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Medicine Notes Gastrointestinal Disease Notes

Gord Ulcers Notes

Updated Gord Ulcers Notes

Gastrointestinal Disease Notes

Gastrointestinal Disease

Approximately 27 pages

Complete set of notes on gastrointestinal diseases. Includes aetiology, presentation, investigation and management. Colour-coded including tables, diagrams and images for visual learners. SImple and succinct. Ideal for clinical finals....

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The following is a more accessible plain text extract of the PDF sample above, taken from our Gastrointestinal Disease Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Gastro-oesophageal reflux disease (GORD)

= Dysfunction of lower oesophageal sphincter predisposes to gastro-oesophageal reflux of acid

Pathophysiology

LOS = physiological sphincter formed by

  • Angle of entry to stomach

  • Mucosal folds of stomach (rugae)

  • Diaphragm

Reflux may be caused by

  • Transient LOS relaxations

  • Low resting tone that fails to increase on lying or with increased intrabdominal pressure

  • Hiatus hernia

  • Delayed gastric emptying

Risk factors for reflux

  • Smoking

  • Alcohol

  • Hiatus hernia

  • Large meals

  • Systemic sclerosis

  • Drugs (antimuscarinics, nitrates, calcium channel blockers)

  • Obesity

  • Pregnancy

Clinical features

  • Heartburn

    • Burning retrosternal discomfort

  • Belching

  • Acid brash

  • Nocturnal asthma

Investigations

  • Clinical diagnosis in most with no need for investigations (<45yrs) for those with no alarm symptoms

    • Dysphagia, weight loss, odonyphagia, anorexia, haematemesis, meleana

  • Otherwise

    • Endoscopy, barium swallow, 24hr oesophageal monometry and pH monitoring

Management

  • Lifestyle

    • Meal times, lying flat, smoking, drinking etc

  • Drugs

    • Antacids

    • H2 receptor antagonists

    • PPI

    • Prokinetics (metoclopramide)

  • Surgery

    • Antireflux surgery for very severe cases

Complications

  • Oesophagitis

  • Ulcers

  • Benign strictures

  • Barretts Oesophagus

  • Adenocarcinoma

Barretts Oesophagus

  • Premalignant condition resulting from prolonged reflux

  • Columnar gastric epithelium extends into oesophagus

  • Upper GI endoscopy and biopsy to investigate

  • If no malignant changes – monitor and give anti-reflux therapy

  • If there are pre-malignant changes, oesophageal resection or mucosal ablation

Peptic Ulcer Disease

Dyspepsia

= Group of non-specific symptoms related to upper GI tract

e.g Upper abdominal pain, heartburn, bloating

Alarm symptoms

A -Anaemia

L – Loss of weight

A - Anorexia

R – Recent onset

M – Malaena/haematemesis

S – Swallowing difficulty

Managing new dyspepsia

>55yrs/alarms present

Urgent endoscopy

Otherwise

Trial of simple antacids for 4 weeks

Symptoms persist No further symptoms

Past ulcer No past ulcer

Test for H. Pylori

H.Pylori present H.Pylori absent

H.Pylori eradication Generic PPI

Duodenal ulcers

Aetiology

  • H.Pylori

  • Drugs (NSAIDS, aspirin,...

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