66 - dysphagia, 67 - haematemesis Flashcards Preview

Sheff 91 core clinical problems > 66 - dysphagia, 67 - haematemesis > Flashcards

Flashcards in 66 - dysphagia, 67 - haematemesis Deck (26)
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1
Q

dysphagia DDx

A

Oral: abscess, tonsillitis, cancer, Bell’s palsy, diphtheria

Pharyngeal: foreign body, cancer, abscess,

Oesophageal: foreign body, cancer, abscess, atresia, strictures, achalasia, bulbar palsy, MG, Crohn’s, candida,

2
Q

oesophageal ca sx

A

dysphagia, pain, hoarse voice, lymphadenopathy, haemoptysis, cough.

3
Q

Rfs oesophageal ca

A

smoking, obesity, GORD, poor diet, alcohol

4
Q

rfs for gord

A

pregancy, obesity, smoking, hernia, stress

5
Q

Mx of GORD

A

Lifestyle

PPI Then double it or switch to an alternate PPI, then add a H2 receptor antagonist (ranitidine).

6
Q

what should you consider in GORD

A

H pylori

7
Q

GORD can progress to?

A

barretts / neoplasia

8
Q

What is achalasia ?

Dx?

A

Failure of smooth muscle relaxation. Lower oesophageal sphincter relaxation incomplete and peristalsis is uncoordinated or absent.

Barium swallow

9
Q

Mx of achalasia

A

Nifedipine Botox may manage.
Nothing is curative.
Surgery.

10
Q

Cell types and function in stomach

A

Foveolar cells produce mucus

Parietal cells secrete HCl and intrinsic factor, which is needed for B12 absorption.

Chief cells secrete digestive enzymes.

G cells secrete gastrin, which promotes HCl secretion.

11
Q

Where are oesophageal varices found?

A

Dilated sub-mucosal veins in the lower 1/3 of the oesophagus

12
Q

usual cause of varices?

A

portal HTN secondary to cirrhosis

13
Q

Dx of varices

A

endoscopy

14
Q

Mx of varices

A

sclerotherapy and banding

15
Q

What is portal HTN? signs?

A

High blood pressure in hepatic portal system.

Signs: ascities, dilated veins, splenomegaly, jaundice, tenderness

16
Q

Causes of portal HTN

A

Pre / intra / post hepatic

Thrombus formation, atresia, liver cirrhosis, fibrosis, sarcoid, TB, pericarditis.

17
Q

Mx of portal HTN

A

portosystemic shunt.

18
Q

Portal HTN -> risk of

A

varices and bleeding, also hepatorenal syndrome and encephalopathy.

19
Q

What is a mallory weiss tear

A

Laceration in stomach and oesophageal lining following protracted vomiting.

20
Q

Causes of mallory weiss

A

alcoholism, bulimia, hyperemesis gravidarum.

21
Q

How deep is tear in mallory weiss

A

submucosa but not muscular layer (Boerhaave syndrome)

22
Q

Mx of serious mallory weiss

A

Endoscopy + cauterisation / adrenaline injections

surgical if needed

23
Q

How is a upper GI blled different to normal haemorrhage

A

transfusion worsens outcomes (unless Pt shocked)

24
Q

Mx of upper GI bleed

A

terlipressin and PPIs instead.

25
Q

DDx gastritis

A

autoimmune (pernicious anaemia), H Pylori, NSAIDs, radiotherapy

26
Q

Mx of gastritis

A

Lifestyle changes, treat underlying disease.
H2, PPIs,
antacids are mainstay of symptom reduction

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