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Year 3 - MedEd Lectures > Upper GI > Flashcards

Upper GI Flashcards

(49 cards)

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1
Q

What is Dyspepsia?

A

General term for a number of symptoms indicating an Upper GI Problem - Typically described as ‘Indigestion’

Epigastric pain/burning

Early Satiety

Belching

Bloating

Nausea

General Discomfort

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2
Q

How does Peptic Ulcer Disease typically present?

A

Recurrent Epigastric pain related to eating

Early Satiety

Nausea & Vomiting

Potential Weight Loss

Signs of Blood Loss (Anaemia)

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3
Q

How do you differentiate between Duodenal and gastric Ulcers?

A

Duodenal - 2-3 Hours after eating, commonly awakens patients at night

Gastric - Pain shortly after eating

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4
Q

What are the most common Risk Factors for Peptic Ulcer Disease?

A

H.Pylori & NSAIDS

Bisphosphonates

Smoking

Head Trauma (Cushing Ulcer)

Zollinger-Ellison Syndrome

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5
Q

How would you investigate H.Pylori as a proposed cause of Peptic Ulcer Disease?

A

Breath test (13C Urea, measure 13-CO2) - Stop PPI beforehand

Stool Antigens

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6
Q

How would you manage a Peptic Ulcer caused by H.Pylori?

A

Triple Therapy

PPI + 2x Antibiotics

Amoxicillin with either Clarithromycin or Metronidazole

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7
Q

What is Zollinger-Ellison Syndrome?

A

Neuroendocrine tumour in the Pancreas.

Produces Gastrin = Higher levels of Gastric Acid secretion

May be associated with MEN1

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8
Q

How would you investigate a possible case of Zollinger-Ellison Syndrome?

A

Fasting serum gastrin

Serum Calcium - MEN1

Imaging

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9
Q

What causes Cushing’s Ulcers?

A

Raised ICP post-head trauma leads to increased Vagal stimulation and gastric acid secretion

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10
Q

What causes Curling Ulcers?

A

Severe burn injuries lead to reduced plasma volume, ichaemia and necrosis of the Gastric Mucosa

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11
Q

How would you manage H.Pylori negative Peptic Ulcer DIsease?

A

PPI (-oprazoles) or H2 Antagonist (-tidines)

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12
Q

What are the main complications of Peptic Ulcer Disease?

A

Bleeding

Perforation (Leading to air under the diaphragm)

Gastric Cancer

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13
Q

Which form of Gastric Cancer is most common?

A

Adenocarcinoma

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14
Q

How does Gastric Cancer present?

A

Epigastric Pain

Nausea & Vomiting (+/- Blood)

Anorexia

Weight Loss

OE - Palpable Mass, Virchow’s Node, Sister Mary Joseph Node

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15
Q

How does GORD typically present?

A

Heartburn

Regurgitation

Dysphagia

Chest Pain

(Minor = Coughing, Hoarseness)

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16
Q

What are the main Risk Factors for GORD?

A

Obesity, Pregnancy

Drugs (Anti-Muscarinics, CCBs, Nitrates)

Hiatus Hernia

Diet, smoking

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17
Q

What is a Hiatus Hernia?

A

Prolapse of the stomach through the Diaphragmatic Oesophageal Hiatus.

Predisposes patients to GORD.

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18
Q

How would you investigate a suspected Hiatus Hernia?

A

Barium Swallow

CXR

Endoscopy

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19
Q

How would you manage a Hiatus Hernia?

A

Risk factor modification

PPI

Fundoplication

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20
Q

How would you investigate a patient with Dyspepsia and Red Flag Signs?

21
Q

How would you investigate and manage a potential case of GORD?

Study These Flashcards
A

Trial of PPI

Success = both therapeutic and diagnostic

22
Q

What are the main complications of GORD?

Study These Flashcards
A

Barrett’s Oesophagus

Adenocarcinoma

Strictures

23
Q

What is Barrett’s Oesophagus?

Study These Flashcards
A

Metaplasia of the oesophagus from squamous epithelium to columnar epithelium.

High chance of developing into Adenocarcinoma - require regular endoscopy.

24
Q

How would you manage a patient with Barrett’s Oesophagus?

Study These Flashcards
A

High Grade - Radiofrequency Ablation

Nodule - Nedoscopic Mucosal Resection

PPI for both

25
How does Oesophageal Cancer present?
Progressive Dysphagia from solids to liquids. Burning Chest Pain FLAWS
26
How would you investigate possible Oesophageal Carcinoma?
OGD and Biopsy CT for staging
27
What are the main types of Oesophageal Cancer?
Lower Third (Adenocarcinoma) - Most common Middle third (Squamous Cell)
28
How would you classify the potential causes of Dysphagia?
High - Throat & Mouth Low - Oesophagus Functional - Motility/Neurological Issue Structural - Obstruction
29
What are the main structural causes of High Dysphagia?
Cancer Pharyngeal Pouch
30
What are the main functional causes of High Dysphagia?
Stroke Parkinson's Myasthenia Gravis MS MND
31
What are the main structural causes of Low Dysphagia?
Cancer Stricture Plummer-Vinson Foreign Body
32
What are the main functional causes of Low Dysphagia?
Achalasia Oesophageal Spasm Limited Cutaenous Scleroderma
33
What is Achalasia?
The absence of Oesophageal peristalsis and the failure of the lower oesophageal sphincter to relax.
34
How does Achalasia typically present?
Dysphagia to both solids and liquids Regurgitation Dyspepsia Weight Loss
35
What is the most concerning cause of Dysphagia?
Oesophageal Cancer New-Onset Dysphagia in over-55s is Carcinoma until proven otherwise.
36
How would you investigate Dysphagia?
Barium Swallow Endoscopy Videofluroscopy Manometry
37
How does Achalasia look on a Barium Swallow?
Birds Beak Appearance
38
How do the presentations of Achalasia and Oesophageal Cancer differ?
Oesophageal Cancer - Old, new onset, Progressive, Structural, FLAWS Achalasia - Younger, Long-term, functional, intermittent.
39
Which signs and symptoms would point towards a Neurological cause of Dysphagia?
Coughing Choking Slow Eating Early Dysphagia for liquids
40
What is a Mallory-Weiss tear?
Tear in the Oesophageal Mucosa Usually occurs due to vomiting. Presents as fresh blood smears in the vomit
41
What is Boerhaave Syndrome?
Complication of a Mallory-Weiss Tear where the full oesophageal wall is torn. Shows Pneumomediastinum on CXR AKA Oesophageal Rupture
42
How does Boerhaave's Syndrome typically present?
Chest Pain Shock Subcutaneous Emphysema Crunching sound upon auscultation of the heart (due to Pneumomediastinum)
43
What are Oesophageal Varices?
Dilated sub-mucosal veins in the lower third of the oesophagus
44
How do Oesophageal Varices present?
Extreme Heamatemesis Loss of consciousness Shock Malaena
45
What are the main Risk factors for the development of Oesophageal Varices?
Liver Cirrhosis - Portal Hypertension & Decreased Clotting Factors Alcohol use
46
How would you investigate a suspected case of Oesophageal Varices?
FBC - Macrocytic Anaemia & Thrombocytopenia LFTs - Raised GGT & Bilirubin, Lowered Albumin U&Es - Raised Urea
47
How would you manage a patient with Oesophageal Varices?
ABCDE Fluids Terlipressin IV (for Portal HTN) Endoscopy (Band Ligation)
48
How does a Ruptured Peptic Ulcer present?
Coffee Ground emesis Malaena
49
How would you manage a Ruptured Peptic Ulcer?
Endoscopy, injection of IM Adrenaline Treatment of underlying ulcer & cause

Year 3 - MedEd Lectures (29 decks)

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