Intro Flashcards
How do you take a dysphagia hx
- Duration
- Solids or liquids
- Pain
- Weight loss
- Previous medical hx
- Immunocompromised - candida infection
- Rheumatological condition affecting motility - systemic sclerosis
- Medications
- Opiates
- Anticholinergics
- Cigarettes and alcohol
- Malignancy risk
How can you organise dysphagia differentials
- Oropharyngeal
- Salivary gland - Sjogren’s
- Tongue - Amyloid, hypothyroid, MND
- Palatal/epiglottal/upper oesophageal - neurodegenerative conditions
- Oesophageal
- Benign mucosal disease: benign peptic stricture, oesophageal web, candidal oesophagitis
- Malignant mucosal disease- Carcinoma
- Motility disorders: Oesophageal spasm, achalasia, pouch
- Gastric
What are some ix for dysphagia
X-ray examination e.g. Barium swallow
- To exclude some benign mucosal disease e.g. benign peptic stricture
Endoscopy - Oesophagastroduodenoscopy
- Allows for biopsy
- 1/5000 risk of perforation
Oesophageal monometry for motility disorders
What are some mx options for dysphagia
Treat underlying cause
Prokinetic drugs e.g. domperidone, metoclopramide
- restricted usage due to risk of arrhythmias/long QT syndrome
What are two scoring systems to assess mortality in endoscopy
Rockall
- Pre and post endoscopy
Glasgow Blatchford
- Most useful in deciding whether a patient needs urgent in-patient endoscopy vs outpatient endoscopy
What are some endoscopic treatments for UGI bleeds
Adrenaline injection
- ulcer
Ablative techniques
Mechanical device
- clip bleeding point
Banding
- for varices
What medications can be given post-endoscopy
- PPI
- High-risk ulcer e.g. visible bleeding point - give IV bolus 72hrs in addition to normal PO regimen
- H. Pylori eradication
- beta-blockers for secondary prevention of varices
- Gastric ulcer - rescope at 6-8 weeks (high dose antacid) to exclude malignancy
What drug do give to a patient with stigmata of liver disease and suspected haematemesis
Terlipressin - reduces portal pressure
- NB) relatively contraindicated in PVD
prophylactic IV antibiotics
- high risk of translocating gut flora into vascular space during endoscopy
Why might ferritin be raised
inflammation
What’s a key test to remember in iron deficiency anaemia
Anti-TTG antibodies
- Coeliac 1/100, 75% have no diagnosis
- cheap test
Tests to assess colon
- Colonoscopy - 1/1000 perforation risk
- Virtual colonoscopy - less sensitive for smaller tumours
- CT w/ long oral prep
- Colon capsule
Exclude renal causes
- Dipstick
- USS renal
What are the four mechanisms of diarrhoea
- Osmotic
- Lactose intolerance
- osmotic laxative
- Secretory
- defects of ion absorption
- stimulant laxative
- enterotoxins
- Malabsorption
- pancreatic insufficiency
- Crohn’s disease
- Coeliac disease
- Abnormal motility
- IBS
- Carcinoid
NB) Most causes are multifactorial
What are the differences between types of IBD
How do you diagnose coeliac
- Anti-TTG antibodies + immunoglobulins (IgA - many coeliac patients are deficient)
- Endomysial antibodies where above indeterminate
- OGD + Duodenal biopsy (villous atrophy)
