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GORD and Hiatus Hernia - Coggle Diagram

- - - - Post prandial fullness
        Early satiety
        Epigastric pain
        Epigastric Burning
    - - Heartburn
        Regurg
        Dysphagia
        Chest pain
        Water brush
        Globus sensation
        Odynophagia
        Extra -oesophageal symptoms - chronic cough, hoarseness, wheeze
        Infequently nausease
  - - - No evidence of structural disease AND
      - Bothersome:
        Postprandial fullness
        Early saitety
        Epigastric pain
        Epigastric bruning
- - - - Noxious gastric refluxate
        
        Acid
        
        Bile / digestive enzymes / pesin
        
        PPIs render gastric content ' weakly acid'
        Duration of exposure - peristalsis, salivation, presonc
  - - - Eorsive Reflix Disease
        
        Oesophagitis
      - Complicated
        
        Barrett's
        
        Peptic stricture
  - - - Heartburn
        Acid / water brush
        Regurg
        Bleching
        Dyspahgia
        Odynophagus
    - - Resp: Chronic ocugh, wheeze
  - - - Mucosal abnormalities / Therapeutics
    - - Structural abnormalities / motility
    - - Symptom index
    - - Bravo pH system
    - - Gold standard
    - - Exclude primary motility disorder
    - - Beware diabetic pt with delayed gastric emptying
        fundoplication may make gas bloat symptoms worse
  - - - Weight loss
        Sleep with head elevating
        Smokign cessation
        Sleep on left side
        Minmise disturbance to normal sleep
    - - PPI
      - H2 receptor antag
      - Alginates
      - Prokinetics
      - Sucralfate
      - Antacids
    - - Fundoplication
        
        Complications
        
        Infection
        Bleeding
        Oesoph perf
        Dysphagia 50% (resolves within 3 months)
        Structural comlications 30%
        Mortality
      - Magnetic Sphinter ?? LINX
    - - LOTUS
      - REFLUX Trial
    - - PONV - Treat Nausea Aggressvley
      - Pain
      - Acitivy
      - Eating
        
        Soft
      - Dysphagia
        
        Perisistent
      - Gas bloat symptoms
      - Heartburn
- - - - Cameron erosion
        Iron def anaemia
  - - - Dissect out sack
        Excise sack
        +/- wrap
        Pexy stomach
      - Mortality
        
        Perf of ischaemic stomach
        
        5% of acute presentations
      - Elective vs Watchful waiting
        
        Younger - repair
        Older - wait
- - - - Liquid = soid
    - - Solid > liquid
- - - - There are 3
    - - Manometry
    - - Important
    - - High surg risk
        
        Botox
      - Low surgical risk
        
        Graded pneumotic dilitation
        
        POEM perioral microscopic
        
        HM Hellers? Myopathy?
        
        Last resort: Oesophagctomy