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Year 3 > MedEd upper GI > Flashcards

MedEd upper GI Flashcards

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1
Q

What is achalasia?

A

Failure of the LOS (lower oesophagal sphincter) to relax and aperistalsis

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2
Q

How does achalasia happen?

A

Degeneration of myenteric plexus which produces NO and VIP for relaxation

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3
Q

What are causes of achalasia?

A

Chagas disease

Largely unknown

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4
Q

How will achalasia present? Describe why symptoms arise

A

Dysphagia of both solids and liquids
Regurgitation due to food trapped in oesophagus
Gradual weight loss due to lack of food ingestion

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5
Q

What type of dysphagia will occur in achalasia?

A

Of both solids and liquids

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6
Q

What is the gold standard investigation for achalasia? What other ones might you do? What will they show

A

High res oesophageal manomentry- will show incomlete relaxationa nd epristalsis
Upper GI endoscopy
Barium swallow - will show birds beak

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7
Q

How is achalasia managed?

A

Pharmacologically- CCB or nitrate before meals to reduce chest pain and dysphagia
Surgery- pneumatic dilation, laparoscopic cardiomyotomy

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8
Q

What is GORD?

A

Symptoms and complications resulting from reflux of gastric contents into the oesophagus or beyond

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9
Q

What are RF for GORD?

A 
LOS hypotension
Alcohol
Smoking
Pregnancy
Obesity
Hiatus hernia
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10
Q

How does GORD present?

A

Heartburn/ pain in chest- appears after meals
Acid regurg causes bitter taste in mouth
Waterbrash (increased salivation)
Odynophagia due to oesophagitis or ulceration
Chronic cough
Noctural asthma

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11
Q

What is the gold standard investigation for GORD? What others might you do? What will you see

A

Gold standard= 8 week trail of PPI- reduces symptoms

May do
OGD- will see erosions and ulcerations
Manometry- low pH

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12
Q

How is GORD managed?

A 
non pharmacological: 
weight loss
smoking cessation
small regular meals
avoid acidic fruits and caffiene

pharmacological:
PPI if it worked before
consider adding h2 blocker
antacids for symptom relief

surgical:
nissen fundoplication

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13
Q

What is peptic ulcer disease?

A

Break in lining of stomach with depth to submucosa

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14
Q

What are RF for PUD?

A

H pylori
NSAIDs
Smoking
Increased/decreased gastric emptying

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15
Q

What ulcers are more common out of duodenal and gastric?

A

Duodenal

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16
Q

What is zollinger ellinson syndrome?

A

Tumor causing high gastrin and huge acid production (causes ulcers in stomach and duodenum)

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17
Q

When do cushings ulcers occur?

A

After brain trauma

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18
Q

When do curlings ulcers occur?

A

Due to ischaemia and dehydration eg burns injuries

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19
Q

How does PUD present?

A

Epigastric pain directly after meals
Nausea and vomitting
Mild weight loss

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20
Q

What investigations are done for PUD? What is gold standard? What will they show

A

Gold standard= upper GI endoscopy
H pylori test- urea breath test or stool antigen test
Serum fasting gastrin test

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21
Q

How is PUD managed?

A

lifestyle= reduce smoking and alcohol
medical=
if h pylori- triple therapy w PPI, 2 abx (amox or clarith then metronidazole) 7 day eradication therapy
if not h pylori then usually drug induced so stop the drug and offer 4-8 weeks of PPI therapy

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22
Q

What is gastritis?

A

Mucosal inflammation fo stomach

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23
Q

What is hiatus hernia?

A

Protrusion of abdo contents into thorax

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24
Q

What are types of hiatus hernia? Which is more common

A

Sliding- more common

Rolling

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25
What are RF for hiatus hernia?
Obesity | Anything that increases intra abdo pressure
26
How does hiatus hernia present?
Mostly asyptomatic GORD symptoms- especially on lying down Palpitations or hiccups due to pericardial nerve irritation
27
What is gold standard investigation for hiatus hernia? What others might you do?
Upper GI endoscopy | CXR- see retrocardiac bubble
28
How is hiatus hernia managed?
``` Lifestyle= weight loss and PPI Surgery= only refractory to medical therapy (fundoplication) ```
29
What are complication of hiatus hernia?
Gastric volvulus and barrett's oesophagys
30
What metaplasia occurs in barrets oesophagus?
normal straitified epithelium to columnar epithelium
31
What is barrets oesophagus?
Metaplasia of normal straitified epithelium to columnar epithelium
32
What are RF for barret's oesophagus?
GORD
33
What is seen on OGD in barrets oesophagus that shows metaplasia?
Light pink to darker pink
34
How does barrets oesophagus present?
GORD symptoms
35
What is gold standard investigation for barrets oesophagus?
Upper GI endoscopy with biopsy
36
How is barret's oesophagus managed
non dysplastic= maximise PPI therapy and surveillance every 2 years dysplastic= radiofrequency ablation or endoscopic mucosal resection for nodular growths, once this is done continue with non dysplastic management
37
What are complications of barrets oesophagus?
oesophageal cancer | oesophageal stricture
38
What is oesophageal cancer?
cancer originating from epithelial lining of oesophagus
39
What are the 2 types of oesophageal cancer? Which is more common
Squamous cell- more common | Adenocarcinoma
40
Where in the oesophagus do squamous cell vs adenocarcinoma occur?
``` Squamous= upper 2/3 Adeno= lower 3rd ```
41
What are RF for squamous cell oesophagus cancer?
``` Alcohol Smoking Strictures Achalasia Nitrosamines ```
42
What are RF for aednocarcinoma oesophagus cancer?
GORD Barrett's oesophagus Obesity Achalasia
43
How does oesophageal cancer present?
Progressive dysphagia- first solids then liquids Rapid weight loss Hoarseness of voice
44
How much does oesophageal cancer metastasise and why?
A lot and quick | It can invade through serosa v quickly
45
What is GS investigation for oesophageal cacner?
Upper GI endoscopy with biopsy
46
What is management for oesophageal cancer?
Resect tumor and chemo if there are mets
47
What is gstric cancer?
Neoplasm origincating anywhere in the stomach
48
What are the 2 types of gastric adenocarcinomas?
Intestinal | Diffuse
49
What is intestinal gastric cancer associated with?
H pylori associated
50
What is diffuse gastric cancer associated with?
E cadherin mutation
51
What are RF for gastric cancer?
H pylori Pernicious anaemia Nitrosamines ``` Also smoking high salt intake low vit c blood type a ```
52
How doesgastric cancer present>
Vague but unusual epigastric pain Weight loss Lymphadenopathy- especially virchow's node (supraclavicular)
53
Where is the sister mary joseph nodule?
Above the belly button
54
What is GS inevstigation for gastric cancer? What will you see? What others might you do
Upper GI endoscopy with biopsy will show signet ring cells CT/MRI for staging Endoscopic ultraosunf/ FNA
55
How is gastric cancer managed?
Resection and chemo if metastasised
56
What is mallory weiss tear?
Longitudinal lacertaion in the mucose and submucosa in near GOS
57
What is the cause of mallory weiss tear?
Sudden increase in GI pressure without reduction in intrabdo pressure
58
What are RF for mallory weiss tear?
Retching Coughing Vomitting Straining and alcoholcs and bulimics
59
What 2 groups of people are more likely to get mallor weiss tear?
Bulimics | Alcoholics
60
How does mallory weiss tear present?
``` Haematemesis Light headed/dizzy Postural hypotension May have dyaphgia/odyphagia malaena ```
61
What is GS inevstigatuon for mallory weiss tear? What will you see? What else might you do?
Upper GI endoscopy FBC- shows anaemia Urea- elevated CXR- rule out perforation
62
What happens to urea levels in mallory weiss tear?
Levels increase
63
What risk assessments are used for upper GI bleeds?
Rockall score | Glasgow-Blatchford score
64
How is mallory weiss tear managed?
Most of them resolve spontaneously First line= inject adrenaline or band ligation w endoscopy Adjuncts= PPI before endoscopy to stop bleeding and antiemetics to stop recurrence Second line= sengstaken blakemore tube
65
How do you differentiate between PUD and duodenal ulcers?
PUD= epigastric pain is directly after eating | Duodenal ulcer= epigastric pain manifests a few hours after eating
66
How is PUD pharmacologically managed when someone is h pylori positive?
PPI and 2 abx (usually amoxicillin or clarithromycin plus metronidazole)- 7 day eradication therapy
67
How is PUD pharmacologically managed when someone is h pylori negative?
Stop the drug which is causing the ulcer (usually drug) | Offer 4-8 weeks of PPI therapy

Year 3 (104 decks)

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