clinical aspects of gastric and duodenal disorders

Question 1

list some upper GI tract symtpoms

Answer 1

• indigestion
• heartburn
• reflux
• vomiting
• haematemesis
• melaena
• weight loss
• anorexia
• early satiety

Question 2

what causes pain in epigastric region?

Answer 2

structures that arise from the embryological foregut. normally difficult to differentiate pain from each of the organs (eg. gall bladder, stomach etc). pathologies in initial part of duodenum also start with epigastric pain

Question 3

what makes up the foregut?

Answer 3

oesophagus, stomach, first part of duodenum, gall bladder

Question 4

what is early satiety?

Answer 4

• sinister symptom
• feel full very quickly after eating a much smaller quantity of food than usual
• can be due to stomach obstruction eg. cancer (stomach able to distend), chronic ulceration causing fibrotic strictures in outlet of stomach (esp seen in younger patients)

Question 5

what does vomiting undigested food suggest?

Answer 5

food has not yet met stomach — suggests obstruction

Question 6

what is a Mallory-Weiss tear?

Answer 6

tear of tissue in lower oesophagus due to violent coughing or vomiting

Question 7

what could vomiting lots of blood be a sign of?

Answer 7

could be a sign of abnormal blood vessel which has bled in upper GI tract, common in chronic alcoholis who have oesophageal/upper GI varices. abnormally large vessels can be weaker and can burst causing sometimes life-threatening bleeding

Question 8

what can smaller haematemesis be due to?

Answer 8

simply from frequent vomiting, bursting of smaller vessels

Question 9

what can significant weight loss imply?

Answer 9

cancer cachexia

Question 10

what is melaena?

Answer 10

black, tarry, smelly stool. blood passes from upper GI tract through the gut and is altered.

however dark stool does not always = melaena. iron tablets can also cause dark stool

Question 11

what is a cause of common conditions such as reflux, and is also associated with some cancers such as cancer of the gastro-oesophageal junction?

Answer 11

obesity — always advise patients to lose weight. can help get rid of reflux symptoms, rather than medicating, surgery etc

Question 12

what is found in situations where you have irritation fo the peritoneal lining of the abdominal cavity, usually in situations with inflammation infection (can arise from eg. perforated duodenal ulcers, gall bladder inflammation etc)

Answer 12

peritonitis

Question 13

what are some signs of anaemia?

Answer 13

pale conjucntiva/skin/fingernails etc.

Question 14

what can anaemia suggest?

Answer 14

slow bleeding from ulcers, cancer

Question 15

where is Virchow’s node?

Answer 15

Virchow’s node lies near to the junction of the thoracic duct and the left subclavian vein. subclavicular fossa

Question 16

what is Virchow’s node a sign of?

Answer 16

advanced cancer. often the first sign of gastric cancer

Question 17

what is an umbilical nodule?

Answer 17

due to metastatic cancer, usually from gastric cancer

Question 18

what is another name for Virchow/s node?

Answer 18

Troiser’s sign

Question 19

what investigations would you do if there are no cancer red flags?

Answer 19

• helicobacter pylori — stool antigen, urea breath test, gastric biopsy
• barium studies
• OGD
• pH and manometry
• BRAVO capsule

Question 20

investigations if there is suspicion of malignant pathology?

Answer 20

• blood tests - FBC, UEs, LFTs, iron studies
• OGD
• CT scan - confined or spread?
• PET-CT scan
• laparoscopy

Question 21

what does manometry assess?

Answer 21

pressure in oesophageal wall. useful to diagnose dismotility and proble in LOS (achalasia - failure of LOS to relax)

Question 22

what is the 1st line investigation for sinister blockage?

Answer 22

endoscopy

Question 23

when is a barium study used?

Answer 23

used to establish if there are any obstructions or strictures. not best test for malignant conditions

Question 24

ultrasound is to make sure the problem is not related to what?

Answer 24

the gall bladder eg. stones

Question 25

what can reflect cancer spread?

Answer 25

liver function tests (abnormalities in liver)

Question 26

what can gastritis be due to?

Answer 26

H pylori infection

Question 27

what is a common cause of ulcers?

Answer 27

NSAIDs

Question 28

what is achalasia?

Answer 28

tight LOS that fails to relax and can be managed with surgery or dilatation

Question 29

what can affect anywhere in the GI tract from mouth to anus?

Answer 29

Crohn’s disease

Question 30

stool antigen test and 13urea breath test for H. pylori — what will interfere with the result?

Answer 30

PPI

Question 31

downside of serology test for H. pylori?

Answer 31

cannot distinguish active from previous infection

Question 32

what is the gold standard test for H. pylori?

Answer 32

CLO test — biopsy during gastroscopy

Question 33

when the peptic ulceration effects the posterior wall of the 1st part of the duodenum, what can happen?

Answer 33

they can erode into the gastroduodenal artery — torrential bleed requiring surgery if cant be managed endoscopically

Question 34

if ulceration is chronic, it can in time develop into a what?

Answer 34

stricture

Question 35

duodenal vs gastric - which can become malignant but which tend to not become malignant?

Answer 35

duodenal ulcer tends not to become malignant, but gastric ulceration can become malignant

Question 36

what are symptoms of peptic ulceration?

Answer 36

• pain
• heartburn
• reflux
• bleeding
• perforation
• stricture/obstruction
  (- malignancy)

Question 37

describe hereditary diffuse gastric cancer (HDGC)?

Answer 37

• genetic gastric cancer
• CDH1 mutation