>>0 >>1 >> 2 >> 3 >> 4 >> the fire in your belly dip mukherjee...
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The fire in your bellyDip Mukherjee
Consultant surgeon
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1. Listen to patients (til they run out of things to say) before asking questions. Believe them even if things sound nonspecific
2. Impact on life to be assessed: eating, social life and sleep
3. Weed out non ulcer dyspespsia, belching, bulemia
4. Beware of new symptoms especially in white males. It is very much a premalignant condition
5. Lifestyle adjustments work only partially.If they don’t respond to PPI they probably do not have GORD
Top Tips for handling reflux patients
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6.Refer difficult refractory and Unhappy patients
7. Gastroscopy for most referred patients. pH testing and manometryreserved for patients being considered for surgery.
8.Thin patients with volume reflux with hiatus hernia benefit most from laparoscopicAntireflux surgery. All paraoesophageal hernia should be repaired in fit patients.
9.Antireflux surgery in well selected patients can be life changing provided expectation are set clearly and well executed
10.Barretts need surveillance even after antireflux surgery
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GastroOesophageal Reflux Disease
GORD
“Following the Jewish tradition, a dispenser of schmaltz (liquid chicken fat) is kept on the table to give the vampires heartburn if they get through the garlic defense.”
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•10-40% of population in the Western world (9% daily, 20% weekly)
•40% take time off work
•£65 million spent on antacids in 1993
•£430 million spent on PPI in 1998
•PPI the highest drug expenditure in NHS
•Cancer of the oesophagus related to GORD is the most rapidly increasing cancer in western countries
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Your Barrier against reflux
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Triggers
•Chocolate
•Caffeine
•Citrus fruits
•Tomato
•Stop drinking (Red wine)
•Fatty Foods
Better Tolerated
•Apple
•Baked potato
•Broccoli
•Cabbage
•Chicken breast, skinless
•Egg whites
•Green beans, Peas
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Hiatus hernia
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Mechanism
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Acid rains
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Acid injury
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Symptoms
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Food sticking in my gullet !
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Diagnosis
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Harold Horace Hopkins FRS (1918–1994)
Twice nominated for Nobel prize
1952 Laparoscope
1959 Rod lens system
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Checking out the barrier … and the acid sweeper… manometry
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Measuring the acidpH test
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Complicationsstricture
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ComplicationsBarretts oesophagus
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Complication Cancer
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1976 …. the first ever blockbuster drug
1981
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Headache
Fatigue
Dizzinss
Diarrhoea
Itching
Osteoporosis
Blisters
Anxiety
Depresion
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Surgery for reflux !!….. Is this your cup of
tea?
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Rudolf Nissen 1955
Nissen R 1956. Swiss Medical weekly Nissen R 1961. American journal of digestive diseases
operations for reflux
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Bernard DellemagneLeige 1991
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Highly effective…… life changing surgery
Recovery & Results
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Case study DF
… no wonder she was feeling a bit breathless
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… with a chest Xray like this
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… May be a CT chest would be handy
… hmmm.. an odd hydro pneumothorax !
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Lung windows …these expensive softwares are useful after all!!
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EW 80 had a femoral hernia repair under local for terrible COAD..
She was a little surprised as she never smoked
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The COAD got worse and she could not eat any more
…. We thought that was strange
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Thank you