Swallowing Difficulties Flashcards by Jessica Lake

Which portion of the oesophagus contains involuntary smooth muscle only?

The inferior third of the oesophagus.

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Which epithelial cells line the lower oesophagus?

Stratified squamous epithelium (to resist abrasion)

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Which cells line the stomach?

Columnar epithelium

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What symptoms can be used to indicated whether dysphagia is due to a structural lesion or due to myomotility/neurological disorders?

Dysphagia to primarily solid foods = indicative of structural lesion
Dysphagia to both solid and liquid from onset of symptoms = indicative of myomotility/neurological disorders.

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What may rapid progression of dysphagia symptoms be suggestive of?

Malignancy

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What is odynophagia?

Pain on swallowing

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What may a long history of vomiting accompanying dysphagia suggest?

A Mallory-Weiss tear

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What type of oesophageal cancer is most prevalent in developed countries?

Oesophageal adenocarcinoma

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What is the predominant type of gastric cancer?

Adenocarcinoma

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What are the typical symptoms of gastric cancer? (3)

-Epigastric pain
-Weight loss
-Dysphagia (in patients with proximal or gastro-oesophageal junction tumours)

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What is Barrett’s Oesophagus?

A metaplastic change of epithelium in the oesophagus from stratified squamous to columnar glandular epithelium (as found in the stomach).

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What is Virchow’s Node?

Enlargement of a left-sided supraclavicular node that can be indicative of gastric cancer.

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When does NICE guidance recommend a 2 week wait pathway referral for oesophageal/gastric cancer? (2)

For patients with dysphagia
OR
For patients aged 55 and over with weight loss and any of following: upper abdominal pain, reflux or dyspepsia.

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What is the first line investigation for dysphagia?

Oesophagogastroduodenoscopy (OGD), to differentiate between oesophageal cancer and benign causes of dysphagia.

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What symptoms are indicative of gastritis? (6)

-Epigastric pain (sometimes worse with hunger)
-Loss of appetite
-Bloating
-Nausea
-Vomiting
-Early satiety

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What are the main symptoms indicative of peptic ulcers? (3)

Chronic, upper abdominal pain related to hunger.
Nausea
Distention and bloating

What symptom is classically taught to be helpful in distinguishing between a gastric and duodenal ulcer?

Nature of the pain:
Worse pain with food = gastric ulcer
Worse pain with hunger = duodenal ulcer

What is Grey Turner’s Sign?

Haematoma around around the flanks, characteristic of haemorrhagic pancreatitis.

What symptoms and signs are indicative of pancreatic cancer? (5)

-Obstructive jaundice signs (pale stools, dark urine, itching)
-Unintentional weight loss
-Nausea and vomiting
-Vague epigastric/back pain
-Epigastric mass

What is Courvoisier’s Law?

A principle stating that a painless palpably enlarged gallbladder accompanied by mild jaundice is unlikely to be caused by gallstones (and is usually cholangiocarcinoma or pancreatic cancer).

What is Trousseau’s Sign of Malignancy?

Refers to migratory thrombophlebitis (blood clots appearing unexpectedly in superficial veins and migrating over time to different locations) as a sign of malignancy.

How does a Mallory-Weiss Tear (MWT) typically present?

Haematemesis after an episode of forceful or recurrent retching, vomiting, coughing or straining.

What are oesophageal varices?

Dilated collateral blood vessels that develop as a complication of portal hypertension.

When is retesting for H. pylori after completing eradication treatment indicated?

Only if patient has had poor compliance with medications, have an associated peptic ulcer, or are experiencing persistent symptoms despite treatment.

How long following a course of antibiotics should you wait before attempting H. pylori testing?

4 weeks

For how long should a patient have stopped PPI treatment prior to H. pylori testing?

At least 2 weeks

What is reported haematemesis and malena suggestive of?

An upper GI bleed.

What is meant by ‘coffee ground vomit’?

Haematemesis, presenting as dark red/brown/black vomit due to presence of clotted blood. Indicative of an upper GI bleed.

What is terlipressin?

A vasopressin analogue, which acts as a vasoconstrictor predominantly in splanchnic circulation to reduce pressure in the portal vein, subsequently slowing or stopping variceal bleeding.

What is terlipressin used to treat? (2)

Variceal bleeding (licensed) Hepatorenal syndrome (unlicensed)

What are the endoscopic treatment options for variceal bleeds? (2)

Bands can be used to cut off blood supply around varices (rubber band ligation) Trans-jugular intrahepatic portosystemic shunt (TIPS)

What is involved in trans-jugular intrahepatic portosystemic shunt (TIPS)?

An interventional radiologist inserts a stent to connect the portal vein to the hepatic vein; this allows blood to be brought back from the bowel to the heart, bypassing the liver thus reducing pressure in the portal vein.

What are the endoscopic treatment options for a peptic ulcer bleed? (4)

-Injection of vasoconstrictors (such as adrenaline) -Mechanical control of bleeding (such as clips) -Thermal coagulation (via a heat probe) -Haemostatic adjuncts (such as fibrin and thrombin)

What is the Rockall Score?

A scoring system used to estimate the risk of rebleeding and of overall mortality from an upper GI bleed, in patients who have had a completed endoscopy.

What are the two most common vascular sources of upper GI bleeding?

Gastroduodenal artery (with posterior duodenal ulcers) Branches of left gastric artery (at lesser curve of stomach)

What is involved in ‘embolisation’?

‘Blocking’ an artery to stop the flow of blood, usually by deploying some small metallic coils directly into the artery that then clot the vessel.

What is the timeframe for the healing of peptic ulcers?

Generally, peptic ulcers heal within 8 weeks with PPI use.