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GI: Key Information > Oral cavity and Oesophagus > Flashcards

Oral cavity and Oesophagus Flashcards

1
Q

most common oral cancer

A

squamous cell carcinoma

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2
Q

causes of oral cancer

A 
tobacco
alcohol
diet
HPV16
candida
syphilis
dental factors
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3
Q

high risk sites for oral cancer

A

ventral and lateral tongue
floor of the mouth
soft palate

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4
Q

presentation of oral cancer

A
  • pain less ulcer (indurated with rolled edges if advanced)
  • red, white (leukoplakia is premalignant-candida) and red and white lesions
  • numb, change in voice, dysphagia
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5
Q

diagnosis of oral cancer

A
  • biopsy

- PET CT of head and neck

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6
Q

define globus

A

sensation of having a lump in your throat (functional dysphagia) diagnose via ruling out other causes

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7
Q

management of globus

A
  • reassurance
  • anti-reflux
  • stop smoking
  • referral to SALT
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8
Q

define achalasia

A

lower oesophageal sphincter fails to relax

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9
Q

presentation of achalasia

A
  • heartburn and chest pain (oesophageal spasm has corkscrew appearance of barium swallow)
  • dysphagia
  • vomiting
  • weight loss
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10
Q

diagnosis of achalasia

A
  • manometry (pressure measurement- swallow and identification of muscles)
  • endoscopy
  • CXR (bird beak appearance in obstruction)
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11
Q

management of achalasia

A
  • muscle relaxations e.g. nitrates or nifedipine
  • balloon insertion via OGD
  • botox injection OGD
  • surgery = Heller’s
  • PPIs for oesophageal spasm
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12
Q

define a pharyngeal pouch

A

bulge in the pharynx - mucosa and submucosa between inferior pharyngeal constrictor muscle (Killian dehiscence)

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13
Q

presentation of a pharyngeal pouch

A
  • dysphagia
  • weight loss
  • chronic cough
  • regurgitation
  • aspiration
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14
Q

diagnosis of a pharyngeal pouch

A

barium swallow (do not do an endoscopy as risk of perforation)

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15
Q

management of pharyngeal pouch

A

staple smaller lesions

diverticulectomy for big lesions

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16
Q

define GORD

A

this is acid reflux that irritates the lining of the oesophagus

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17
Q

three causes of GORD

A
  1. incompetent LOS
  2. poor oesophageal clearance
  3. visceral hypersensitivity
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18
Q

presentation of GORD

A
  • heart burn and chest pain (worse on bending or lying down and with alcohol)
  • acid reflux (can cause dental erosion)
  • dysphagia and odynophagia
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19
Q

diagnosis of GORD

A
  • OGD

- oesophageal manometry and pH studies

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20
Q

management of GORD

A
  • lifestyle modification e.g. prop head of bed up, weight loss and antacids
  • PPIs and H2RAs
  • surgery e.g. fundoplication and gastroplication
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21
Q

define oesophagitis

A

this is inflammation of the oesophagus (acute or chronic), reflux causes epithelial expansion and increased WCC.

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22
Q

what is allergic oesophagitis characterised by?

A

eosinophils

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23
Q

presentation of oesophagitis

A
  • dysphagia
  • chest pain (behind breastbone)
  • heartburn and reflux (can cause ulcerations and strictures)
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24
Q

diagnosis of oesophagitis

A
  • pH probe for reflux (negative in allergic)
  • bloods for eosinophil count
  • endoscopy (feline)
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25
Q

management of allergic oesophagitis

A
  • steroids
  • sodium cromoglicae
  • montelukast
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26
Q

define Barrett’s oesophagus

A

replacement of stratified squamous epithelium by columnar epithelium

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27
Q

explain of metaplasia

A

Barrett’s oesophagus

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28
Q

cause of Barrett’s oesophagus

A

persistent reflux causes the protective response of faster epithelium generation leading to an unstable mucosa

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29
Q

presentation of Barrett’s

A 
frequent reflux
dysphagia
chest pain
haematemesis
often presents with a hiatus hernia
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30
Q

diagnosis of Barrett’s

A
  • OGD with biopsy

- barium oesophagogram for hiatus hernia

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31
Q

management of Barrett’s

A
  • surveillance for adenocarcinoma
  • PPIs with radio frequency ablation (eliminate metaplasia-not routine)
  • resection and oesophagectomy for high grade dysplasia
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32
Q

presentation of oesophageal cancer

A
  • dysphagia (tumour obstruction)
  • anaemia
  • weight loss
  • malaise
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33
Q

diagnosis of oesophageal cancer

A
  • OGD with biopsy

- CT thorax and abdomen

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34
Q

management of oesophageal cancer

A
  • resection or oesophagectomy

- chemotherapy or radiotherapy

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35
Q

define oesophageal varices

A

presence of abnormal enlarged veins in the oesophagus which can rupture and bleed (consequence of portal hypertension)

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36
Q

presentation of oesophageal varices

A
  • haematemesis
  • spider naevi, ascites, jaundice, encephalopathy (liver disease)
  • leukonychia
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37
Q

diagnosis of oesophageal varices

A
  • FBC for anaemia

- OGD

38
Q

what is the Rockall score used for?

A

predictor of rebleeding

39
Q

management of a variceal bleed

A
  • resuscitation
  • adrenaline
  • antibiotics
  • terlipressin, vasoactive drug (reduces blood flow to the oesophagus)
  • OGD with EVL
  • beta blockers reduce pressure in portal veins
  • TIPS
  • sclerotherapy to improve appearance of veins
  • balloon tamponade
40
Q

define a mallory-weiss tear

A

tear in the lining of the oesophagus that can be caused by violent coughing or vomiting

41
Q

presentation of mallory-weiss tear

A
  • haematemesis
  • melaena (stools with digested blood)
  • SOB
  • dizziness, weakness
42
Q

diagnosis of a mallory-weiss tear

A

endoscopy

43
Q

management of a mallory-weiss tear (only if persistent)

A

adrenaline injection, band ligation and coagulation

44
Q

define a peptic ulcer

A

this is the presence of an ulcer where the mucosa is exposed to HCl or pepsin

45
Q

causes of peptic ulcer

A

H. pylori

NSAIDS

46
Q

presentation of a peptic ulcer

A
  • burning epigastric pain

- acute bleeding (haematemesis and/or melaena)

47
Q

diagnosis of a peptic ulcer

A
  • gastric biopsy (upper GI endoscopy)
  • urea breath test for H. pylori
  • faecal antigen test for H. pylori
  • serology for IgA antibodies (not diagnostic in elderly)
48
Q

management of a peptic ulcer

A
  • endoscopy with adrenaline, clip, heater probe coagulation or haemspray
  • PPIs and H2RAs
  • eradication of H. pyrloi
49
Q

medication for eradication of H. pylori

A

PPI
amoxicillin/metronidazole
clarithromycin

50
Q

define peptic stricture

A

narrowing in the oesophagus

51
Q

presentation of peptic stricture

A

end stage GORD
over 60
intermittent dysphagia for solid which gradually worsens

52
Q

diagnosis of peptic stricture

A

OGD

53
Q

management of peptic stricture

A

PPIs

if severe then endoscopic dilation

54
Q

define Bechet’s syndrome

A

rare disorder of vasculitis that can cause GI bleeding

55
Q

presentation of Bechet’s

A
  • GI bleeding
  • uveitis
  • erythema nodosum
  • ulcers
56
Q

management of Bechet’s

A

steroids and immunosuppression

57
Q

what causes oral hairy leukoplakia?

A

EBV

58
Q

what increases your risk of getting oral hairy leukoplakia?

A

HIV

59
Q

what does recent antibiotics increase the risk of in the mouth?

A

candidiasis

60
Q

how to tell the difference between candidiasis and leukoplakia?

A

candidiasis brushes off

61
Q

management of aphthous ulcers

A

tetracyclines
topical steroids
analgesia

if severe= systemic corticosteroids or thalidomide

62
Q

management of candidiasis

A 
nystatin suspension (swill and swallow)
fluconazole if oropharyngeal
63
Q

define microstomia

A

small mouth from thickening and tightening of perioral skin e.g. burns, systemic sclerosis

64
Q

other surgical options for pharyngeal pouch

A

heller’s myotomy
fundoplication
H.H repair
reconstruction

65
Q

what does intermittent dysphagia suggest?

A

oesophageal spasm

66
Q

causes of odynophagia

A

ulceration
oesophagitis
candidiasis
spasm

67
Q

causes of congenital dysphagia

A

cleft palate/ lip

cerebral palsy

68
Q

what are oesophageal varices?

A

submucosal venous dilations secondary to increased portal pressures

69
Q

why is bleeding brisk in varices?

A

liver complications (coagulation factors)

70
Q

common locations for varices

A

gastro-oesophageal junction
ileocacaecal junction
rectum
periumbilical vein (caput medusa)

71
Q

what is the Rockall score

A

used for risk of rebleeding

used post-endoscopy

72
Q

long-term management of varices

A

beta blockers

73
Q

describe melaena

A

black tarry stool from upper GI haemorrhage

74
Q

what to stop in GI bleed?

A

NSAIDs

anticoagulants

75
Q

what is group and save?

A

patient’s blood group is checked and a sample is kept in case they need to crossmatch

76
Q

what is crossmatch?

A

lab finds out if the patient’s blood is compatible and keeps blood in the fridge ready to be used

77
Q

what is Boerhaave’s syndrome?

A

complete rupture of the lower thoracic oesophagus

78
Q

signs of Boerhaave’s syndrome?

A

hartmann’s sign= crunching sound upon auscultation of the heart
chest pain
shock
subcutaneous emphysema

79
Q

drug causes of peptic ulcer

A

SSRIs
NSAIDs
steroids

80
Q

which location of peptic ulcers are most at risk of bleeding?

A

posterior duodenal ulcers due to being nearest to the gastroduodenal artery

81
Q

does eating worsen gastric ulcers?

A

yes

82
Q

does eating worsen duodenal ulcers

A

no

83
Q

what needs to be done post peptic ulcer treatment?

A

repeat endoscopy in 6-8 weeks to exclude malignancy

84
Q

what is the Glasgow-Blatchford score?

A

severity of upper GI haemorrhage
indicates prognosis/ need for intervention
score of 0 often doesn’t need admission

85
Q

what is Nissen fundoplication

A

wrapping fundus of stomach around lower oesophagus in rolling hiatus hernia to prevent volvulus

86
Q

what is Plummer-Vinson syndrome?

A

webbing of oesophagus- extension of normal oesophageal tissue

87
Q

presentation of Plummer-Vinson syndrome

A

dysphagia
iron deficiency anaemia
oesophageal webs

88
Q

diagnosis of Plummer-Vinson syndrome

A

barium swallow

OGD

89
Q

management of Plummer-Vinson syndrome

A

increased risk of oesophageal cancer so needs monitoring
iron replacement
dilatation of webs if required

90
Q

what to do if malignant change in peptic ulcer?

A

consider distal gastrectomy

  • Billroth 1= gastroduodenostomy
  • Billroth 2= gastrojejunostomy

GI: Key Information (24 decks)

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