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Year 2 revision > GI pathology symptom based > Flashcards

GI pathology symptom based Flashcards

1
Q

Diagnostic indications for upper GI endoscopy

A
  • haematemesis/melaena
  • dysphagia
  • dyspepsia (>55yrs old, alarm symptoms or treatment refractory)
  • duodenal biopsy (coeliac)
  • persistant vomiting
  • iron deficiency (cancer)
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2
Q

Therapeutic indications for upper GI endoscopy

A
  • treatment of bleeding lesions
  • variceal banding and sclerotherapy
  • argon plasma coagulation for suspected vascular abnormality
  • stent insertion, laser therapy
  • stricture dilation, polyp resection
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3
Q

Upper Gi endoscopy pre-procedure

A
  • stop PPIs 2 weeks pre op if possible
  • nil by mouth for 6 hours beforehand
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4
Q

Sigmoidoscopy views:

A

the rectum and distal colon

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5
Q

Sigmoidoscopy preperation

A

Phosphate enema PR

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6
Q

Diagnostic indications for colonoscopy

A
  • rectal bleeding
  • iron deficiency anaemia (bleeding cancer)
  • persistent diarrhoea
  • positive faecal occult blood test
  • assessment or suspicion of IBD
  • colon cancer surveillance
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7
Q

Therapeutic indications for colonoscopy

A
  • Haemostasis
  • Colonic stent deployment (cancer)
  • volvulus decompression (flexible sigmoidoscopy)
  • polypectomy
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8
Q

Video capsule endoscopy

A

To evaluate obscure GI bleeding and to detect small bowel pathology

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9
Q

Dysphagia

A

Difficulty in swallowing and should prompt urgent investigation to exclude malignancy

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10
Q

Dysphagia - 5 key questions to ask

A
  1. Was there dificulty swallowing solids and liquids from the start?
  2. Is it difficult to initiate a swallowing movement?
  3. Is swallowing painful?
  4. Is the dysphagia intermittent or is it constant and getting worse?
  5. Does the neck bulge or gurgle on drinking?
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11
Q

Dysphagia - difficulty swallowing solids and liquids from the start

A

Motility disorder - achalasia, CNS or pharyngeal cause

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12
Q

Dysphagia - difficulty swallowing solids and then liquids

A

Suspect a stricture (malignant or benign)

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13
Q

Dysphagia - it is difficult to initiate a swallowing movement

A

Suspect bulbar palsy, especially if the patient coughs on swallowing

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14
Q

Dysphagia - swallowing is painful

A

Suspect ulceration of spasm

Causes of ulceration:

  • malignancy
  • oesophagitis
  • viral infection
  • Candida in immunocompromised
  • poor steroid inhalor technique
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15
Q

Dysphagia is intermittent

A

Suspect oesophageal spasm

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16
Q

Dysphagia is constant and worsening

A

Suspect malignant stricture

17
Q

Dysphagia - the neck bulges or gurgles on drinking

A

Suspect a pharyngeal pouch

18
Q

Signs to look for in patient presenting with dysphagia

A
  • is the patient cachexic or anaemic
  • examine the mouth
  • feel for supraclavicular nodes
  • look for signs of systemic disease
19
Q

What does an enlarged left supraclavicular node suggest?

A

Virchow’s node - suggests intra-abdominal malignancy

20
Q

Dysphagia - investigations

A
  • FBC (anaemia)
  • U&Es (dehydration)
  • Upper GI endoscopy +/- biopsy
  • consider contrast swallow (pharyngeal pouch)
  • oesophageal manometry for dysmotility
21
Q

Symptoms of diffuse oesophageal spasm

A

intermittent dysphagia +/- chest pain

22
Q

Achalasia pathophysiology

A

Coordinated peristalsis is lost and the lower oesophageal sphincter fails to relax due to degeneration of the myenteric plexus

23
Q

Achalasia symptoms

A
  • dysphagia
  • regurgitation
  • ↓ weight
24
Q

Achalasia - characteristic findings on manometry or contrast swallow

A

dilated tapering oesophagus

25
Q

Achalasia treatment

A

Endoscopic baloon dilation then proton pump inhibitors

26
Q

Causes of benign oesophageal sphincter

A
  • gastro-oesophageal reflux
  • corrosives
  • surgery
  • radiotherapy
27
Q

Treatment for benign oesophageal stricture

A

Endoscopic baloon dilation

28
Q

Associations with oesophageal cancer

A
  • male
  • GORD
  • smoking
  • alcohol
  • Barett’s oesophagus
29
Q

Alarm symptoms

A
  • Anaemia (iron deficiency)
  • Loss of weight
  • Anorexia
  • Recent onset/progressive symptoms
  • Melaena/haematemesis
  • Swallowing difficulty

Year 2 revision (15 decks)

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