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Flashcards in Gastroenterology Deck (240)
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1

What are aphthous ulcers?

Shallow, painful ulcers with inflammatory haloes that heal without scarring
Often recur

2

List aetiology/risk factors for aphthous ulcers

Inflammatory bowel disease
Iron deficiency
Infection
Trauma
Pemphigus/pemphigoid

3

Outline treatment for aphthous ulcers

Avoid oral trauma, acidic food/drink
Steroid lozenges
Tetracycline/antimicrobial mouthwash
Oral prednisolone if severe

4

What is leucoplakia?

Mucosal white patch that does not rub off and is not attributable to another disease process
Usually pre-malignant

5

List aetiology/risk factors of leucoplakia

EB virus causes oral hairy leucoplakia esp in HIV
Transient candidiasis/SLE/trauma

6

All leucoplakia should be referred for biopsy. True/False?

True, when in doubt

7

What is oral thrush?

White patches on buccal mucosa caused by candidiasis

8

List aetiology/risk factors for oral thrush

Elderly
Immunosuppression
Diabetes
Antibiotics
Long-term steroid + inhaler use
Malignancy

9

Outline treatment for oral thrush

Nystatin suspension
Amphoterecin lozenges
Oral fluconazole

10

Describe the typical appearance of oral squamous cell carcinoma

Raised ulcer with firm edges
Found at floor of mouth or on lateral tongue

11

List aetiology/risk factors for oral squamous cell carcinoma

Smoking
Alcohol
Family history
Soft areas are high-risk sites

12

Outline treatment for oral squamous cell carcinoma

Radiotherapy
Surgery

13

What is GORD?

Reflux of stomach acid causes inflammation of oeseophagus
Can lead to basal zone hyperplasia and metaplasia

14

List aetiology/risk factors for GORD

Incompetent lower oeseophageal sphincter
Hiatus hernia
Obesity
Increased acid secretion
Pregnancy
Achalasia surgery
Overeating/heavy fatty meals
Drugs (tricyclics, anticholinergics, nitrates)
H. pylori

15

List clinical features of GORD

"Heartburn"
Worse lying down and after meals
Relieved by antacid
Belching, regurgitation of food
Waterbrash
Odynophagia
Nocturnal asthma/cough
Laryngitis

16

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

17

Outline treatment of GORD

Lifestyle improvement (smoking, weight, raise bed, small regular meals, avoid hot/spicy food/drinks)
Antacid for symptom relief
PPI (omeprazole)
H2 antagonist may be tried (ranitidine)
Surgery (endoscopic fundoplication to repair LOS) if unresponsive

18

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

19

How would you investigate Barett's oesophagus?

Endoscopy and biopsy

20

Outline treatment of Barett's oesophagus

Avoid acidic food/drink
PPI
Argon
Mucosal resection/RF ablation

21

What is achalasia?

Failure of relaxation of lower oesophageal sphincter due to degeneration of myenteric plexus

22

List clinical features of achalasia

Intermittent dysphagia
Regurgitation
Substernal pain/cramping
Weight loss

23

What investigations would you do for achalasia?

CXR shows dilated oesophagus
Barium swallow shows bird-beak appearance

24

Outline treatment of achalasia

Endoscopic balloon dilation
Heller's cardiomyotomy + PPI
Botox injection
Ca channel blocker

25

What are the most common types of oesophageal cancer?

Squamous or adenocarcinoma
50% middle oesophagus, 30% lower oesophagus, 20% upper oesophagus

26

List aetiology/risk factors for oesophageal cancer

Low vitamin A and/or C
Smoking
Alcohol excess
Achalasia
Plummer-Vinson syndrome
Obesity
Barett's oesophagus
Reflux oesophagitis

27

List clinical features of oesophageal cancer

Dysphagia
Weight loss
Retrosternal chest pain
Hoarse voice
Cough

28

What investigations would you do for oesophageal cancer?

Barium swallow
CXR
Endoscopy + biopsy
CT staging

29

Outline treatment of oesophageal cancer

Palliative care
Surgery if no invasion/wide mets/poor fitness
If localised T1/T2 disease, may try radical oesophagectomy

30

What is gastritis?

Inflammation and mucosal injury to stomach lining