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Gastro > GORD, Peptic Ulcers, Upper GI bleed > Flashcards

GORD, Peptic Ulcers, Upper GI bleed Flashcards

1
Q

What is GORD?

A

Acid from the stomach (columnar epithelial lining) refluxes through the lower oesophageal sphincter
irritates the lining of the oesophagus (squamous epithelial lining)

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2
Q

Presentation of GORD (6)

A 
Heartburn
Acid regurgitation
Retrosternal or epigastric pain
Bloating
Nocturnal cough
Hoarse voice
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3
Q

When is GORD referred for endoscopy?

A

Used to assess for peptic ulcers, oesophageal or gastric malignancy

Evidence of a GI bleed needs admission and urgent endoscopy

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4
Q

Red flags indicating 2ww referral (8)

A

Dysphagia at any age

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

Low haemoglobin

Raised platelet count

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5
Q

Lifestyle changes for managing GORD (6)

A

Reduce tea, coffee and alcohol

Weight loss

Avoid smoking

Smaller, lighter meals

Avoid heavy meals before bed time

Stay upright after meals rather than lying flat

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6
Q

Acid neutralising medication when required:

A

Gaviscon

Rennie

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7
Q

Proton pump inhibitors (reduce acid secretion in the stomach)

A

Omeprazole

Lansoprazole

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8
Q

What is the alternative to PPI?

A

Ranitidine - H2 receptor antagonist (antihistamine)

Reduces stomach acid

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9
Q

Surgical resolution of GORD

A

Laparoscopic fundoplication

Involves tying the fundus of the stomach around the lower oesophagus to narrow the lower oesophageal sphincter

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10
Q

What is H. pylori?

A

Gram negative aerobic bacteria

Causes damage the epithelial lining of the stomach resulting in gastritis, ulcers and increasing the risk of stomach cancer

Forces its way into the gastric mucosa, breaks it creates exposes the epithelial cells to acid

Produces ammonia to neutralise the stomach acid. The ammonia directly damages the epithelial cells

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11
Q

Who is offered test for H. pylori?

A

Anyone with dyspepsia

Need 2 weeks without using a PPI before testing for H. pylori

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12
Q

Tests for H. pylori

A

Urea breath test using radiolabelled carbon 13

Stool antigen test

Rapid urease test (CLO test) can be performed during endoscopy - biopsy

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13
Q

How does the CLO test work?

A

Urea is added to biopsy

If H. pylori are present, they produce urease enzymes that converts the urea to ammonia

Ammonia makes the solution more alkali giving a positive result on when the pH is tested

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14
Q

How is H. pylori treated?

A

Triple therapy for 7 days

2 Abx - Amox + Clarith

1 PPI - Omeprazole

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15
Q

What is Barretts Oesophagus?

A

Constant reflux of acid - metaplasia from a squamous to a columnar epithelium
Typically get an improvement in reflux symptoms

Barretts oesophagus is considered a “premalignant”
Risk factor for the development of adenocarcinoma of the oesophagus (3-5% lifetime risk with Barretts)

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16
Q

What is the treatment for Barretts/

A

PPI
(aspirin)

Ablation treatment can destroy the epithelium so that it is replaced with normal cells
Has a role in low and high grade dysplasia in preventing progression to cancer

17
Q

What are the causes of an upper GI bleed? (4)

A

Oesophageal varices

Mallory-Weiss tear

Ulcers of the stomach or duodenum

Cancers of the stomach or duodenum

18
Q

What is the presentation of upper GI bleed?

A

Haematemesis - (Coffee ground” vomit

Melaena

Haemodynamic instability occurs in large blood loss, causing a low blood pressure, tachycardia and other signs of shock (Young, fit patients may compensate well until they have lost a lot of blood)

Epigastric pain and dyspepsia - peptic ulcers
Jaundice, ascites - liver disease with oesophageal varices

19
Q

What is the Glasgow-Blatchford Score?

A

Scoring system in suspected upper GI bleed based on initial presentation

Establishes risk of having an upper GI bleed

score > 0 indicates high risk
1 for each of the following:

Drop in Hb
Rise in urea
Blood pressure
Heart rate
Melaena
Syncopy
20
Q

Why is urea raised in upper GI bleed?

A

Blood in the GI tract gets broken down by the acid and digestive enzymes

Breakdown products is urea and then absorbed in the intestines

21
Q

What is Rockall score?

A

Used for patients that have had an endoscopy to calculate percentage risk of rebleeding and overall mortality

Age
Features of shock (e.g. tachycardia or hypotension)
Co-morbidities
Cause of bleeding (e.g. Mallory-Weiss tear or malignancy)
Endoscopic stigmata of recent haemorrhage such as clots or visible bleeding vessels

22
Q

What is the management of upper GI bleed?

A

A – ABCDE approach to immediate resuscitation

B – Bloods

A – Access (ideally 2 large bore cannula)

T – Transfuse

E – Endoscopy (arrange urgent endoscopy within 24 hours)

D – Drugs (stop anticoagulants and NSAIDs)

Definitive treatment is oesophagogastroduodenoscopy (OGD) to provide interventions that stop the bleeding - banding of varices or cauterisation of the bleeding vessel

23
Q

What bloods are sent for in upper GI bleed?

A

Haemoglobin (FBC)

Urea (U&Es)

Coagulation (INR, FBC for platelets)

Liver disease (LFTs)

Crossmatch 2 units of blood

24
Q

Treatment if source is oesophageal varices?

A

Terlipressin

Prophylactic broad spectrum antibiotics

25
Q

When to transfuse in upper GI bleed?

A

Patients with massive haemorrhage

Platelets should be given in active bleeding and thrombocytopenia (platelets < 50)

Prothrombin complex concentrate can be given to patients taking warfarin that are actively bleeding

26
Q

Where can peptic ulcers occur?

A

Duodenum (most common)

Stomach - gastric ulcer

27
Q

How do peptic ulcers occur?

A

Breakdown of the protective layer of the stomach and duodenum (by H. pylori or NSAIDS)

Increase in stomach acid from:
Stress
Alcohol
Caffeine
Smoking
Spicy foods
28
Q

How does a peptic ulcer present? (5)

A

Epigastric discomfort or pain

Nausea and vomiting

Dyspepsia

Bleeding causing haematemesis, “coffee ground” vomiting and melaena

Iron deficiency anaemia (due to constant bleeding)

29
Q

How are peptic ulcers managed?

A

Diagnosed by endoscopy (CLO test/biopsy)

PPI

30
Q

Complications of peptic ulcers?

A

Bleeding

Perforation resulting in an “acute abdomen” and peritonitis

Scarring and strictures of the muscle and mucosa can lead to pyloric stenosis - presents with upper abdominal pain, distention, nausea and vomiting, particularly after eating

Gastro (9 decks)

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