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Flashcards in GORD Deck (10)
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1

Anat

Oes 25cm. Striated to smooth musc. Squam epith.
UOS striated musc, close at rest.
LOS smooth musc, 3-4cm, high rest press, diaph contribs.

2

Peristalsis

Prim peristalsis- induced by swallow, 2-4cm/s, clear and neuts rfluxed acid.
Secondary- stubborn bolus or refluxed food.
Teritary contrac- non peristaltic waves, abn but comm in eld.

3

Px

HB
Epig pain
Regurg
NV
Dental eros
Dysphagia
Odynophagia
Globus
CP
Resp symps
ENT symps
Rumination

4

Mx

Medical. PPI 1st line. Poo rev for motil modif drugs.
Surg. Indics- choice, high vol reflux, PPI intol, fail drugs. Risks- death, fail, s/e (dysphagia, gas, flatus). Us laparoscopic- fundoplication wrap stom rnd oes. Linx new mag beads.
Endosc- suturing tx to form valve, uncomm.
Radio freq tx- stretta, musc hypert.

5

Causes

Impaired clearance- saliva, distal oes motil.
Impaired intrinsic LOS
Impaired ext LOS of diaph crural fibres eg hiatus hernia
Acid and pepsin
Delayed gastric emptying
Duodenogastric reflux- PPI not help

6

RF

Western popn
Obese
Smoking
Alc
Coffee
Choc
Genetic

7

defin

Reflux gastric conts to oes causing oesophagitis, reflux symps suffic to impair qol or risk LT complics.

8

Hiatus hernia

Gastric mucosa folds over 3cm above diaph
Most dont have GORD but most oesophagitis pts have one.
Hernia alone us asymp
T1- sliding, GO junc to chest, lax hiatus
T2- true paraoes (rolling)- fundus rolls up nest to oes, GO junc might be correct place.
T3 mixed.

9

Ix

Endosc if mucosal inj ev
24hr ph study of acid reflux symps
Oes manometry if motil disorder
NICE- endosc if alarm symps, and if malig concern over 555 new onset dyspepsia. Actually do more often than that.

10

Complics

Oesophagitis
Stricture
Barretts metaplasia squam to col