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Flashcards in GI Deck (139)
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1

What is the aetiology and risk factors of oesophageal reflux

Problems with Lower oesophageal spinchter

-abnormal oesophageal anatomy
eg LOS relaxed, decreased resistance to acid

- Hiatus hernia
-sliding
-paraesophageal

Risk Factors
-Pregnancy
-Obesity
-smoking
-alcohol excess
- Drugs: lowering LOS pressure
- alcohol
-hypo-mobility

2

What is the pathology of oesophageal reflux

Reflux of gastric acid into oesophagus causing thickening of squamous epithelium cells, due to the healing process of fibrosis, as oesophagus lining cant tolerate the acid

3

What is the alarm features of oesphgeal reflux and the possible complications

Alarm Features:
-Dysphagia
-Vomiting
-Weight loss


Ulcerations
(as epithelium not adapted)

Barrets oesophagus

Healing by fibrosis
- Impaired motility
- Oesophageal obstruction
- Stricture formation

4

What is the symptoms of oesophageal reflux

- Dyspepsia due to reflux of acid
-Water brash - sudden flow of saliva
-Cough
-Sleep disturbance

5

What is the management of oesophageal reflux

Management
- Lifestyle modification
- PPI therapy eg omeprazole, lanzoprazole
- Aliginates eg gaviscon
-H2Ra (ranitidine)
-Antacid (malox)

Surgery
-Laparoscopic Hiatus Hernia repair
(Fundoplication)

6

What is the pathology of barrels oesophagus

Type of metaplasia that has the transformation from squamous epithelium to glandular epithelium
(mucin secreting columnar epithelial cells)

Is a premalignant for oesophageal adenocarcinoma

7

What is the investigations fro Oesophageal reflux and barrels oesophagus

oesophageal pH studies manometry

Endoscopy+/-biopsy/ Ultrasound (used in alarm features)

CT +/-PET
-allows staging

CT contrast Barium swallow
-for dsyphagia

8

What is the treatment for barrels oesophagus with high grade dysplasia

- Endoscopic Mucosal Resection (EMR)
- Radio-Frequency Ablation (RFA)
- Oesophagectomy (rarely due to high mortality)

9

What is the two types of oesophagus cancers and their aetiologies

Squamous (TOP)
-Smoking
-Alcohol
-Dietary carcinogen

Adenocarcinoma (BOTTOM)
-Barretts oesophagus
-Obesity

10

What is the local and distant effects of oesophageal cancer

Local Effects
- Obstruction
- Ulceration
- Perforation
(Food passes into thorax due to perforation causing a potential abscess)

Metasases occurs through:
Direct spread
Lymphatic spread
Blood Spread (liver)

11

What is the symptoms of oesophageal cacer

Symptoms caused by Local Effect
-Dysphagia
-Weight loss, anorexia
-Odynophagia
-Chest/heart burn
-Cough
- Anaemic (due to blood loss via ulceration)
-Hematemesis (blood in vomit)
-vocal cord paralysis

12

What is used for the diagnosis and staging of oesophageal cancer

DIAGNOSIS
Endoscopy and over 8 biopsies

oesophageal pH studies manometry

Barium swallow

STAGING

CT scan - distant metastases

Endoscopic US
- TNM staging

PET scan

Bone scan

Laparoscopy
-peritoneal spread

13

What is the treatment of oesophageal cancer

Osesophagectomy (remove oesophagus and use either stomach or colon as conduit) +chemotherapy (fit)

Chemo/radiotherapy (unfit)

14

What is the aetiology of peptic ulcer

- Liver disease
-Alcohol
-Smoking
-H.Pylor (due to acid production)
-NSAIDS/aspirin (reduced mucus and HCO3)
- Systemic stress ulcers

15

What is the symptoms and signs of peptic ulcer

What is the complications

Haematemesis

Melaena

Elevated Urea (h.p)

dyspepsia,

reflux,

epigastric pain, back pain


Complications: Bleeding, Perforation, stricture formation

16

Management of peptic ulcers

Proton pump inhibitors - omeprazole
Antacid
H2 receptors antagonists

Endoscopy with endotherapy
-Injection
(Adreanline constricts area)
-Thermal
(heat area to damage BV)
- Mechanical (Clip)
- Heamospray
(mineral blend powder)

Angiography with embolization

Laparotomy

17

Aeitiology of gastritis

Autoimmune (atrophy and loss leads to inflammation)
Bacterial H.Pylori (increased acid production and inflammation)
Chemical: Drugs, alcohol, bile reflux (inflammation)

18

What is the aetiology of gastric cancer

Previous/current
H. Pylori infection (in body and antrum)

Diet

Genetic (most sporadic though)

Previous gastric resection

Biliary reflux

Smoking

Peptic ulcer

Pre malignant gastric pathology

19

What is the cell type of gastric cancer

what is the prognosis

Adenocarcinoma
- Develops through phase of intestinal metaplasia and dysplasia and is a malignant tumour carcinoma form in glandular epithelium

5 year survival 20%

20

How and where does Gastric cancer metastases

Metastasis How
- Direct
- Lymphatic spread
- Blood spread (liver)
- Trancoelomic spread (spread within peritoneal cavity)

Metastases Where
- Lymph nodes
-Liver
-Lungs
-Peritoneum
-Bone marrow

21

What is the signs and symptoms of Gastric cancer

GI bleeding
-Iron deficiency
- anaemia
Gastric outlet Obstruction

Usually symptomatic

-dyspepsia
-early satiety
-nausea/vomiting
-weight loss

22

What is the investigations and stagings of gastric cancer

Test for Heliobacter Pylori

Histological Diagnosis
-Endoscopy and biopsies

Staging of Gastric Cancer
-CT Chest/ Abdomen
-Asses patients fitness
-Determine the histology

Imaging
-Endoscopy
-Contrast meal/barium enema

23

What is the treatment of gastric cancer

Surgery

-Sub total gastrectomy - preserves some of the stomach
- Total Gastrectomy and roux en reconstruction
- Laparoscopic distal gastrorectomy
- Open gastrorectomy


Chemotherapy

24

What is the alarm symptoms of dyspepsia (bad digestion pain) for an endoscopy

- Anorexia
- Loss of weight
- Anaemia – iron deficiency
- Recent onset >55 years or persistent despite treatment
- Melaena/haematemesis (GI bleeding) or mass
- Swallowing problems dysphagia

ALARMS

25

What is H.Pylori

A gram negative spiral shaped microaeriphilli that is flaggelated allowing movement,

Can only colonise in gastric type mucosa in stomach, but provoked an immune response in underlying mucosa

Creates an alkaline environment around itself by promoting own survival and neutralising acid
by releasing enzyme urease that breaks down urea into ammonia and bicarbonate

26

What does H.Pylori response depend upon

Response dependant on:
- Genetic susceptibility
- Environmental factors (smoking)
-Site of colonisation
-Expresses different proteins that evoke different responses

27

What is the tests for H.Pylori

Non Invasive:

Serology
test IgG against H. pylori

Urea Breath test
uses up urea for food source and creates product Bicarbonate that is CO2 in your breath that can be determined in test

Stool antigen test
need to be on PPI 2 weeks prior

Invasive:

Endoscopy
- Histology, gastric biopsies stained for bacteria
- Culture of gastric biopsies,
- Rapid slide urease test
test for ammonia

28

What is the treatment for H.pylori

ERADICATION THERAPY
Triple therapy of Clarithromycin 500mg bd
Amoxycillin 1g bd or Metronidazole 400mg bd
(tetracycline if penicillin allergic)
PPI: e.g. omeprazole 20mg bd
For 7 days

29

What is the two main aetiologies of acute liver failure

Hepatitis
Bile duct obstruction

30

What is the pathology of acute liver failure

Fatty liver develops into liver fibrosis then causes liver cirrhosis