strongest irratant

Question 2

What is Barrets oesophagus?

What is it associated with? What cell types are seen in this condition?

What association do hiatus hernias and GORD have? (barium swawllow photo example)

Answer 2

It is a pre-malignant condition seen in patient with GORD: it is associated with replacement squamous mucosa with Gastric columnar epithelium:

• this columnar epithelium is non functional and patients often lose symptoms but have damage - Can transfor into adenocarcinoma

Patients often have 1) Stricture formation 2) chronic blood loss - leading to IDA

Resp issues such as chronic infections (children) and asthma, occasionally cause GORD -

Question 3

Clinical presentation of GORD?

Investigations?

Answer 3

• Majority of patients present with retrosternal burning pain occuring after eating - in particular certain foods. Example: Sweets, acidity (tomatos) and fatty foods are likely to cause heartburn
• Certain types of activity can bring it on: stooping, excercising, laying down
• Waking at night due to symptoms is common. Especially if eating prior or etoh
• ETOH + strong causative factor
• Regurgitation of gastric contents occurs, can wake pt at night, causing patient to cough
• Some patients may present with difficulty swallowing - But other may present with tiredness and iron deficient anaemia, recurrent respiratory infections, hoarseness of voice, halitosis and loss of teeth enamel

Question 4

Treatment of GORD?

Answer 4

Lifestyle:

1) weight reduction
2) Reducing alcohol
3) Avoidance of trigger foods
4) Pt taken OTC antacids

Medical:

1) Prolonged administration of Proton pump inhibitors (omeprazole, lanzoprazole) - Disadvantages - decreased ca absorption long term - still unknown

Surgical: Fundoplication -

1) Antireflux surgery (fundoplication) -

Pros- Stops reflux, Cons: