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Met 3a > Upper GI Pathology > Flashcards

Upper GI Pathology Flashcards

1
Q

Dyspepsia definition

A

Group of symptoms that suggest UGI disease

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2
Q

Dyspepsia symptoms

A

Pain or discomfort in epigastrium (‘ulcer-like’)
May include:
Heartburn/regurgitation (GORD like)
Bloating, nausea, vomiting, excess wind (dysmotility like)

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3
Q

Dyspepsia red flag symptoms

A 
Dysphagia
Weight loss (unintentional)
Persistent vomiting
Epigastric mass
GI bleeding
Iron deficiency
New/persistent unexplained symptoms >55y
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4
Q

Dyspepsia facts

A 
Chronic or recurring symptoms
25-40% adults have it
Only 20-25% of these seek help
5% primary care physician visits
20-40% GI consultations
Billions in direct and indirect care costs
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5
Q

Dyspepsia- dealing with uncertainty

A 
Often a clinical diagnosis
Symptoms very non-specific
Often 'no cause' found
50-75% non-ulcer dyspepsia
15-25% peptic ulcer disease
5-15% oesophagitis
<2% cancer
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6
Q

Non-ulcer dyspepsia- Disturbances in:

A 
GI motility
Visceral sensation
Gastric accommodation
Intestino-gastric reflexes
Gastric acid sensitivity
Psycho-social factors
?Relationship with H Pylori?
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7
Q

Non-ulcer dyspepsia

A

Endoscopy is normal

Improves with time and symptomatic treatment (PPI)

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8
Q

GORD

A

Symptoms and/ore mucosal damage resulting from reflux of gastric contents into distal oesophagus
80% mild/moderate
Non-consulters, self medicate
20% consult, often GP
Few % have chronic persistent symptoms and complications

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9
Q

GORD prevalence

A 
Heartburn reported in 29% age 20-69
50% US adults have used antacids
27% take>2 doses/month
Mostly OTC medication
PPIs are huge drug cost
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10
Q

GORD pathophysiology

A 
Dysfunction of OG junction (low LOS pressure, high intra-abdo pressure)
Decreased oesophageal acid clearance
Delayed gastric emptying
Gastric acid production normal
Hiatus hernia may contribute
?Role of H Pylori?
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11
Q

GORD actions

A 
Therapeutic trial of PPI
Endoscopy
50% have no mucosal lesion at endoscopy
Los Angeles scoring for oesophagitis
24hr pH monitoring/manometry
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12
Q

Some GORD endoscopy findings

A

Macroscopic oesophagitis in minority of patients

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13
Q

Complications of GORD

A

Stricture
Barrett’s oesophagus
Cancer

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14
Q

GORD Extra-oesophageal manifestations

A 
Middle ear problems
Chronic sinusitis
Dental erosions and halitosis
Sore throat/pharyngitis/laryngitis
Cough
Asthma
Aspiration pneumonia
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15
Q

Gold standard GORD diagnosis

A

24hr pH monitoring

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16
Q

Treatment of GORD- objectives

A

Resolution of symptoms
Healing of oesophagitis
Prevention of complications

17
Q

GORD Treatment- options

A 
Education and explanation
Lifestyle modifications
Antacids and alginates
Acid suppression; PPI/H2RA
Endoscopic/surgical (last resort)
18
Q

GORD Lifestyle modification

A 
Eliminate triggering foods and drinks
Rigorously timed meals
Weight loss
Eliminate smoking
No pressure on stomach
Sleeping in chair
Inclined sleeping position
19
Q

Peptic ulcer disease

A

Duodenal ulcer

Gastric ulcer

20
Q

Peptic ulcer disease- duodenal ulcer

A

Pain after food (or not)
99% H pylori- related
Not malignant

21
Q

Peptic ulcer disease- gastric ulcer

A 
Symptoms not reliable to diagnose
Weight loss more likely
60-70% H Pylori-related 
NSAIDs are significant cause
5-10% malignant
22
Q

NSAID-related gastric ulcers RFS

A 
Older patients (>70)
First 3m of treatment
Smokers
Co-morbidity
Other drugs e.g. anticoagulants
23
Q

NSAID related gastric ulcers- NSAIDs cause

A

Dyspepsia in 60%
BUT
50% NSAID ulcers are asymptomatic

24
Q

H Pylori- highly significant association with

A

Duodenal ulcer
Gastric ulcer and cancer
Common aetiological agent- 2 disease phenotypes are virtually mutually exclusive

25
Q

H Pylori DU pathway

A

Antral gastritis
Increased gastric secretion
Gastric metaplasia
Duodenal ulcer

26
Q

H Pylori GU pathway

A

Corpus gastritis
Decreased acid secretion
Gastric atrophy
Dysplasia + neoplasia

27
Q

Treatment of peptic ulcer

A

PPI (to heal and prevent recurrence)
H. Pylori eradication therapy (PPI + antibiotics)
Always confirm H.pylori eradication (urea breath test, Hp faecal antigen test)
Stop NSAIDs
Stop smoking

28
Q

Gastric ulcers malignant

A

Biopsy all gastric ulcers

Always re-scope for healing

29
Q

Red flag symptoms gastric ulcer malignancy

A 
Dysphagia
Weight loss (unintentional)
Persistent vomiting
Epigastric mass
GI bleeding
Iron deficiency
New/persistent unexplained symptoms >55y
30
Q

Take home messages

A

Dyspepsia is commonest GI problem
NUD influences quality of life but not life expectancy
GORD is common and troublesome
PUD important and potentially serious, still common worldwide
Cancer is relatively rare but important to detect early

Met 3a (7 decks)

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