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Flashcards in GORD Deck (18):
1

Reflux of gastric contents into the oesophagus is normal
GORD is said to occur when this causes symptoms.

What may prolonged/ excessive reflux cause?

Oesophagitis
Benign oesophageal strictures
Barret's oesophagus

2

Causes of GORD?

Lower oesophageal sphincter hypertension

Hiatus hernia (stomach squeezes into thorax via diaphragm hiatus)

Abdominal obesity

Gastric acid hyper-secretion

Slow gastric emptying

3

Risk factors for GORD

Overeating
Smoking
Alcohol
Pregnancy
Surgery on oesophagus
Drugs: tricyclic antidepressant, anticholinergics, nitrates

4

Describe pathophysiology of GORD?

Lower oesophageal sphincter (LOS) tone is reduced, and there are frequent transient LOS relaxations

Increased mucosal sensitivity to gastric acid

Reduced oesophageal clearance of acid

Delayed gastric emptying and prolonged post-prandial and nocturnal reflux also contribute


5

What oesophageal symptoms present clinically?

Heartburn – burning, retrosternal discomfort after meals, lying, stooping or straining, relieved by antacids

Belching

Acid brash

Water brash

Odynophagia- painful swallowing (due to ulceration or oesophagitis)

6

What extra oesophageal symptoms present clinically

Nocturnal asthma
Chronic cough
Sinusitis
Laryngitis (hoarseness and throat clearing)

7

Complications of GORD?

Oesophagitis
Ulcers
Benign stricture
Iron deficiency
Metaplasia—> dysplasia—> neoplasia

8

Differential Diagnosis of GORD

Oesophagitis from corrosives, NSAIDs, herpes, Candida

Duodenal or gastric ulcers/ cancers

Non-ulcer dyspepsia

Sphincter of Oddi (in ampulla of Vater) malfunction

Cardiac disease

9

Diagnostic tests and results

Mostly clinical
Endoscopy if alarm signs for upper GI malignancy
Barium swallow may show hiatus hernia

24 hour oesophageal ph monitoring will help diagnose GORD if endoscopy is normal

10

What lifestyle changes are advised as management for GORD?

Weight loss
Avoid excess alcohol/ aggrevating food
Smoking cessation
raising bed head
Small meals

11

What medical treatment is given to patients with GORD?

Alginates- form a foam raft on gastric contents
Antacids
PPIs
H2- receptor antagonists

12

PPIs inhibit gastric H+/K+-ATPase, blocking luminal secretion of gastric acid
Name 2

lansoprazole, omeprazole

13

Name a H2 receptor antagonist

Ranitidine

14

How do antacids work?

Contain alkaline ions

15

What surgical options are available in severe GORD

laparoscopic (key hole)
Aims to increase resting pressure in lower oesophageal sphincter

16

What is a Mallory- Weiss tear?

Persistant vomiting/ retching causes haematemesis via oesophageal mucosal tear.

17

What is a mallory weiss tear associated with?

alcoholism and eating disorders

18

How may mallory Weiss tear present?

May present as episode of haematemesis following violent retching/vomiting, or as melena (old blood in stool)

Bleeding usually stops in 24-48h