Session 8- Upper and Lower GI malignancies

Question 1

what are some benign causes of dysphagia

Answer 1

strictures
foreign bodies
nerve palsies

Question 2

what are some malignant causes of dysphagis

Answer 2

squamous cell carcinoma

adenocarcinoma

Question 3

what carcinoma arises from stratified squamous epithelium

Answer 3

squamous cell carcinoma

Question 4

what type of epithelia does a adenocarcinoma arise from

Answer 4

simple columnar epithelium

Question 5

how can we diagnose barretts oesophagus

Answer 5

endoscopy - can take biospy

barium swallow - cant take biopsy

Question 6

what is the prognosis of barretts

Answer 6

5 years

Question 7

red flags of upper GI malignancy

ALARM

Answer 7

a- anaemia
l- loss of weight
a- anorexia
r- recent onset of progressive symtoms
m-masses- maleana

Question 8

what three ways can a oesophagel malignancy be

Answer 8

intra-luminal
extra-luminal
luminal

Question 9

red flags of epigastric pain

Answer 9

maleana

haemtemesis

Question 10

what causes haematemesis

Answer 10

varices
ulcers
mallory-weiss- tears in oesophagus

Question 11

benign causes of epigastric pain

Answer 11

gastritis
peptic ulcers
pancreatitis

Question 12

where can an adenocarcinoma present in stomach

Answer 12

antrum

cardia

Question 13

risk factors for gastric cancer

Answer 13

high salt diet
smoking
FHx
H. pylori 
old age ]men

Question 14

how can you get malignancy in the liver

Answer 14

hepatocellular carcinoma- cirrhosis

metastises - portal circulation

Question 15

what are common metasis to the liver

Answer 15

breast
colon
lung 
skin 
ovaries

Question 16

how can metastise to the liver

Answer 16

haemtogenous
transcoelemic
lymph

Question 17

what are the majorty of pancreatic cancers

Answer 17

exocrine- 90%

Question 18

what is an exocrine pancreatic cancer

Answer 18

ductal adenocarcinoma

Question 19

how does a ductal adenocarcinoma affect the pancreas

Answer 19

head- jaundice as it interfers with billary flow into duodenum
tail/body- malabsorption

Question 20

risk factors for pancreatic cancer

Answer 20

FHx
smoking
male
old age 
chronic pancreatitis

Question 21

what is a malignancy of the bie dicts called

Answer 21

cholangiocarcinoma

Question 22

what are the 2 forms of oesophageal cancer

Answer 22

adenocarcinoma

squamous cell carcinoma

Question 23

what are adenocarcinomas linked to

Answer 23

barretts oesophagus

Question 24

what are the most common form of pancreatic malignacies

Answer 24

ductal adenocarcinomas`

Question 25

what are most colerectal cancers

Answer 25

adenomas

Question 26

what is familial adenomatous polyposis

Answer 26

autosomal dominant condition caused by a mutation in the APC gene( tumour suppressor gene) where invariably the numerous polyps arise which can undergo dysplasia and become a cancer

Question 27

what are colorectal cancers linked to

Answer 27

several genetic events such as the activation of oncogenes, ineffective DNA repair and the loss of tumour suppressor genes

Question 28

where do most colorectal cancers occur

Answer 28

sigmoid colon -30% | rectum - 50%

Question 29

how do small bowel obstructions present compared with large

Answer 29

vomiting in small bowel wheres constipation in large bowel

Question 30

benign causes of PR bleeding

Answer 30

``` haemorrhoids anal fissures IBS diverticular disease infective gastroenteritis ```

Question 31

what is tenesmus

Answer 31

feeling the need to pass stools even though bowel is empty

Question 32

how do right sided malignancies grow

Answer 32

fungating, gow out into lumen

Question 33

where is obstruction more likely on the right or left side

Answer 33

left -descending colon

Question 34

how do malignanies grow in left side

Answer 34

stenosing- obstruct lumen | lumen is narrower

Question 35

how do we investigate large bowel cancer

Answer 35

colonoscopy | endoscopy

Question 36

blood tests for large bowel cancer

Answer 36

FBC Tumour marker CEA CA19-9

Question 37

risk factors of small nowel cancer

Answer 37

FAP IBD coeliac anything that causes the growth of polyps/inflammation

Question 38

what is common cause of chronic gastritis

Answer 38

infection with H pylori

Question 39

How does autoimmune gastritis result in Vit B12 deficiency?

Answer 39

Antibodies to the parietal cells not only affect the acid production, but also the release of intrinsic factor. Intrinsic factor is required for the binding of B12 and its subsequent absorption.

Question 40

State one way that H-pylori can interfere with the mucus layer lining the stomach epithelium

Answer 40

It releases mucinases (enzymes that breakup mucus)

Question 41

Colonisation of which region of the stomach, by H-pylori, can increase the likelihood of duodenal ulceration?

Answer 41

antrum

Question 42

To qualify as a peptic ulceration, what layer of the gastric or duodenal wall must the erosion pass through?

Answer 42

muscularis mucosae

Question 43

In basic terms, what causes Malaena?

Answer 43

Slow upper gastrointestinal bleed. Blood is oxidised as it passes through gut turning stool black

Question 44

where are meckels diverticuli commonly situated

Answer 44

middle to distal ileum

Question 45

where in the oesophagus do you get adenocarcinomas

Answer 45

lower third