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Upper GI Flashcards

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1
Q

What is dyspepsia?

A

Inexact term used to describe collection of UPPER GI symptoms eg. heartburn, acidity, pain or discomfort, nausea, wind, fullness or bleching

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2
Q

Which symptoms of dyspepsia are suggestive of serious disease?

A

ALARM symptoms

Anaemia
Loss of weight
Anorexia
Recent onset of progressive symptoms
Melaena or Haematemesis (black, tarry faeces associated with upper GI bleeding)
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3
Q

What does faeculent vomit suggest?

A

Low intestinal obstruction or presence of gastrocolic fistula

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4
Q

Contraindications to OGD

A

Severe COPD, recent MI, severe instability of atlantoaxial joints

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5
Q

What is Behcets disease?

A

Rare condition causing inflammation of small blood vessels, aka small-vessel vasculitis

Often presents with mucous membrane ulceration and eye problems

Also ache, headache and joint problems

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6
Q

What is pemphigus vulgaris?

A

Pemphigus vulgaris - autoimmune blistering disease of skin and mucosa. Due to autoantibodies to desmogleins. Therefore attack desmosomes causing skin to blister.

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7
Q

What is pemphigoid?

A

Group of autoimmune skin blistering diseases but no acantholysis (targeting of desmosomes)
Believed to be IgG or IgA mediated. IgA rarely affect the mouth.

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8
Q

What is lichen planus?

A

Disease of skin and mucosal surfaces that resembles lichen – cause unknown (autoimmune?), no cure but can have symptomatic control

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9
Q

Treatment of mild aphthous ulcers?

A

Avoid trauma, avoid acidic food and drink

tetracycline or antimicrobial mouthwashes = chlorhexidine

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10
Q

Treatment of serious aphthous ulcers?

A

Corticosteroids (prednisolone)

Biopsy any ulcer not clearing after 3 weeks - query malignancy

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11
Q

What is oral hairy leucoplakia?

A

Shaggy white patch on side of tongue, benign

Seen in HIV with EBV

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12
Q

Risk factors for candidiasis?

A

Extremes of age
DM
Immunosuppressed
Antibiotics

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13
Q

Treatment of candidiasis?

A

Nystatin
Amphotericin
Fluconazole

All anti-fungals

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14
Q

What is chelitis - what caused by?

A

Also called angular stomatitis
Fissuring of mouth corners

Caused by denture problems, candidiasis, B12 or iron deficiency

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15
Q

What is gingivitis?

A

Gum inflammation and hypertrophy

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16
Q

Causes of gingivitis?

A 
Poor oral hygiene
Pregnancy
Vit C deficiency
Acute myeloid leukaemia 
Systemic sclerosis/scleroderma
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17
Q

What is microstomia and causes?

A

Small narrow mouth

Caused by thickening and tightening or perioral skin

Caused by:

  • Burns
  • Epidermolysis bullosa - connective tissue disease
  • Scleroderma
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18
Q

What is Peutz-jeghers syndrome?

A

Hamaratmous polyps in GIT

Hyperpigmented macules on lips and oral mucosa

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19
Q

What are fordyce glands?

A

Creamy yellow spots at border of oral mucosa and lips - sebaceous cysts - common and benign

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20
Q

What is xerostomia? - causes?

A

Dry tongue

Dehydration, TCA’s, after radiotherapy, Crohn’s disease, Sjogren’s

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21
Q

What is glossitis? - cause?

A

Smooth, red, sore tongue

Caused by iron, B12 or folate deficiency

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22
Q

Causes of macroglossia?

A

Myxoedema (hypothyroidism)
Acromegaly
Amyloid

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23
Q

How does tongue cancer present?

A

On tongue edge, raised ulcer with firm edges

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24
Q

Main risk factors for tongue cancer? x2

A

Smoking and alcohol

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25
Treatment of tongue cancer?
Radiotherapy or surgery | 5year survival of early disease = 80%
26
What is odynophagia and what does it suggest?
Pain during swallowing and suggests oesophagitis eg. due to reflux Infection Chemical oesophagitis due to drugs such as bisphosphonates, or slow-release potassium
27
Causes of GORD
Lower oesophageal sphincter hypotension Hiatus hernia Loss of peristalsis function Gastric acid hypersecretion Obesity, overeating, smoking, alcohol and pregnancy Surgery for achalasia Drugs - TCAs, anticholinergics, nitrates Helico bacter pylori
28
Symptoms of GORD
Heartburn - retrosternal burning discomfort - worse on stooping, eating, lying down or straining Belching Acid brash Waterbrash (increased salvation) Odynophagia Asthma, nocturnal cough, laryngitis, voice hoarseness
29
Complications of GORD
Oesophagitis Ulcers Benign stricture Malignancy Iron-deficiency
30
Tests in GORD
Endoscopy if ALARM signs or symptoms persisting despite treatment, or >55 Barium swallow may show hiatus hernia Oesophageal manometry
31
Conservative treatment of GORD
Raise bed head Loose weight, stop smoking, reduce alcohol Regular meals and avoid trigger food/drink Avoid eating 3 hours before bed Avoid drugs which affect GI motility - nitrates, anticholinergics, Calcium channel blockers Avoid drugs that damage mucosa - NSAIDs, K+ salts, bisphosophonates
32
Medical treatment of GORD
Antacids - neutralise stomach acid eg. alginate containing - Gaviscon PPI - lansoprazole H2 receptor antagonists - cimetidine, ranitidine, famotidine
33
When is surgery implicated in GORD?
If drugs not working, concern of long-term side effects Recurrent hiatus hernia
34
What is the surgery for GORD?
Fundoplication - tighten the crura in diaphragm Nissen - 360 degree wrap and others are less Done laparoscopically
35
What is Barrett's oesophagus?
When normal oesophageal squamous epithelium is replaced by metaplastic columnar mucosa Almost always a hiatus hernia present From acid exposure by GORD
36
Diagnosis of Barrett's oesophagus? Treatment?
Endoscopy and biopsies Can do mucosectomy or oesophageal resection
37
Risk with Barrett's oesophagus?
Oesophageal adenocarcinoma - quantity of increased risk is debated
38
What is achalasia?
Impaired peristalsis of oesophagus and impaired relaxation of lower oesophageal sphincter
39
How does achalasia present?
Long history of intermittent dysphagia Both liquids and solids from onset Regurgitation of food - especially at night Chest pain + heartburn Weight loss but not loads of marked weight loss Difficulty belching
40
Investigations in achalasia
Chest x ray - dilated oesophagus and widened mediastinum Barium swallow - lack of peristalsis and failure of sphincter to relax CT scan - exclude distal cancer
41
Treatment of achalasia?
Drug therapy rarely effective (nifedipine, sildenafil) 1) Endoscopic dilatation of LOS with a balloon - needs redoing as wears off after a few years 2) Botox injections into sphincter - wears off after a few months - less chance of perforation than balloon 3) Surgical division of LOS - Heller's operation - surgical treatment of choice
42
What is diffuse oesophageal spasm?
Oesophageal dysmotility - bizarre contractions of oesophagus without normal peristalsis when swallowing - Causes chest pain and dysphagia Nutcracker oesophagus - variant of this - very high amplitude peristalsis - Chest pain more common than dysphagia Treatment - antispasmodics, nitrates, Calcium channel blockers and GABA agonists (baclofen)
43
What is pharyngeal pouch?
Oesophageal diverticulum just above upper oesophageal sphincter - dysphagia and regurgitation May see visible pouch Also get diverticulum in middle of oesophagus or just above lower sphincter
44
What is most common cause for benign oesophageal stricture?
Peptic stricture secondary to reflux | Also after ingestion of corrosives, after radiotherapy, after sclerosis of varices, prolonged NG tube intubation
45
2 types of hiatus hernia
Sliding - 80% - where gastro-oesophageal junction slides up into the chest through the diaphragm acid reflux common Rolling - 20% - gastro-oesophageal junction in the abdomen but bulge of stomach herniates into chest alongside oesophagus as GO junction remains intact - gross acid reflux is uncommon
46
When are hiatus hernia more common?
Obesity
47
Imaging in hiatus hernia
Barium swallow
48
Treatment of HH
Lose weight, treat reflux symptoms Surgery if intractable symptoms - rolling HH may strangulate therefore surgery advised
49
Which is more common duodenal ulcer or gastric ulcer?
Duodenal = 4x more common
50
2 x major risk factors for duodenal ulcer
H.pylori - 90% | Drugs - NSAIDs, steroids, SSRI
51
Minor risk factors for duodenal ulcer
Increased gastric acid secretion, increased gastric emptying (lower duodenal ph), blood group 0, smoking
52
Symptoms/signs of duodenal ulcer
Epigastric pain - before meals or at night Relieved by eating or having milk Worse several hours later Epigastric tenderness 50% asymptomatic Mean age 30s
53
Diagnosis of DU
Upper GI endoscopy Test for h.pylori - C-Urea breath test IgG antibody against H.pylori confirms exposure but not eradication
54
What is Zollinger-Elson syndrome and how do you test for it if suspected?
Gastrin secreting tumour of pancreas Stimulates stomach parietal cells Causes GI mucosal ulceration Measure gastrin concentrations when off PPI for diagnosis - Secretin test (IV Secretin causes a rise in serum gastrin in ZE patients but not normal)
55
Treatment of duodenal ulcer
PPI
56
Where do gastric ulcers most commonly occur?
Lesser curvature of stomach - if elsewhere, often malignant GU mostly in elderly
57
Risk factors for GU
``` H pylori - 80% Smoking NSAIDs Delayed gastric emptying Stress ```
58
Presentation of GU
Pain - epigastric - relieved by antacids Weight loss Mean age 50s Worse soon after eating
59
Diagnosis of GU
Endoscopy - exclude malignancy | Biopsy of ulcer
60
Treatment of ulcers
Purge stress, avoid aggravating foods | Decrease smoking and drinking
61
Treatment of h-pylori
Triple therapy PAC500 regimen - PPI, amoxicillin, clarithromycin PMC250 regimen - PPI, metronidazole and clarithromycin
62
Medical treatment of ulcers
``` PPIs H2 blockers (ranitidine) ```
63
When do you do surgery for ulcers?
Only really for complications - haemorrhage, perforation Or if don't respond to medical therapy
64
Emergency surgery for ulcer haemorrhage
Adrenaline injection, laser coagulation, heat probe
65
What is pyloric stenosis
Late complication of duodenal ulcers - vomiting large amounts of food some hours after meals Treat with endoscopic balloon dilatation
66
What type of oesophageal carcinomas occur where?
Squamous cell carcinoma can occur throughout Adenocarcinoma only in distal third 20% in upper, 50% in middle, 30% in lower
67
Risk factors for oesophageal carcinoma?
``` Smoking and alcohol Diet (nitrosamines) Vitamin A & C deficiency Achalasia Coeliac disease ``` Barrett's oesophagus + GORD (adeno)
68
Presentation of oesophageal carcinoma
Often insidious Dysphagia, solid and then liquid Weight loss Coughing or choking after food upper 1/3 - hoarseness (may indicate recurrent laryngeal nerve palsy)
69
Diagnosis of O carcinoma
Barium swallow Endoscopy - biopsy CT scan
70
Treatment of O carcinoma
25% of patients are operable - can do radical oesophagectomy Can do early endoscopic mucosal resection SSC more radiosensitive than adenocarcinoma Pre-op chemotherapy may be useful but morbidity Palliation - stent or dilation
71
Prognosis of o carcinoma
5% have 5 year survival
72
What type of cancer is stomach cancer normally?
``` 85% = adenocarcinoma 15% = lymphoma ```
73
Risk factor for stomach cancer
Nitrites Nitrosamine exposure H.pylori exposure Lower social class Smoking Alcohol Diet - high nitrate, low vit c
74
Presentation of stomach cancer
Insidious Early satiety Nausea, weight loss, anorexia, fatigue, anaemia (bleeding) - haematemesis Dyspepsia
75
Presentation from stomach cancer mets
Transperitoneal - ascites Ovarian masses - Krukenberg tumour Virchow's node - Troisiers sign Acanthosis nigrans - hyperpigmentation of skin
76
Diagnosis of stomach cancer
Barium and endoscopy Gastroscopy and biopsy Endoscopic ultrasound - depth of invasion CT/MRI - staging
77
Treatment of stomach cancer
30% - surgery for potential cure - gastrectomy (can be partial - Bilroth 1 and 2 partial gastrectomy) Chemotherapy - 30% partial response - therefore combine with surgery Endoscopic mucosal resection - for early tumours confined to mucosa
78
Prognosis for stomach cancer
5 year 5% survival
79
Prevalence of small intestine tumour
Rare

Gastroenterology (5 decks)

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