Gastrointestinal Title:Gastro-oesophageal reflux disease, Barretts & Dysmotility of oesophagus & stomach Flashcards Preview

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Flashcards in Gastrointestinal Title:Gastro-oesophageal reflux disease, Barretts & Dysmotility of oesophagus & stomach Deck (34):
1

What happens to the quality of life for patients with refluc

It decreases and can be similar to quality of life of a patient with an acute coronary event

2

Why does reflux occur

Incompetent Lower Oesophageal sphincter
Poor oesophageal clearance
Barrier/ function / Visceral senstitivity (some mucus for protection but if changed, an ulcer can form)

3

What are the symptoms of reflux

Heartburn
Acid reflux
Waterbrash
Dysphagia
Odynophagia
Weight loss
Chest pain
Hoarseness
Coughing

4

What investigations are carried out for reflux

Endoscopy
Ba swallow
Oesophageal manometry (measures pressure) & pH studies (probe and leave down for 24-48 hours - they will confirm with a diary)
Nuclear studies

5

How much of the population get reflux symptoms

40%

6

Who should we investigate

Weight loss
Anaemia
Vomiting
F/H UGI cancer
Barrett's (10% of patients reflux patients)
Pernicious Anaemia (association with cancer)
PUD surgery >20 years
Dysphagia

7

What are the grades for oesophagitis

Grade A -
Grade B =
Grade C
Grade D -

8

What is achatsies ring?

Caused by acid reflux

9

Who is most likely to get oesophageal carcinoma?

Males

10

What are the treatment options for oesophageal carcinoma?

Radiotherapy
Surgery
Palliation (treat symptoms only)

11

What is the 5 year survival rate?

5-10%

12

What causes an increase in oesophageal adenocarcinoma?

More reflux

13

What causes a decrease in squamous cell carcinoma?

I dont know

14

What is the pathogenesis of adenocarcinoma

Normal
Oesophagitis (reversible)
Barrett's (Irresversible?)
Adenocarcinoma (too late)

15

What is the management of GORD

Doubling the dose of PPI therapy
Adding an H2RA at bedtime
Extending the length of treatment
Surgery

16

What lifestyle modifications can be made for reflux?

Stop smoking
Lose weight if obese
Prop up the bed head
Avoid provoking factors

17

GIve two types of H2 antagonists

Cinetidine
Ranitidine

18

How does cinetidine work?

Rapid symptom relief
Less effective at healing than placebo

19

How does ranitidine work?

Tolerance after 4 week therapy
Poor in preventing ....

20

What are Proton pump inhibitors (PPI)

Block the hydrogen pump that makes the acid in the first place. It is irreversibly bound to it.

21

What happens after 8 hours of taking a PPI

only half of the proton pumps remain blocked

22

What do the proton pumps do?

Heal the mucosa
Relieve the symptoms

23

What is the correct dose of Lansoprazole for healing and maintenance?

20mg or 30mg for healing and maintenance

24

What are the benefits of surgery in GORD

Controls symptoms
Heals oesophagitis
Cost effective for Young patients (dont need to have them on PPI for a long period of time)
Severe / unresponsive disease

25

What define's Barratts oesophagitus

Intestinal Metaplasia
Irreversible
Increased risk of adenocarcinoma

26

How can we manage dysplasia

More frequent surveillance
Optimise PPI (if on suboptimal dose)
Endoscopic mucosal resection
Radiofrequency abalation (HALO) to abalate the rest of the mucus.
Argon

27

What can a Hiatus hernia do?

Can be sliding or just push the oeophagus upwards causing reflex

28

What is gastroparesis

Delayed gastric emptying with no physical obstruction

29

What are the symptoms of gastroparesis

Feeling of fullness / bloating
Nausea
Vomiting
Weight loss
Upper abdominal pain

30

What are the causes of gastroparesis

Idiopathic
Diabetes mellitus
Cannabis
Medication e.g. opiates, anticholinergics
Systemic diseases e.g. systemic sclerosis

31

What investigations are done for gastroparesis

Gastric emptying studies (images of stomach using isotopes to calculate how long it takes to empty)

32

WHat can we do to manage gastroparesis

Removal of precipitating factor se.g. drugs
Liquid / slopy diet
Eat little and often
Promotility

33

What is achalasia?

Relatively uncommon condition
Lower OS is in spasm
requires surgery
cut longitudinally through sphincter, separate the fibres and pull them back
Now can be dilated with a balloon but can be dangerous

34

How do we manage achalasia ?

Use of Botulinum toxin

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