Upper GI Conditions Flashcards by Alexander Tunnah

What is Cirrhosis?

Chronic Liver injury givens ongoing inflammation leading to structural changes

How well did you know this?

Not at all

Perfectly

What does Liver Cirrhosis lead to?

Portal Hypertension

Impairment of function

How well did you know this?

Not at all

Perfectly

What are some common causes of Liver Cirrhosis?

Alcoholic Liver Disease
Viral Hepatitis
Non-Alcoholic Fatty Liver Disease

How well did you know this?

Not at all

Perfectly

What causes the liver changes in alcoholic liver disease?

Build up of Acetaldehyde leading to fatty liver changes and eventual Cirrhosis

How well did you know this?

Not at all

Perfectly

What can fatty liver lead to?

Rapid Onset Jaundice
Hepatomegaly
RUQ Pain

How well did you know this?

Not at all

Perfectly

What is NAFLD due to?

Accumulation of triglycerides and other lipids in hepatocytes

How well did you know this?

Not at all

Perfectly

What are some less-common causes of cirrhosis?

Hereditary Haemochromatosis
Wilson’s Disease
Primary Sclerosing Cholangitis
Primary Biliary Cirrhosis

How well did you know this?

Not at all

Perfectly

What is Hereditary Haemochromatosis?

An autosomal recessive condition giving abnormal iron metabolism and increased serum iron

How well did you know this?

Not at all

Perfectly

What is Wilson’s Disease?

A disease giving abnormal copper metabolism leading to copper build-up. Presents with Kayser-Fleischer rings around the eyes

How well did you know this?

Not at all

Perfectly

What is Primary Schlerosing Cholangitis?

A condition giving fibrosis of Intrahepatic/Extrahepatic bile ducts

How well did you know this?

Not at all

Perfectly

What is Primary Biliary Cirrhosis?

A condition giving destruction of intrahepatic bile ducts

How well did you know this?

Not at all

Perfectly

Why does liver cirrhosis lead to Portal Hypertension?

The fibrotic liver is not expandable and compresses the portal venous system.

How well did you know this?

Not at all

Perfectly

What are varices?

Shunts of blood from the portal venous system to the systemic venous system leads to venous distension at the point of anastomoses

How well did you know this?

Not at all

Perfectly

What are three common sites of varices?

Oesophageal
Umbilical
Anorectal

How well did you know this?

Not at all

Perfectly

What are Gallstones?

Small stones formed from Bile

How well did you know this?

Not at all

Perfectly

What are Gallstones made of?

Cholesterol
Bile Pigments
Phospholipids

How well did you know this?

Not at all

Perfectly

What are some potential complications of Gallstones?

Biliary Colic
Acute Cholecystitis
Ascending Cholangitis
Pancreatitis

How well did you know this?

Not at all

Perfectly

What is Biliary Colic?

RUQ pain due to temporary obstruction of the Cystic/Common Bile duct by a stone

How well did you know this?

Not at all

Perfectly

What is the management of biliary colic?

Analgesia +/- Cholecystectomy

How well did you know this?

Not at all

Perfectly

What is Acute Cholecystitis?

Impaction of a stone in the cystic duct

How well did you know this?

Not at all

Perfectly

How does Acute Cholecystitis present?

Inflammatory features

Murphy’s +ve

How well did you know this?

Not at all

Perfectly

What is Ascending Cholangitis?

Infection of the biliary tree

How well did you know this?

Not at all

Perfectly

How does Ascending Cholangitis present?

Features of Charcot’s Triad:
Pain
Features of Inflammation
Jaundice

How well did you know this?

Not at all

Perfectly

What is the management of Ascending Cholangitis?

IV Antibiotics

Fluid resuscitation

How well did you know this?

Not at all

Perfectly

What is Pancreatitis?

Acinar cell injury and necrosis evokes an inflammatory response giving epigastric pain that radiates posteriorly

What clinical sign can pancreatitis demonstrate?

Cullens and Grey Turners signs

What is the management for Pancreatitis?

Fluids Manage Gallstones Organ support

What is the investigation of choice for suspected gallstones?

MRCP

How can impacted gallstones be treated?

ERCP +/- stent

What are some causes of pancreatitis?

``` Gallstones Ethanol Trauma Scorpion Bite Mumps Autoimmune Steroid use Hyperlipidaemia ERCP Drugs ```

What is haematemesis?

Vomiting of blood due to bleeding from the Upper GI tract

Which causes of haematemesis require emergency treatment?

Oesophageal Varices | Gastric Ulceration

What are Oesophageal varices?

Dilation of the porto-systemic venous anastomoses in the oesophagus

How are perforated oesophageal varices managed?

Endoscopic Banding

What is the Glasgow-Blatchford bleeding score?

A scoring system used to assess the need for intervention in patients with an Upper GI bleed

How does gastric ulceration lead to haematemesis?

Leads to erosion of the blood vessels supplying the upper GI tract

Which causes of haematemesis do not require emergency treatment?

Mallory-Weiss Tear | Oesophagitis

What is a Mallory-Weiss Tear?

A tear in the epithelial lining of the oesophagus after episodes of vomiting. Often benign and self-healing

What is oesophagitis?

Inflammation of the intraluminal epithelium layer of the oesophagus. Usually due to GORD.

What is Dyspepsia?

Complex of upper GI tract symptoms that are present for more than 4 weeks, that include upper abdo pain, heartburn, acid reflux, nausea and/or vomiting

What is GORD?

Reflux due to abnormality of the lower oesophageal sphincter which is tonically contracted

What is Acute Gastritis?

Exposure of gastric mucosa to chemical injury leads to damaged epithelial cells and reduced mucus production. The mucosa responds with vasodilation +/- oedema

What is Chronic Gastritis?

Similar to acute gastritis, only over a longer timeframe

What are some causes of Chronic Gastritis?

H.Pylori Auto-Immune Chemical/Reactive

What is Peptic Ulcer disease?

Defects in the gastric/duodenal mucosa extending through the muscularis mucosa. Most commonly in the first part of the duodenum

What are some causes of Peptic Ulcer disease?

``` Stomach acid H.Pylori NSAIDs Smoking Stress Burns ```

What are the symptoms of Peptic Ulcer disease?

Epigastric Pain - Burning/Knawing, following meals Anaemia Satiety Weight Loss

What is a Hiatus hernia?

The protrusion of an organ from the abdominal cavity into the thorax through the oesophageal hiatus

Which organ usually herniates in a hiatus hernia?

Stomach

What are the subtypes of hiatus hernia?

Sliding Hiatus Hernia | Rolling Hiatus Hernia

What is a sliding hiatus hernia?

The abdominal part of the oesophagus and the cardia of the stomach frequently move into the thorax

What is a rolling hiatus hernia?

Just the fundus of the stomach herniates, creating a stomach bubble within the chest

What are risk factors for a Hiatus hernia?

Age Pregnancy Obesity Ascites

What are clinical features of a hiatus hernia?

``` Asymptomatic GORD - Epigastric pain, worse when lay flat Vomiting/Weight loss Hiccups/Palpitations Swallowing difficulties ```

What are some differentials for a hiatus hernia?

Cardiac CP | Gastric Cancer

What investigations are appropriate for a suspected hiatus hernia?

OGD - Disruption to "Z" line visible | Contrast swallow

What are some conservative management options for hiatal hernias?

PPIs Lifestyle changes Smoking and Alcohol cessation

What are surgical management options for hiatal hernias?

Cruroplasty | Fundoplication

What is a Mallory-Weiss tear?

A linear mucosal tear occuring at the oesophagogastric junction due to a sudden increase in intra-abdominal pressure

What are some common causes of a Mallory-Weiss tear?

Coughing Retching Alcoholic "Dry Heaves"

What is the primary treatment recommended for a Mallory-Weiss tear?

Conservative, usually self resolving

What is Boerhaave's Syndrome?

Transmural perforation of the oesophagus typically after forceful emesis

What is Boerhaave's Syndrome also known as?

Spontaneous Oesophageal Rupture

How does Boerhaave's Syndrome present?

Mackler's Triad: Chest Pain Vomiting Subcutaneous Emphysema