Flashcards in Upper GI Presentations Deck (80)
What is a Mallory-Weiss tear?
A longitdinal tear in the mucosa around the gastro-oesophageal junction
What generally causes a Mallory-Weiss tear to bleed?
Increased abdominal pressure, usually due to vomiting
What is the typical presentation of a Mallory-Weiss tear?
Small amounts of haematemesis after several episodes of vomiting (most commonly due to alcohol)
What is the management for a Mallory-Weiss tear?
Usually conservative, as the bleeding will generally resolve
What is a hiatus hernia?
When the proximal stomach herniates through the diaphragmatic hiatus
What two kings of hiatus hernia can you get?
Sliding hernia (80%) = Gastroesophageal junction slides up into the chest
Rolling hernia (20%) = Gastroesophageal junction remains in abdomen, portion of stomach herniates into the chest
What BMI is associated with hiatus hernias?
Over 30 (obesity)
What is the best diagnostic test for a hiatus hernia?
What is the treatment for a hiatus hernia?
H2 antagonists, alginates, antacids, proton pump inhibitors and pro kinetic drugs = relieve reflux symptoms
Surgery = symptoms are intractable or complications develop
What are the risk factors for GORD?
Drugs (e.g. nitrates, anticholinergics)
What happens to the lower oesophageal sphincter tone in GORD?
It is decreased
What condition can result from long term GORD?
Which change occurs in the epithelium in Barrett's Oesophagus?
Metaplastic change from squamous to columnar epithelium
How do nitrates affect the symptoms of GORD?
Usually aggravate symptoms
Which value is likely to be raised in an Upper GI beed?
Due to metabolism of amino acids from protein rich blood contents
Why is there a change in lower oesophageal tone in GORD?
Usually due to increased intra-abdominal pressure
What are the symptoms of GORD?
Heartburn (particularly when lying down, stooping, straining or after meals)
Acid or bile regurgitation
Waterbrash (mouth fills with water)
What are the potential complications of GORD?
Metaplastic change (Barrett's Oesophagus)
How is damage to the oesophagus by GORD graded?
Grade 1 = erosions less than 5mm
Grade 2 = erosions more than 5mm
Grade 3 = less than 75% of lower oesophagus involved
Grade 4 = more than 75% of lower oesophagus involved
Which medications can be used to treat GORD?
H2 receptor antagonists
Proton Pump Inhibitors
How do antacids help in GORD?
Relieve reflux by coating the lower oesophageal lining
Only relieve symptoms, do not prevent complications
How do H2 receptor antagonists help in GORD?
Cause acid suppression
Symptoms can worsen on stopping medication
How do PPIs help in GORD?
Effective at both reducing acid secretion and preventing acid related damage
Timing is important for these drugs
When might surgery be considered for GORD, and what are the aims of surgery?
Ongoing symptoms despite medication, or poor tolerance to medication
Keyhole laparoscopic surgery to physically repair the damaged sphincter
In which type of hiatus hernia is acid reflux more common?
Sliding hiatus hernia
What are the symptoms of achalasia?
What caused achalasia?
Lower oesophageal sphincter fails to relax
Food cannot easily enter the stomach and so oesophagus fills with food
usually accompanied by poor oesophageal motility
How is achalasia diagnosed?
Barium swallow = shows dilated tapering oesophagus
How is achalasia treated?
Endoscopic balloon dilatation
Botox injections for a non-invasive treatment