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Y4 - CCC & PC > GORD + Diverticulitis > Flashcards

GORD + Diverticulitis Flashcards

1
Q

What is the definition of GORD?

A

symptoms resulting from the reflux of gastric contents into the oesophagus / beyond

there is usually a problem with the lower oesophageal sphincter (LOS) in which it doesn’t contract properly

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2
Q

What are the risk factors / causes associated with GORD?

A
  • LOS hypotension
  • hiatus hernia
  • obesity
  • gastric acid hypersecretion
  • alcohol
  • smoking
  • pregnancy
  • LOS tone reducing drugs (TCAs, nitrates, anticholinergics)

anything that puts pressure on the abdomen / stomach can force regurgitation into the oesophagus

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3
Q

What is the main symptom associated with GORD?

A

retrosternal (sometimes + epigastric) chest pain as a result of reflux of acidic contents

this pain may radiate to the jaw, back and arms

it can be difficult to distinguish from MI in the acute presentation

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4
Q

What are the other symptoms associated with GORD?

A
  • chest pain comes on after eating
  • acid regurgitation leaves a bitter taste in the mouth
  • waterbrash (increased salivation)
  • odynophagia (if ulceration / oesophagitis)
  • chronic cough / nocturnal asthma

nocturnal asthma results from acid entering the trachea when lying flat

there is also a risk of aspiration pneumonia

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5
Q

What is the gold-standard investigation for GORD?

A

patient is given an 8 week trial of PPIs to see if symptoms resolve

resolution of symptoms = positive diagnosis

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6
Q

What other investigations may be performed in GORD?

A

OGD:
* will detect erosions and ulcerations if oesophagitis is present

Oesophageal manometry:
* pH monitoring can be useful if OGD does not show anything

there is a poor correlation between symptoms and endoscopy appearance

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7
Q

What are the indications for upper GI endoscopy in GORD?

A
  • age > 55
  • symptoms > 4 weeks or persistent symptoms despite treatment
  • dysphagia
  • relapsing symptoms
  • weight loss

if endoscopy is negative - consider 24-hour oesophageal pH monitoring (gold standard)

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8
Q

What lifestyle advice is given to GORD patients?

A
  • weight loss
  • smoking cessation
  • small regular meals
  • avoid foods that can exacerbate symptoms (acidic fruit, coffee, alcohol)
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9
Q

What is involved in the medical treatment for GORD?

A
  • full dose PPI given for 1-2 months
  • if there is a response, a low dose treatment is given as required
  • if there is no response, consider adding histamine (H2) blocker
  • antacids for symptom relief
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10
Q

What are the potential complications associated with GORD?

A
  • oesophagitis
  • ulcers
  • anaemia
  • benign strictures
  • Barrett’s oesophagus
  • oesophageal carcinoma
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11
Q

What is the definition of a diverticulum?

What are the 2 different types?

A

herniation of the mucosa and submucosa through the muscle layer of the colonic wall

Pseudo:
the muscle layer does NOT outpouch

True:
there is outpouching of the muscle layer

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12
Q

How common is diverticular disease?

A
  • 60% of people will develop a diverticulum at some point in their life
  • this may NOT progress to diverticulitis
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13
Q

What is meant by “diverticulum” and “diverticula”?

A

diverticulum:
* the presence of a single outpouching

diverticula:
* the presence of multiple outpouchings

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14
Q

What is meant by diverticulosis, diverticular disease and diverticulitis?

A

diverticulosis:
presence of multiple diverticula, but they are asymptomatic

diverticular disease:
presence of multiple diverticula + symptoms

diverticulitis:
inflammation + infection of one or more outpouchings

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15
Q

Why do diverticula occur?

A
  • the taenia coli (muscle that runs along the colon) is present in bands
  • herniation of the mucosa occurs BETWEEN the bands
  • this occurs as a result of increased intra-colonic pressure
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16
Q

Which part of the colon is most commonly affected by diverticulosis?

A
  • almost ALL diverticula are found in the sigmoid colon
  • in Western patients, they are ALWAYS on the LEFT side
  • diverticula may be seen on the right side in Asian patients
  • they are NEVER found in the rectum
17
Q

What are the risk factors for diverticulosis?

A
  • low fibre diet
  • age > 50
  • obesity
  • sedentary lifestyle

low fibre diet increases the intra-luminal pressure

18
Q

What is the presentation of diverticulosis?

A
  • this is usually asymptomatic
  • there may be some blood in the stool which is painless
19
Q

How do patients with diverticular disease tend to present?

A
  • intermittent abdominal pain - particularly in the LLQ
  • bloating
  • change in bowel habit - constipation or diarrhoea
20
Q

How does someone with diverticulitis tend to present?

A

severe abdo pain:
* this is in the LLQ (or RLQ in some Asian patients)
* associated bloating

nausea / vomiting:
* not as common
* due to ileus or complicated diverticulitis with colonic obstruction

change in bowel habit:
* constipation is more common, but also diarrhoea

urinary changes:
* increased frequency, urgency or dysuria (due to irritation of bladder by inflamed bowel)

PR bleeding:

Systemic signs:
* fever
* tachycardia

21
Q

What signs might be present on examination of someone with diverticulitis?

A
  • tachycardia / pyrexia
  • reduced bowel sounds
  • tender LIF (+/- tender palpable mass)
  • guarding / rigidity / rebound tenderness can suggest complicated diverticulitis with perforation
22
Q

What are the investigations performed for diverticular disease?

A

barium enema:
* shows a saw-tooth appearance of lumen due to multiple diverticula

colonoscopy:
* shows presence of diverticula

CT scan:
* used to confirm acute diverticulitis

barium enema / colonoscopy should be AVOIDED in acute diverticulitis due to risk of perforation

23
Q

What investigations are performed for acute diverticulitis?

A

Blood tests:
* FBC shows raised WCC
* CRP raised

CXR / AXR:
* CXR can show pneumoperitoneum if there is perforation
* AXR shows dilated bowel loops, obstruction / abscesses

CT is the imaging modality of choice to confirm diagnosis

24
Q

What is the treatment for uncomplicated and complicated diverticulitis?

A

uncomplicated:
* oral antibiotics, liquid diet + analgesia

complicated:
* if symptoms severe or do not settle in 72 hours
* admission for IV antibiotics, fluids and analgesia

CT-guided drainage is performed if an abscess is present

25
Q

What does the long-term management of diverticular disease aim for?

A
  • you cannot reverse the growth of diverticula, only prevent the progression
  • this involves weight loss, smoking cessation, increasing fibre + fluid
26
Q

What caution needs to be taken when giving analgesia in diverticulitis?

A

AVOID OPIATES !!

  • these are constipating and will raise the intra-luminal pressure
27
Q

What other medications may be given in diverticular disease?

A

osmotic laxatives

  • avoid stimulant laxatives as these increse intra-luminal pressure

Y4 - CCC & PC (34 decks)

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