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GI, liver, kidney > GORD > Flashcards

GORD Flashcards

1
Q

What is GORD?

A

Chronic condition where reflux of gastric contents - bile, acid and pepsin - back into oesophagus -> heartburn and acid regurg symptoms

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2
Q

What symptoms are atypical but present in GORD?

A

Hoarseness
Cough
Asthma
Dental erosions

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3
Q

What are the diagnosis of GORD on endoscopy?

A

Oesophagitis - orophageal inglammation and erosions seen
Endoscopy negatie reflux disease - symptoms of GORD but normal endoscopy

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4
Q

Pathology of GORD

A

transient relaxation (reduced tone) of the lower oesophageal sphincter, increased intra-gastric pressure (for example straining and coughing), delayed gastric emptying, and impaired oesophageal clearance of acid

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5
Q

GORD risk factors

A

Stress and anxiety
Smoking and alcohol
Trigger foods - coffee, chocolate, fatty foods
Obestiy
Drugs that decrease LOS pressure
Preganancy
Hiatus hernia
FH

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6
Q

How do coffee + chocolate vs fatty foods worsen GORD?

A

c+c -> lowered LOS tone,
Fatty foods - delay gastric emptying

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7
Q

Drugs that increase risk of GORD

A

Alpha blockers
Anticholinergucs
benzos
Beta blockers
Bisphosphonates
CCBs
Corticosteroids
NSAIDs
Theophyllines
Tricyclic antidepressnts

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8
Q

Risk factors for developing barretts oeophagus

A

Male
Long duration and increased frequency of GORD symptoms
Prev oesophagitis or hiatus hernia, stricutre or ulcers

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9
Q

Complications of GORD

A

Oesophageal ulcers
Oesophageal haemorrhage
Anaemia - chronic blood losss - severe oesophagitis
Oesophageal structure - fibrosis narrows lumen
Aspiration pneumonia
Barretts
Oral problems - gingivitis, eroisions, halitosis

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10
Q

What is barretss oesophagus?

A

Columnar metaplasia of distal oesophagus
Malginant potential + risk oeophageal adenocarcinoma

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11
Q

Lifestyle advice for GORD

A

Lose weight if overwieight
Avoid trigger foods - coffe, chocolate, tomatos, fatty, spicy
Smaller meals and eat evening meals 3-4 hours before going to bed
Stop smoking
Reduce alcohol consumption

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12
Q

Mananging GORD

A

Raised head of bed, not additional pillows
Assess for stress and anxiety
Ask about OTCs
Offer lifestyle advice
Review meds + consider stopping exacerbatinig

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13
Q

Medication management for proven GORD

A

Full dose PPI for 4 weeks to aid healing

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14
Q

Severe oesophagitis medicaiton

A

Full dose for 8 weeks to aid healing and as long term maintenance treatment

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15
Q

When are PPIs given in the day?

A

30 mins before breakfast and evening meal

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16
Q

Contraindications PPIs

A

-alarm symptoms before endoscopy - mask symtpoms
- stop 2 weeks before endoscopy
-at risk of osteoporosis
-at risk of hypomagnesaemia

17
Q

Common Adverse effects of PPIs

A

Headahce, diarrhoea, nausea, vomitting, abdo pain, constipation, dizziness

18
Q

Long term PPI risks serious adverse effects

A

hypomagnesaemia
Increased fracture risk
C difficile
Rebound hypersecretion syndrome

19
Q

What else can be used to treat GORD?

A

H2 receptor agonists
Antacids

20
Q

Antacid examples

A

Aluminium hydroxide, sodium bicarb, calcoium carbonate

21
Q

H2 receptor antagonists examples

A

Ranitidne, cimetidine

22
Q

Surgeries for GORD

A

Fundoplication - strengthen LOS by wrapping gastric fundus around it
Laprascopic insertion of magnetic bead band

23
Q

Investigations GORD

A

FBC
Endoscopy
CXR
Barium swallow
Oeophageal pH monitoring

24
Q

Why do FBC in GORD

A

Exclude anaemia

25
Q

What is investgiation of choice GORD

A

Endoscopy

26
Q

What can diagnose a hiatus hernia?

A

CXR
Barium swallow

27
Q

What causes GORD?

A

Incompetenve of atirefluc barriers at oesophagetic juntion
Lower oesophageal sphinctre and crural diaphragm
Causes refluc of acid and irritatnts into oesophagus froms tomach

28
Q

What causes severe oesophagitis?

A

Loss of mucosal defence mechanisms on prolonged exposure to acid

29
Q

Risk factors for GORD

A

Stress and anxiety
Smoking
Alcohol excess
Fatty foods and coffee
Drugs that decrease LOS pressure
Pregnancy
Hiatus hernia
FH

30
Q

What drugs decrease LOS pressure

A

Tricyclic antidepressants, anticholinergics, nitrates and CCBs

31
Q

Clinical features of GORD

A

Heartburn - lying, stooping, straingin
trosternal discomfort
Acid brash
Water brash
Odynophagia
Chest pain/epigastric pain
Bloating
Chronic hoarseness, cough and asthmatic sym,ptoms

32
Q

Acid vs water brash

A

Regurg of acid or bile
Excessive salivation

33
Q

What does being ashkenazi jewish descent make you more likely to have?

A

UC

34
Q

When do you get hypoalbuminaemia in UC?

A

Severe disease

35
Q

Biologics that can be used in UC

A

Anti-TNFa (e.g. Infliximab)
Anti-IL-12/23 (e.g. Ustekinumab)
Anti a4b7 (e.g. Vedolizumab)

36
Q

What does barretts oesophagus increase the risk of?

A

Oesophageal carcinoma

37
Q

What does epithelium change from to in Barretts?

A

From squamous to columnar intestinal epithelium

38
Q

What is seen on endoscopy with barretts?

A

Slamon coloured columnar epithelium above the gastro-oeophageal junction - at least 1 cm

39
Q

What determines severity of barretts

A

Prague C+M classification

GI, liver, kidney (50 decks)

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