Upper GI disorders Flashcards
(38 cards)
What are the common oesophageal disorders?
- GORD (gastro-oesophageal reflux disease)
- Oesophagitis
- Barrett’s oesophagus
- Benign oesophageal stricture
- Oesophageal motility disorders (e.g. Achalasia)
- Eosinophilic oesophagitis
- Oesophageal cancer
These disorders can affect the function and health of the oesophagus.
What is GORD?
Gastro-oesophageal reflux disease, characterized by acid reflux and symptoms like heartburn.
It is a common condition that can lead to complications if untreated.
What are the symptoms of oesophageal disease?
- Dysphagia
- Odynophagia
- Heartburn
- Acid regurgitation
- Waterbrash
- Dental erosions
- Chest pain
- Food regurgitation
- Food bolus obstruction
- Globus
- Cough
- Dysphonia
Symptoms can range from common to very rare, with some being indicative of serious conditions.
Define dysphagia.
Difficulty in swallowing solids or liquids.
It is an alarm symptom that requires immediate evaluation.
What are the classifications of dysphagia?
- Oropharyngeal
- Oesophageal
Each classification has different underlying causes and treatment approaches.
What are the hints in the diagnosis of dysphagia in the elderly?
Think of neurological causes (e.g. Alzheimer Disease) or sinister causes (e.g. oesophageal cancer) if new and progressive with regurgitation and weight loss.
Early diagnosis is crucial for effective management.
What investigations are used in oesophageal disease?
- Endoscopy and biopsy
- Barium swallow
- Oesophageal function tests (Manometry, pH and Impedance monitoring)
These tests help to diagnose various oesophageal conditions.
What is Barrett’s oesophagus?
Specialized intestinal metaplasia in the lower oesophagus, often asymptomatic and considered premalignant.
It can progress to low-grade dysplasia, high-grade dysplasia, and adenocarcinoma.
List the major risk factors for oesophageal adenocarcinoma.
- Gastroesophageal reflux/Barrett’s oesophagus
- High BMI – central obesity
- Age >50 years
- Male gender
- p53 aneuploidy
- cyclin D1
- p16 LOH
These factors significantly increase the risk of developing this type of cancer.
What is the treatment for GORD?
- Lifestyle measures (smoking, alcohol, diet, weight reduction)
- Mechanical (posture, clothing, elevate bed-head)
- Antacids
- Acid suppression (PPIs - omeprazole, H2RA - ranitidine)
- Surgical - fundoplication
Treatment options vary depending on severity and response to initial management.
What is Achalasia?
A motility disorder characterized by failure of the lower oesophageal sphincter relaxation and absence of peristalsis.
It presents with dysphagia for liquids and solids, chest pain, and weight loss.
What is eosinophilic oesophagitis?
A condition characterized by eosinophilic infiltration in the oesophagus, leading to symptoms like dysphagia and food bolus obstruction.
It is associated with atopy and food allergies.
What are the adverse effects of Proton Pump Inhibitors (PPIs)?
- Increased risk of fractures
- Osteoporosis
- B12 deficiency
- Microscopic colitis
- Gastric cancer (theoretical risk)
- Iron deficiency
- Enteric infections
- Community-acquired pneumonia
These risks highlight the importance of careful prescribing and monitoring.
Fill in the blank: The typical symptoms of GORD include _______ and _______.
[Heartburn], [acid regurgitation].
These symptoms are commonly reported by patients with GORD.
What is the primary condition discussed in the text?
Haemochromatosis
What are the serum iron levels after an iron-containing meal on a PPI?
Reduced
What rising infection rates are associated with increased PPI usage?
Clostridium difficile infection rates
What are the symptoms presented by the 67-year-old man?
Abdominal pains, vomiting after eating, epigastric pains, loss of appetite, weight loss
What was the hemoglobin level in the blood test of the patient?
110 g/dl
What was the ferritin level indicating iron deficiency?
5
What is the probable diagnosis for the patient?
Upper GI pathology with chronic blood loss, likely peptic ulcer
What test is recommended next for the patient?
Endoscopy
What does the CLO test indicate?
Presence of Helicobacter Pylori
What are the invasive methods for testing Helicobacter pylori?
- Culture
- Histology
- CLO test
