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Phase 1c > Upper GI > Flashcards

Upper GI Flashcards

1
Q

How does Achalasia happen

A

failure of the LOS to relax and aperistalsis - degeneration of the myenteric plexus which produce NO and VIP for relaxation

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2
Q

Which one of these diseases can be a secondary cause of achalasia?

Buerger’s disease
Chagas disease
Lyme disease
Behcets disease
Crohn’s disease

A

Chagas diseas (trypanosoma cruzi)

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3
Q

Achalasia presentation

A

dysphagia - both solid and liquids
regurgitation - due to food trapped in oesophagus
gradual weight loss - due to lack of food ingestion

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4
Q

Achalasia investigations

A

gold standard:
high resolution oesophageal manometry - will demonstrate incomplete relaxation and aperistalsis

others:
1st line: upper GI endoscopy - can show retained food debris with dilated wall
barium swallow - “bird beak” appearance

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5
Q

Achalasia differentials and complications

A

differentials:
oesophageal cancer
benign stricture

complications:
aspiration pneumonia
GORD
oesophageal cancer

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6
Q

A 58 year old man presents to the GP. He complains of retrosternal chest pain after eating meals. His wife has noticed his breath is foul smelling and he often experiences a bitter taste in his mouth. What is the most likely diagnosis?

Barrett’s oesophagus
Plummer Vinson syndrome
Zenker’s diverticulum
GORD
Acute gastritis

A

GORD

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7
Q

GORD definition

A

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

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8
Q

GORD risk factors/causes

A

LOS hypotension
hiatus hernia
obesity
gastric acid hypersecretion
alcohol
smoking
pregnancy
LOS tone reducing drugs (TCAs, nitrates, anticholinergics)

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9
Q

GORD presentation

A

++ heartburn (pain in chest) usually after meals
++ acid regurg leaving bitter taste in mouth
+ increased salivation
+ odynophagia if oesophagitis or ulceration
+ chronic cough or nocturnal asthma

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10
Q

GORD investigations

A

gold standard:
- resolution of symptoms after 8 week PPI trial

other:
- OGD - will detect erosions and ulcerations (oesophagitis)
- oesophageal manometry with pH monitoring is useful if OGD shows nothing

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11
Q

GORD management

A

lifestyle:
weight loss
smoking cessation
small regular meals
avoid certain foods (acidic fruit, coffee, alcohol)

medical:
continue PPI that was working
consider adding H2 blocker
antacids may be useful for symptom relied

surgery:
Nissen fundoplication
all forms of surgery aim to increase LOS pressure

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12
Q

GORD differentials and complications

A

differentials:
ACS
stable angina

complications:
ulceration/perforation
barrett’s oesophagus
oresophageal cancer

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13
Q

Peptic ulcer disease definition

A

break in lining of stomach with obvious depth through the submucosa

duodenal ulcers > gastric ulcers

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14
Q

peptic ulcer risk factors

A

H.pylori
NSAIDs
smoking
increased/decreased gastric emptying

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15
Q

gastric specific ulcers

A

Cushing and Curling ulcers

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16
Q

peptic ulcer disease - presentation

A

epigastric pain that the patient can point towards
key difference is gastric directly after meals while duodenal manifests couple hours later
nausea and vomiting
mild weight loss

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17
Q

complications of peptic ulcer disease

A

haemorrhage, perforation or obstruction

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18
Q

peptic ulcer disease investigation

A

gold standard:
upper GI endoscopy - reveals ulcerations and can perform a biopsy of the tissue

other:
- h.pylori tests - most common are urea breath tests and stool antigen test (retest after 6-8 weeks)
- serum fasting gastrin level

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19
Q

peptic ulcer disease management

A

lifestyle:
reduce smoking and alcohol

medical: h.pylori +ve
triple therapy: ppi + 2 abx (normally amoxicillin or clarithromycin unless CI, then metronidazole) - 7 day eradication

medical: h.pylori -ve (maybe drug induced)
stop drug causing ulcer immediately
offer 4-8 weeks of ppi therapy

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20
Q

gastritis definition

A

histological presence of mucosal inflammation

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21
Q

gastritis risk factors

A

h.pylori
NSAIDs
alcohol
Zollinger Ellison syndrome
Menetrier disease
autoimmune

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22
Q

gastritis investigations

A

mainly h.pylori tests
other tests needed for other causes

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23
Q

gastritis management

A

tailor treatment towards each condition

24
Q

hiatus hernia types

A

sliding (80%) and rolling (20%)

25
Q

risk factors for hiatus hernia

A

obesity
anything increasing intra-abdominal pressure

26
Q

hiatus hernia presentation

A

most are asymptomatic
GORD symptoms may be the only reveal
GORD usually worse when lying flat
palpitation or hiccups indicate pericardial irritation

27
Q

hiatus hernia investigations

A

gold standard:
upper GI endoscopy

other:
CXR - retrocardiac bubble

28
Q

hiatus hernia management

A

lifestyle and medical:
similar to GORD - weight loss and PPI

surgery:
only refractory to medical therapy
involves pushing the hernia back into the abdomen
the stomach is also wrapped around the oesophageal junction to help tighten it

29
Q

hiatus hernia differentials and complications

A

differentials:
GORD

complication:
gastric volvulus
Barrett’s oesophagus

30
Q

Barrett’s oesophagus definition

A

metaplasia of normal stratified squamous epithelium to columnar epithelium

31
Q

Barrett’s oesophagus risk factors

A

GORD
anything modulating GORD

32
Q

Barrett’s oesophagus presentation

A

symptoms of GORD

33
Q

Barrett’s oesophagus investigations

A

gold standard:
upper GI endoscopy WITH BIOPSY

34
Q

Barrett’s oesophagus - management

A

non-dysplastic:
maximise PPI therapy and surveillance every 2 years

therapeutic intervention:
radiofrequency ablation or endoscopic mucosal resection for nodular growths

35
Q

Barrett’s oesophagus differentials and complications

A

differentials:
oesophagitis
GORD

complications:
oesophageal cancer
oesophageal stricture

36
Q

oesophageal cancer definitions and types

A

cancer originating from the epithelial lining of the oesophagus

split into two types:
squamous (upper 2/3rd)
adenocarcinoma (lower 1/3rd)

37
Q

risk factors for squamous oesophageal cancer

A

alcohol
smoking
strictures
achalasia
nitrosamines

38
Q

risk factors for adenocarcinoma oesophageal cancer

A

GORD
Barrett’s
obesity
achalasia

39
Q

oesophageal cancer presentation

A

dysphagia - first solids then liquids (progressive)
rapid weight loss
hoarseness if recurrent laryngeal pressed

40
Q

oesophageal cancer investigations

A

gold standard:
upper GI endoscopy WITH BIOPSY

other:
CT/MRI for staging - important for treatment

41
Q

oesophageal cancer differentials and complications

A

differentials:
benign stricture
achalasia

complications:
aspiration pneumonia
fistulas

42
Q

Gastric cancer definition

A

neoplasm originating in any portion of stomach most commonly adenocarcinoma

others include lymphoma, GI stromal tumours, carcinoid

43
Q

types of gastric cancers

A

intestinal - H.pylori associated
diffuse - e-cadherin mutation associated

44
Q

risk factors for gastric cancers

A

pernicious anaemia
h.pylori
nitrosamines
smoking
high salt/ low vit C
blood type A

45
Q

gastric cancer presentation

A

vague but usually epigastric abdominal pain
weight loss
lymphadenopathy

46
Q

gastric cancer investigations

A

gold standard:
upper GI endoscopy with biopsy showing signet ring cells

other:
CT/MRI for staging
EUS with FNA - for staging

*EUS- endoscopic US
*FNA- fine needle aspirate

47
Q

gastric cancer differentials and complications

A

differentials:
PUD
benign stricture

complications:
haemorrhage
obstruction
perforation

48
Q

Mallory-Weiss tear definition

A

longitudinal lacerations in mucosa and submucosa near GOS
usually self-limiting and resolves spontaneously

49
Q

Mallory-Weiss tear risk factors

A

persistent retching. coughing, vomiting or straining

found in alcoholics and bulimics

50
Q

Mallory-Weiss tear presentation

A

haematemesis
lightheaded/dizziness
postural hypotension
may experience dysphagia, odynophagia and melaena

51
Q

Mallory-Weiss tear Ix

A

Gold standard:
upper GI endoscopy to visualise tears

points to note:
risk assessments
rockall score
glasgow-blatchford score

other:
FBC- may show anaemia
urea- elevation may indicate upper GI bleed
CXR- to rule out perforation

52
Q

Mallory-Weiss tear management

A

1st line:
with endoscopy inject adrenaline or conduct band ligation to stop bleeding

adjuncts:
give anti-secretory therapy (PPIs) before endoscopy to reduce bleeding
give anti-emetics to prevent recurrence

2nd line:
Sengstaken-Blakemore tube

53
Q

Mallory-Weiss tear differentials and complications

A

differentials:
oesophageal varices
oesophagitis

complications
Boerrhave’s perforation
re-bleeding

54
Q

which one of these investigations would be used initially in achalasia?

  1. colonoscopy
  2. CXR
  3. Upper GI endoscopy
  4. Oesophageal manometry
  5. Transoesophageal MRI
A
  1. Upper GI endoscopy

Although oesophageal manometry is the gold standard for diagnosing achalasia, with any new onset dysphagia, especially in older patients, an endoscopy to rule out insidious growths is needed

55
Q

PPIs are often trialled and used as 1st line for GORD. which is an example of PPI

  1. ketoconazole
  2. albendazole
  3. riluzole
  4. Carbimazole
  5. Omeprazole
A
  1. Omeprazole

ketoconazole is a commonly used antifungal
albendazole is a commonly used anti-helminth
riluzole is used for motor neurone disease
carbimazole is used in Cushing’s disease

56
Q

A 50 yr old male presents to a+e with excruciating epigastric pain. the pain is also felt in his right shoulder. it is later revealed that he has been suffering from recurrent gastric ulcers lately. What sign is observed in CXR?

  1. Rigler sign
  2. McBurney’s sign
  3. Dome sign
  4. Haemoperitoneum
  5. Sail sign
A
  1. Dome sign

When gastric ulcers burst, free air is released into the peritoneum. Air will naturally rise on an erect CXR displacing the diaphragm causing a dome shape

57
Q

A 60 yr old female presents with severe epigastric pain and retching without vomiting. Small bowel obstruction is suspected and a ‘drip and suck’ protocol is initiated. The NG however is unable to be passed into the stomach. What is the likely diagnosis?

  1. large bowel obstruction
  2. gastric cancer
  3. oesophageal spasm
  4. gastric volvulus
  5. achalasia
A
  1. gastric volvulus

a gastric volvulus is a classic complication of a hiatus hernia. the triad is severe epigastric pain, retching without vomiting and not being able to pass ng tube into stomach

Phase 1c (13 decks)

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