Upper GI Conditions Flashcards by Shona Urquhart

Presentation of GORD (Gastro oesophageal Reflux Disease)?

Heartburn (worsened by lying down)
Acid reflux 
Water brash (excess salivation)
Dysphagia 
Odynophagia 
Hoarseness
Coughing (nocturnal)
Weight loss 
Chest pain

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Investigations for GORD?

Endoscopy if: >55yrs, symptoms >4wks, dysphagia, persistent symptoms despite weight loss
Barium swallow - may show hiatus hernia
Manometry/pH studies - if endoscopy normal

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Treatment for GORD?

PPIs (omeprazole)
Antacids for symptoms (Gaviscon)
H2 Receptor Antagonist (Ranitidine)
Lifestyle changes
Endoscopic fundoplication (repair LOS/ unresponsive to drugs)

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What is Barrett’s Oesophagus?

Columnar gastric epithelium replaces normal oesophageal squamous epithelium (metaplasia)

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What are some classic complications of GORD?

Ulceration, bleeding
Barrett’s Oesophagus
Oesophageal Cancer
Stricture formation (scarring)

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True or False - Barrett’s Oesophagus can be asymptomatic?

TRUE

Symptoms largely the same as GORD but can be asymptomatic

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Investigations to diagnosis Barrett’s Oesophagus?

Endoscopy - shows changes in the epithelium

May also do biopsy to check for oesophageal cancer (mainly adenocarincoma)

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What is the treatment for Barrett’s Oesophagus?

No premalignant changes = Argon, PPI + regular endoscopy

Premalignant/High grade dysplasia = oesophageal resection or eradication mucosectomy, Radiofrequency ablation

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What is Achalasia?

Intermittent dysphagia and impaired relaxation of lower oesophageal sphincter

LOS fails to relax due to degeneration of myenteric plexus

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Typical symptoms of Achalasia?

Intermittent dysphagia for both solids and liquids
Regurgitation (esp. at night)
Chest pain (spasms)

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Investigations of Achalasia?

CXR dilated oesophagus, fluid level 
Barium swallow (bird-beak appearance) - dilated, tapering oesophagus

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Buzzword - bird-beak appearance on barium swallow?

Achalasia

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Treatment for Achalasia?

Endoscopic balloon dilation
Heller’s cardiomyotomy then PPIs
Nifedipine (CCBs + nitrates can relax sphincter)

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Buzzword - Corkscrew oesophagus (Ba swallow)

Diffuse oesophageal spasm (also may show abnormal contractions)

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What is hypertensive peristalsis?

Distal peristaltic contractions >180mmHg

Assoc. with pain and dysphagia

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What is Gastroparesis?

Investigations?

Delayed gastric emptying with no physical obstruction

Gastric Emptying Studies

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Symptoms of gastroparesis?

Feeling of fullness
N&V
Weight loss
Upper abdominal pain

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Causes of gastroparesis?

Idiopathic, diabetes mellitus, cannabis, medications (anticholinergics, opiates), systemic disease (systemic sclerosis)

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What is the causes of Oesophageal Varices?

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Portal hypertension causes dilated collateral veins (varices) at sites of portosystemic anastamosis e.g. oesophagus, superior rectum

Signs of oesophageal varices?

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Upper GI bleeding (vomiting blood)
Melaena or haematemesis
With other signs of chronic liver disease (splenomegaly, encephalopathy, ascites, hyponatraemia)

Variceal bleeding treatment:
Intial -
Bleeding stops -
Bleeding continues -

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Initial - resuscitation, antibiotics, terlipression + early endoscopy

Stops - propranolol + banding programme

Continues - EVL or S-B tube (balloon inflated in stomach)
==> TIPSS (consider transplant if hepatic function still poor)

True or False - Gastric ulcers are more common than Duodenal ulcers?

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FALSE

Duodenal ulcers 4 fold commoner than GU

What are the major risk factors for Duodenal ulcers?

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H pylori (90%)
NSAIDs

True or False - GU occur mainly in young people on less curve of stomach?

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FALSE
occur mainly on less curve of stomach in ELDERLY
(Ulcers elsewhere are often malignant)

Risk factors for Gastric ulcers?

H pylori (80%), smoking, NSAIDs, refluex od duodenal contents, delayed gastric emptying, stress, burns

What are the symptoms and investigations for Duodenal ulcers?

Symp - epigastric pain typically before meals or at night, RELIEVED by eating and drinking milk Ix - upper GI endoscopy (stop PPI 2wks before), H pylori test, measure gastrin while off PPI (Z-E syndrome)

What are the symptoms and investigations for Gastric Ulcers?

Symp - asymptomatic or epigastric pain related to meals , relieved by antacids?, could have weight loss Ix - upper GI endoscopy, multiple biopsies (histology + H pylori), brushings

Treatment for GU and DU

``` Avoid food that worsens symp Stop smoking (allows healing) H pylori eradication (Triple Therapy) Reduce acid (PPI or H2RA) Stop NSAID ```

What is Zollinger-Ellison Syndrome?

Gastrin secreting adenoma Gastrin excites excessive gastric acid secretion which produces ulcers in duodenum and stomach

True or False - in Zolllinger-Ellison syndrome the adenoma is most commonly found in the pancreas

True

What are the findings on Ix of Zollinger-Ellison Syndrome

Increased fasting serum gastrin level

What are the treatment options for Oesophageal Cancer?

Aim is palliation of oesophageal obstruction Surgery only chance of cure (50% suitable) NOT T4 or M1 5 year survival - 11%

What are some contraindications for surgery in oesophageal cancers?

Direct invasion of adjacent tissue structures Fixed cervical lymph nodes Widespread mets Poor medical condition

How can pain be relieved in Hypertensive Peristalsis?

Nitrates, sublingual nifedipine or smooth muscle relaxant Sildenafil

What is Gastritis?

Inflammation causing mucosal injury of the stomach

Name some causes of acute and chronic gastritis

Acute - Chemical irritation, trauma, burns, infection Chronic - chemicals (NSAIDs, alcohol, bile reflux), H pylori, autoimmunity

Where does Autoimmune Gastritis affect?

Affects fundus + body, antibodies destroy parietal cells and intrinsic factor leading to gastric atrophy

What can Autoimmune gastritis lead to?

Pernicious anaemia and metaplasia

What is Peptic Ulcer Disease?

Breach of the GI mucosa by acid/pepsin

Order from most common to least: Gastric ulcer Oesophageal ulcer Duodenal ulcer

1. Duodenal ulcer 2. Gastric ulcer 3. Oesophageal ulcer (rare but can occur)

What is the most common gastric cancer?

Adenocarcinoma | 4th most common cancer worldwide

Prevalence of gastric adenocarcinoma

Increases with age M>F Occurs proximally in cardia/GO junction

Explain the link between H.pylori infection and adenocarcinoma

H.pylori > chronic gastritis > metaplsia > dysplasia > carcinoma

What are the main Types of adenocarcinoma?

Type 1 Intestinal - polypoid mass, better prognosis Type 2 Diffuse - expansive, infiltrative mass

Gastrointestinal Stromal Tumours (GISTs): Age affected? Linked defect?

Mesenchymal tumours affect age 55-65 Linked with defect of pacemaker cells (ICC)

Upper GI Conditions Flashcards

(45 cards)