Week Ten - Case Two Flashcards
according to the NICE guidelines, how should you organise an urgent direct access upper GI endoscopy
1.3
Referral guidance for endoscopy links to NICE guidelines on suspected cancer: recognition and referral for patients with dysphagia or those over the age of 55 with weight loss and either upper abdominal pain, reflux or dyspepsia
what is GORD
describes the symptomatic passing of gastric contents back up into the oesophagus.
what is the pathophysiology of GORD
the pathology is complex and can involve the abnormal transient relaxation of the LOS, impaired oesophageal clearance and delayed gastric emptying that increase gastric pressure
what is GORD also associated with
also associated with hiatus hernia where a weakness in the curial diaphragm allows the proximal stomach to pass upwards into the chest
what are the risk factors for GORD
Smoking and alcohol
Obesity
Stress
Hiatus hernia
Pregnancy
Trigger foods
Medications that reduce the lower oesophageal sphincter tone (such as NSAIDS and beta-blockers)
for patients where cancer is not suspected, what is organised?
a routine upper GI endoscopy can be organised for patents who do not respond to acid suppression therapy such as proton pump inhibitors
what can objectively assess the degree of reflux as well as the motility of the oesophagus for those who are being considered for surgery
oesophageal manometry and ambulatory 24 hour oesophageal pH monitoring
what are the surgical options used to treat GORD
Nissen fundoplication
this is usually performed laparoscopically and involves wrapping the funds of the stomach around the lower oesophagus to reinforce the lower oesophageal sphincter
what are the potential complications resulting from untreated GORD
benign stricture
Barrett’s oesophagus
oesophagi’s
chronic cough
recurrent chest infections
what are the indications for surgery in GORD treatment
failure of medical therapy, desire to discontinue medical therapy or the presence of a hiatus hernia
what kind of lining does the oesophagus have
a squamous epithelial lining that makes it more sensitive to the effects of stomach acid
the stomach has a columnar epithelial lining that is more protected against stomach acid
what are the causes and triggers of GORD
Greasy and spicy foods
Coffee and tea
Alcohol
Non-steroidal anti-inflammatory drugs
Stress
Smoking
Obesity
Hiatus hernia
what is dyspepsia
non-specific term used to describe indigestion
what symptoms does dyspepsia cover
Heartburn
Acid regurgitation
Retrosternal or epigastric pain
Bloating
Nocturnal cough
Hoarse voice
what are the red flags
Dysphagia (difficulty swallowing) at any age gets an immediate two week wait referral
Aged over 55 (this is generally the cut-off for urgent versus routine referrals)
Weight loss
Upper abdominal pain
Reflux
Treatment-resistant dyspepsia
Nausea and vomiting
Upper abdominal mass on palpation
Low haemoglobin (anaemia)
Raised platelet count