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PUD/GORD (Pathophysiology: (GORD: A multifactorial problem, largely…
PUD/GORD
Causes:
GORD:
Factors that decrease oesophageal tone: hiatus hernia, decreased oesophageal motility, ETOH, previous surgery, drugs, chocolate, caffeine, tobacco
Factors that increase intra-abdominal pressure: obesity, pregnancy, coughing, stress, trauma, gastric outlet obstruction
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Pathophysiology:
GORD: A multifactorial problem, largely associated with inappropriate relaxation of the lower oesophagel sphincter and increased intra-gastric pressure --> retrograde flow of stomach contenets into the oesphagus
PUD: Imbalance between protective factors (e.g. mucus and HCO3) AND mucosa damaging factors (e.g. pepsinogen and HCL) --> breach in mucosal barrier--> underlying connective tissue is exposed to acid-pepsin attack --> acute inflammatory process --> ulcer formation
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Complications:
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GORD
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Barrett's oesophagus: occurs in 10% of patients; normal squamous epithelium is replaced by columnar epithelium (metaplasia) --> dysplasia --> adenocarcinoma
Recurrent pneumonia, laryngitis, pharyngitis
Investigations:
Gastroscopy
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In GORD: > 45- perform gastroscopy to exclude malignancy, <45 - Rx patient
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24 hour continuous pH monitoring of lower oesophagus (GORD): done before surgery, not routine, GOLD standard
Definition:
Peptic Ulcer Disease (PUD): Eroded area of mucosa caused by digestive activities of gastric juices which are susceptible to perforation or bleeding
Gastro Oesophageal Reflux Disease (GORD): A pathologically excessive entrance of gastric contents into the oesophagus
Clinical Features:
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GORD:
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Hoarseness, sore throat, feeling a lump in the throat
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Management:
GORD
Conservative
1st line: Lifestyle modification e.g. weight, diet, smoking, alcohol
1st line: 6 week trial of PPI, continue if appropriate
Other drugs: Dopamine receptor antagonists (increase gastric motility and clearing + enhance sphincter activity e.g. metocloperamide), Pink lady (antacid + xylocaine), H2 receptor blocker
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PUD
Conservative
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Eliminate H.pylori infection: Clarythromycin, omeprazole, amoxicillin (can be replaced with metronidazole)
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Other drugs may be used for cytoprotection e.g. sucralfate (facilitates ulcer healing) and misoprostol (reduces risk of ulcer formation)
Surgical
Rare, used in emergencies