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semester 2 (3rd year) > Case 17: Swallowing difficulties > Flashcards

Case 17: Swallowing difficulties Flashcards

1
Q

does the LOS contain muscle

A

no it is a physiological (functional) sphincter so does not have any specific sphincteric muscle

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2
Q

which cells line the lower oesophagus

A

stratified squamous epithelium

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3
Q

which cells line the stomach

A

columnar epithelium

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4
Q

what do surface mucous cells do

A

secrete a protective coat of alkaline mucus
line gastric glands
prevents stomach from digesting itself

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5
Q

what do tight junctions do in the stomach

A

they are between epithelial cells and they prevent gastric juice from penetrating the underlying tissue

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6
Q

what do parietal cells do

A

what do parietal cells do
produce HCl and intrinsic factor (needed for B12 absorption)

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7
Q

what do chief cells do

A

secrete pepsinogen
HCl cleaves pepsinogen into its active form- pepsin

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8
Q

what do eneteroendocrine cells do

A

secrete various hormones into the interstitial fluid of the lamina propria
one of these hormones is gastrin

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9
Q

what do stem cells in the stomach do

A

they are located where the gastric glands join the gastric pits
they quickly replace damaged epithelial mucosal cells

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10
Q

how often is the surface epithelium of the stomach replaced

A

every 3-6 days

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11
Q

differentials for dysphagia

A

gastrooesophageal reflux
hiatus hernia
oesophageal cancer
oesophageal candidiasis
achalasia
muscle tension dysphagia
diffuse oesophageal spasm
pharyngitis

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12
Q

what does dysphagia to solids suggest

A

structural lesion

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13
Q

what does dysphagia to liquids and solids suggest

A

liquids and solids suggest
myomotility/neurological disorder

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14
Q

which type of oesophageal cancer is more common with alcohol and smoking

A

squamous cell carcinoma

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15
Q

which type of oesophageal cancer is more associated with barrett’s

A

adenocarcinoma

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16
Q

which type of oesophageal cancer is more common

A

squamous cell carcinoma

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17
Q

what may predispose/trigger GORD

A

alcohol
smoking
coffee
mints
citrus
fats

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18
Q

most common type of gastric cancer

A

adenocarcinoma

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19
Q

what type of gastric cancer may present with dysphagia

A

tumour of the gastro-oesophageal junction

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20
Q

is gastric cancer more common in men or women

A

twice as common in men

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21
Q

what is barrets

A

metaplasia change of the distal oesophagus from stratified squamous to columnar epithelium

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22
Q

is barrets malignant

A

no it is premalignant
increases risk of oesophageal cancer by 50 fold

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23
Q

when would you consider referral for barrets rather than surveillance

A

if there is dysplasia

24
Q

when would those with barrets get endoscopes

A

every 3-5 years

25
Q

what type of cancer is related to virchows node

A

gastric

26
Q

when would you do 2 week endoscopy wait

A

dysphagia

or

55 or over with weight loss and any of following- upper abdominal pain, reflux, dyspepsia

27
Q

what is first line investigation for dysphagia

A

ODG (oesophago-gastro duodenoscopy) with biopsy

28
Q

what abnormal bloods may be seen in oesophageal cancer

A

hypokalaemia due to the inability to swallow potassium rich saliva

iron deficiency anaemia/ anaemia of chronic disease

LFTs deranged in liver metastases

CRP raised in malignancy

bone profile (including ALP) may be raised in bone metastases

29
Q

what investigation would you do to identify a stricture

A

barium swallow

30
Q

why would you use a PET scan for oesophageal cancer

A

used for staging
used before initiating therapy to identify primary tumour sight, locoregional disease and metastases

31
Q

pain with peptic ulcer disease is usually associated with what

A

hunger

32
Q

2 most common causes of peptic ulcer disease

A

NSAIDs
H.pylori

33
Q

age and sex most commonly affected by peptic ulcer disease

A

50-70
men= women

34
Q

when does a mallory weiss tear typically occur

A

after a period of recurrent wrenching, vomiting, coughing or straining

35
Q

treatment for mallory weiss tear

A

usually self limiting so treatment is supportive

36
Q

do more men or women get malllory weiss tear

A

more men

37
Q

most common cause of mallory weiss tear in women of childbearing age

A

hyperemesis gravidarum

38
Q

causes of peptic ulcer disease in order of importance

A

h.pylori
drugs- NSAIDs, bisphosphonates, corticosteroids, potassium supplements, SSRIss, recreational drugs
smoking, alcohol consumption and stress
zollinger-ellison syndrome

39
Q

how is h.pylori able to survive in the stomach

A

it migrates to less acidic regions
it uses urease enzyme to convert urea to CO2 and ammonia
this ammonia neutralises the stomach acid and protects h.pylori

40
Q

what cancers is h.pylori linked with

A

gastric
malt lymphoma

41
Q

criteria for h.pylori testing work

A

must stop PPI within 14 days of treatment
must not of had antibiotics in past 4 weeks
retesting is only needed in those with associated peptic ulcer or persistent symptoms despite treatment

42
Q

what is the glasgow blatchford score

A

screening tool used to assess the likelihood that someone with an upper GI bleed with need to have medical intervention such as a blood transfusion/endoscopic intervention

43
Q

which medication would you give specific for variceal bleeding

A

terlipressin

44
Q

how does terlipressin work

A

it acts on the splanchnic circulation to reduce pressure in the portal vein which will help slow or stop bleeding varices

45
Q

two methods of endoscopic treatment for variceal bleeding

A

banding (cuts off blood supply)

trans-jugular intrahepatic portosystemic shunt (TIPS)

46
Q

how does TIPS procedure work

A

radiologist inserts a stent to connect portal vein to hepatic vein

this allows blood to be brought back from the bowel to the heart whilst bypassing the liver

this reduces the pressure in the portal vein

47
Q

what are the endoscopic treatments for a peptic ulcer bleed

A

clips (mechanical)
thermal coagulation (heat probe)
fibrin and thrombin (haemostatic adjuncts)
injection of vasoconstrictors (adrenaline)

48
Q

what does the rockhall score estimate

A

estimates the risk of rebleeding and overall mortality with upper GI bleeds

49
Q

what factors affect the rockhall score

A

age
shock
comorbidities
diagnosis
major stigmata of recent haemorrhage

50
Q

what drug must be given following peptic ulcer bleed

A

omeprazole (or other PPI)

51
Q

what artery is the cause for most bleeding due to duodenal ulcers

A

posterior duodenal ulcers cause bleeding from the gastroduodenal artery most commonly

52
Q

secondary prevention for peptic ulcer bleeding

A

stop NSAIDs
stop smoking
stop drinking

53
Q

which symptom indicated gastric cancer rather than any other upper GI cancer

A

stomach pains (constant burning sensation)

54
Q

what criteria does the glasgow blatchford scale take into account

A

Hb
BUN (urea nitrogen)
initial systolic BP
sex
heart rate over 100
melena present
recent syncope
hepatic disease
cardiac failure

55
Q

what score is considered high risk GI bleed which is likely to require medical intervention on glasgow blatchford

A

score above 0

semester 2 (3rd year) (12 decks)

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