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Z Year3 Gastro Conditions > GORD > Flashcards

GORD Flashcards

1
Q

How common is GORD?

A

10-30% of people in developed countries

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2
Q

What are the risk factors for GORD?

A
  1. FHx of heartburn or GORD
  2. Obesity
  3. Older age
  4. Hiatus hernia
  5. Lower oesophageal sphincter hypotension
  6. Stress
  7. Asthma
  8. Smoking
  9. Alcohol
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3
Q

What are the oesophageal symptoms of GORD like?

A
  1. Hearburn
  2. Acid regurgitation
  3. Bloating
  4. Dysphagia
  5. Waterbrash + acid brash
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4
Q

What is the heart burn like in GORD?

A
  • burning sensation in the chest
  • after meals is typical
  • worse after the patient has been lying down or bending over
  • at night, but is not usually
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5
Q

What the acid regurgitation like in GORD?

A

sour bitter taste usually after meals

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6
Q

What are the extra-oesophageal symptoms of GORD?

A
  1. Cough
  2. Nocturnal Asthma
  3. Laryngitis
  4. Sinusitis
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7
Q

What are the possible differential diagnosis of GORD?

A
  1. Acute coronary syndrome
  2. Stable angina
  3. Functional oesophageal disorder/functional heartburn
  4. Achalasia
  5. Functional (non-ulcer) dyspepsia
  6. Peptic ulcer disease
  7. Eosinophilic oesophagitis
  8. Proton pump inhibitor-responsive oesophageal eosinophilia
  9. Malignancy
  10. Laryngopharyngeal reflux
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8
Q

What is the first line investigation for GORD?

A

PPI trial: symptoms improve 8 week

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9
Q

When do you consider further investigations?

A

ALARM symptoms or no improvement with PPIs after 8 weeks

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10
Q

What other investigations do you consider and why?

A
  1. OGD: may show oesophagitis (erosion, ulcerations, strictures) or Barrett’s oesophagus
  2. Ambulatory pH monitoring
  3. Oesophageal manometry: check for motility disorders
  4. Barium swallow
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11
Q

What definitions are used to classify oesophageal syndromes?

A

montreal defintion

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12
Q

What is the 1st line treatment of acute initial presentation GORD?

A
  • 1st line: standard dose PPI inhibitor: 8 weeks e.g. omeprazole: 20 mg orally once daily
  • Plus: lifestyle changes
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13
Q

What is the 1st line ongoing treatment for GORD that is PPI-responsive?

A

continued standard dose PPI

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14
Q

What is the 2nd line ongoing treatment for GORD that is PPI-responsive?

A
  1. 2nd line: surgery e.g open fundoplication, laparoscopic fundoplication, magnetic sphincter augmentation
  2. 2nd line: transoral incisionless fundoplication
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15
Q

What is the 1st line treatment for incomplete response to PPI GORD?

A

1st line: High dose PPI + further testing

Adjunct: H2 antagonist e.g famotidine

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16
Q

What are the possible complications of GORD?

A
  1. Oesophageal ulcer, haemorrhage or perforation
  2. Oesophageal stricture
  3. Barrett’s oesophagus
  4. Adenocarcinoma of the oesophagus
17
Q

What is the prognosis of GORD?

A

need to maintain medication compliance

18
Q

What are other RF of GORD?

A
  1. Hiatus hernia
  2. Gastric acid hypersecretion
  3. Pregnancy
19
Q

What is common presentation for GORD?

A
  1. Heartburn (pain in chest) after meals
  2. Acid regurgitation leaving bitter taste in mouth - ASK IN OSCE
  3. Waterbrash (increased salivation)
  4. Odynophagia if oesophagitis or ulceration
  5. Chornic cough or nocturnal asthma
20
Q

What is the lifestyle management for GORD?

A
  1. Weight loss
  2. Smoking cessation
  3. Small regular meals
  4. Avoid food that can exacerbate
21
Q

What is the medical management of GORD?

A
  1. Continue PPI was working before adding H2 blocker as well
  2. Antacids may be useful for symptom relief as well
22
Q

What is the surgical management of GORD?

A
  1. Nissen fundoplication
  2. Magnetic bead band
  3. All forms of surgery aim to increase LOS pressure
23
Q

What are other complications of GORD?

A
  1. Ulceration/perforation
  2. Barrett’ oesophagus
  3. Oesophageal cancer
24
Q

What are some LOS tone reducing drugs?

A
  1. TCA’s
  2. Nitrates
  3. Anticholinergics

Z Year3 Gastro Conditions (48 decks)

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