Flashcards in Gastroenterology Deck (240)
What are aphthous ulcers?
Shallow, painful ulcers with inflammatory haloes that heal without scarring
List aetiology/risk factors for aphthous ulcers
Inflammatory bowel disease
Outline treatment for aphthous ulcers
Avoid oral trauma, acidic food/drink
Oral prednisolone if severe
What is leucoplakia?
Mucosal white patch that does not rub off and is not attributable to another disease process
List aetiology/risk factors of leucoplakia
EB virus causes oral hairy leucoplakia esp in HIV
All leucoplakia should be referred for biopsy. True/False?
True, when in doubt
What is oral thrush?
White patches on buccal mucosa caused by candidiasis
List aetiology/risk factors for oral thrush
Long-term steroid + inhaler use
Outline treatment for oral thrush
Describe the typical appearance of oral squamous cell carcinoma
Raised ulcer with firm edges
Found at floor of mouth or on lateral tongue
List aetiology/risk factors for oral squamous cell carcinoma
Soft areas are high-risk sites
Outline treatment for oral squamous cell carcinoma
What is GORD?
Reflux of stomach acid causes inflammation of oeseophagus
Can lead to basal zone hyperplasia and metaplasia
List aetiology/risk factors for GORD
Incompetent lower oeseophageal sphincter
Increased acid secretion
Overeating/heavy fatty meals
Drugs (tricyclics, anticholinergics, nitrates)
List clinical features of GORD
Worse lying down and after meals
Relieved by antacid
Belching, regurgitation of food
What investigations would you do for GORD?
Trial PPI for 2 weeks + antacid
Endoscopy if over 55 yo, symptoms longer than 4 weeks, dysphagia or weight loss
24h manometry +/- pH monitoring if normal endoscopy
Barium swallow if indicated e.g. hernia
Outline treatment of GORD
Lifestyle improvement (smoking, weight, raise bed, small regular meals, avoid hot/spicy food/drinks)
Antacid for symptom relief
H2 antagonist may be tried (ranitidine)
Surgery (endoscopic fundoplication to repair LOS) if unresponsive
What is Barett's oesophagus?
Metaplastic change from stratified squamous to columnar epithelium due to persistent acid abuse
Mucosa becomes unstable and susceptible to dysplasia
How would you investigate Barett's oesophagus?
Endoscopy and biopsy
Outline treatment of Barett's oesophagus
Avoid acidic food/drink
Mucosal resection/RF ablation
What is achalasia?
Failure of relaxation of lower oesophageal sphincter due to degeneration of myenteric plexus
List clinical features of achalasia
What investigations would you do for achalasia?
CXR shows dilated oesophagus
Barium swallow shows bird-beak appearance
Outline treatment of achalasia
Endoscopic balloon dilation
Heller's cardiomyotomy + PPI
Ca channel blocker
What are the most common types of oesophageal cancer?
Squamous or adenocarcinoma
50% middle oesophagus, 30% lower oesophagus, 20% upper oesophagus
List aetiology/risk factors for oesophageal cancer
Low vitamin A and/or C
List clinical features of oesophageal cancer
Retrosternal chest pain
What investigations would you do for oesophageal cancer?
Endoscopy + biopsy
Outline treatment of oesophageal cancer
Surgery if no invasion/wide mets/poor fitness
If localised T1/T2 disease, may try radical oesophagectomy