IBS + GORD + MW Tear + Oesophageal Varices Flashcards
(30 cards)
What does IBS stand for?
what is it?
Irritable bowel syndrome
‘Functional’ chronic bowel disorder
What is IBS related to?
Psychology (stress, anxiety, poor diet), 3+ months GI Sx with NO UNDERLYING CAUSE (everything ruled out)
What are the 3 types of IBS?
What are they mostly?
IBS-C = Mostly Constipation
IBS-D = Mostly Diarrhoea
IBS-M = Mostly mixed, alternating C/D
Symptoms of IBS
Abdo pain + bloating RELIEVED BY DEFACATION (going for poo)
Altered stool form/frequency
Diagnosis of IBS
Exclusions - exclude coeliacs (serology), IBD (fecal calprotectin) & infection (high ESR/CRP/blood cultures)
Treatments of IBS
- Conservative - Patient education + reassurance eg. IBS-C = More fibre
- Moderate -
IBS-C = Laxatives (Senna)
IBS-D = Anti motility drug (loperamide) - Severe - TCA (tricyclic antidepressants) eg. Amitriptyline (relieves pain and changes bowel activity + consider CBT/GI referral
Definition of GORD
Gastric reflux into oesophagus due to decreased pressure across lower oesophageal sphincter (LOS) causes Oesophagitis
Causes of GORD
Increased intraabdominal pressure (obesity, pregnancy)
Hiatial Hernia (mostly with sliding - stomach & oesophagus LOS slide up through oesophageal hiatus, an opening in diaphragm)
Drugs - eg. anti mucarinics
Scleroderma (muscle replaced with connective tissue,
LOS = Scarred)
Pathology of GORD
decreased LOS pressure = more potential for free up passage of acid
Symptoms of GORD
“Heartburn” = retroperitoneal burning chest pain
chronic cough and nocturnal asthma
Dysphagia (difficulty swallowing) - bad sign
When are Sx worse?
when lying down, acid easier to reflect this way
Diagnosis of GORD
If no red flags = go straight to treatment (Dx = clinical)
Red Flags (dysphagia, haematemesis (vomit blood), weight loss)
Endoscopy = Oesophagitis or barretts
Oesophageal manometry = measure LOS pressure + monitor gastric pH
Treatment of GORD
- Conservative lifestyle change (smaller meals, 3+ hours before bed)
- PPI (or H2RA if CI)
Antacids - SE = Diarrhoea (neutralise acid)
Alginates - Gaviscon (symptomatic)
Last resort = Surgical tightening of LOS - Nissen fundoplication = Wrap kudus around LOS externally to increase pressure across it
What are the 2 complications of GORD
Oesophageal strictures (tightening of oesophagus)
Barretts oesophagus
What are oesophageal strictures?
what are the typical patients looking like?
Sx and treatment?
Tightening of oesophagus
usually 60+ Px, progressively worse dysphagia
Tx = oesophageal dilation (endoscopic) + PPI
Barrets oesophagus
How many GORD patients develop this?
What cause does it always involve?
What is the pathology?
Typical Patient and Sx?
Diagnosis?
10% GORD Px develop this
Always involves Hiatal Hernia
Metaplasia (stratified squamous non keratinising epithelium –> simple columnar)
increased risk of adenocarcinoma
Normal –> Metaplasia (Barrets) –> Dysplasia (Adenocarcinoma)
Middle aged caucasian male with history of GORD and progressively worsening dysphagia
Dx with biopsy
Mallory Weiss Tear
Definition
Linear lower oesophageal mucosal tear due to sudden increased abdominal pressure
MW Tear
Typical patient? and Sx?
Presents typically as young male with acute history of retching (eg. after night out) eventually causing haematemesis
MW Tear
RF?
Alcohol, Chronic cough, bullemia, ‘hyperemesis gravidarum’ - pregnancy complication of severe N+V - much worse than morning sickness, weight loss and dehydration
What is there no history of?
Liver disease or pulmonary hypertension
Pul HTN = think oesophageal varices rupture
No liver Hx, retching Hx - think MW tear
Symptoms of MW Tear
Haematemesis (after retching/vomiting Hx)
Hypotensive if severe (often mild therefore this is unlikely)
Diagnosis of MW Tear
OGD (Endoscopy) to confirm
ROCKALL SCORE = for severity of upper GI bleeds
Treatment of Tear
Most spontaneously heal within 24hrs
What are oesophageal varices?
enlarged veins that protrude into the oesophagus
