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Gastro > Upper GI > Flashcards

Upper GI Flashcards

1
Q

How long is the Oesophagus

A

27cm

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2
Q

Where does the oesophagus start and end?

A

C6 to T10, where it enters the diaphragm at the oesophageal hiatus

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3
Q

How can the oesophagus be split

A

Upper third mucosa - non keratinising squamous epithelium
Columnar cells lower down

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4
Q

What does the upper sphincter split?
What is it composed of?
What is its function?

A

Upper oesophagus and pharynx
Mainly composed of thyropharyngeal and cricopharyngeal muscle pressing against the cricoid

Function - prevent acid reflux going into your mouth and things gong into your airway

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5
Q

What are the normal constrictions during the course of the oesophagus and when can you see this?

A

Bariums swallow
-Level of the cricoid
-Level of the left main bronchus/left atrium
-When the oesophagus enters the diaphragm at T10

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6
Q

Anatomy of Lower Oesophageal Sphinter?

A

-Angle of His - Angle at which oesophagus enters the diaphragm at T10
-Lt and Mainly Rt Crux of diaphragm forming a circular muscular ring
-Apposition of the mucosal folds
-Phrenoesophageal ligament, which is connective tissue

3-4cm distal oesophagus within abdomen
Intra-abdominal pressure acting against the abdominal component of oesophagus

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7
Q

Describe the phases of swallowing

A

Oesophageal phase - autonomic

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8
Q

How is motility of oesophagus measured?

A

Manometry - probe passed into oesophagus and pressure readings taken

Peristaltic waves ~ 40 mmHg

LOS resting pressure ~ 20 mmHg
↓<5 mmHg during receptive relaxation
Mediated by inhibitory noncholinergic nonadrenergic (NCNA) neurons of myenteric plexus

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9
Q

Functional Disorders of the Oesophagus

A
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10
Q

What is dysphagia?

A

Red flag symptom for oesophageal cancer if type changes

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11
Q

What is odynophagia?

A

pain on swallowing

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12
Q

What is regurgitation?

A

refers to return of oesophageal contents from above an obstruction
-May be functional or mechanical

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13
Q

What is reflex?

A

passive return of gastroduodenal contents to the mouth

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14
Q

Symptoms vs signs

A

Symptoms - What the patient reports
Signs - What you illicit from examination

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15
Q

What is achalasia?
What are the causes?

A

Hypermotility
-Failure of LOS to relax ; increased resting pressure

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16
Q

What is this?

A

Barium Swallow
-Radio opaque liquid to drink and pacifies the entire oesophagus
-Bird’s beak appearance - tapering of distal oesophagus
-Dilated oesophagus proximally to this
(Shows achalasia- later feature though so clinically manometry diagnoses it)

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17
Q

What is achalasia a risk factor or?

A

Squamous oesophageal cancer
Increases risk 28 fold

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18
Q

What else happens in achalasia?

A
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19
Q

Disease course of achalasia?

A

Has insidious onset - symptoms for years prior to seeking help
Without treatment → progressive oesophageal dilatation of oesophagus.

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20
Q

What is pneumatic dilation ?

A

Risk of perforation

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21
Q

What surgical treatment is available for achalasia?
What are the risks?

A

Second procedure prevents acid reflux

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22
Q

What is Scleroderma?
What treatment is available?

A
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23
Q

What is diffuse oesophageal spasm?
Treatment?

A

Disordered coordination

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24
Q

Where are oesophageal perforations?

A

Cricopharyngeal constriction
Aortic and bronchial constriction
Diaphragmatic

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25
Q

Aetiology of oesophageal perforations?

A

Iatrogenic (OGD) >50%
Spontaneous (Boerhaave’s) - 15%
Foreign body - 12%
Trauma - 9%
Intraoperative - 2%
Malignant - 1%

26
Q

How does Iatrogenic Oesophageal perforation occur?

A
27
Q

How does Boerhaave’s Oesophageal perforation occur?

A

Someone has been drinking a lot etc then…

27
Q

How does Foreign Body Oesophageal perforation occur?

A
28
Q

How does Trauma Oesophageal perforation occur?

A
29
Q

What is the presentation of Oesophageal perforation?

A

Pain 95 %
Fever 80 %
Dysphagia 70 %
Emphysema 35 %

30
Q

What investigations are done for oesophageal perforation?

A

CXR
CT
Swallow (gastrograffin)
OGD

31
Q
A

Pneumo-mediastinum
Black shows air

32
Q

What is the initial management for oesophageal perforation?

A

NBM
IV fluids
Broad spectrum A/Bs & Antifungals – due to high burden of fungi in oesophagus
ITU/HDU level care
Bloods (including G&S)
Tertiary referral centre

33
Q

What is the definitive management for oesophageal perforation?

A

Chest drain, stent and then ITU

34
Q

Why is the LOS usually closed?

A

As a barrier against reflux of harmful gastric juice (pepsin & HCL)

35
Q

What is LOS pressure increase by ?

A
36
Q

What is LOS decreased by?

A
37
Q

When does sporadic reflux occur

A

Is normal
-pressure on full stomach
-swallowing
-transient sphincter opening

38
Q

What are 3 mechanisms protect following reflux

A

Volume clearance - oesophageal peristalsis reflex
pH clearance - saliva
Epithelium - barrier properties

39
Q

What is chronic acid reflux a risk factor for?

A

Oesophageal Adenocarcinoma

40
Q

What are failures of protective mechanisms in GORD?

A
40
Q

What are failures of protective mechanisms in GORD?

A
41
Q

What is sliding hiatus hernia?

A

Stomach is herniating through the hiatus of the diaphragm

42
Q

What is a hernia?

A

Protrusion of a viscous of a defect of its walls of its containing cavity in abnormal position

43
Q

What is a rolling/paraesophageal hiatus hernia?

A

GOJ is in the correct position but a portion of stomach that is herniated alongside that
Theoretical risk that is can strangulate - therefore surgery

44
Q

In a GP, if a patient comes in with acid reflux and no red flags, what do you do?

A

Treat them there

45
Q

If referred to secondary care, what investigations do you do for acid reflux?

A

OGD
—To exclude cancer
—Oesophagitis, peptic stricture & Barretts oesophagus confirm ∆
Oesophageal manometry
–Important for those with difficult to control reflux to check whether achalasia first
24-hr oesophageal pH recording
(Last two are standard investigations for those considering anti acid surgery)

46
Q

What are the treatments for acid reflux?

A

Medical
—Lifestyle changes (wt loss, smoking, EtOH)
—PPIs
Surgical
—Dilatation peptic strictures
—Laparoscopic Nissen’s fundoplication

47
Q

What are the functions of the stomach?

A

Breaks food into smaller particles (acid & pepsin)
Holds food, releasing it in controlled steady rate into duodenum
Kills parasites & certain bacteria

48
Q

Anatomy of Stomach

A

cells?

49
Q

What is erosive & haemorrhagic gastritis?

A

Numerous causes
Acute ulcer – gastric bleeding & perforation

50
Q

What is Atrophic (fundal gland) gastritis?

A

Fundus
Autoantibodies vs parts & products of parietal cells
Parietal cells atrophy
↓acid & IF secretion

51
Q

What is reactive gastritis?

A
52
Q

What is Nonerosive, chronic active gastritis?

A

Antrum
Helicobacter pylori - Triple Rx (amoxicillin, clarithromycin, pantoprazole) for 7-14/7

53
Q

How is gastric secretion stimulated

A
54
Q

How is gastric stimulation inhibited?

A
55
Q

What is the natural mucosal protection composed of?
What can non-steroidal drugs like ibroprofen do?

A

-They can inhibit bicarbonates so they should be taken with an acid suppressant

56
Q

What are the mechanisms for epithelial repair and wound healing?

A
57
Q

What is the biggest reason for ulcer (break in epithelium) formation?

A
58
Q

What are the treatment of ulcers?

A

Gastro (6 decks)

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