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Alimentary > Upper GI pathology and disease > Flashcards

Upper GI pathology and disease Flashcards

1
Q

What upper GI pathology are hiatus hernias associated with ?

A

GORD

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2
Q

What are the 2 types of hiatus hernia ?

A

Sliding and paraoesophagheal

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3
Q

What happens to mucosa when acid refluxes up ?

A

It thickens and ulceration may occur. Heals via fibrosis which may cause stricture formation leading to impaired motility and obstruction.

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4
Q

What pre-malignant cancer is GORD linked to ?

A

Barrett’s oesophagus

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5
Q

What are the phases of cancer cell formation ?

5

A

1) Normal
2) Metaplasia
3) Low grade dysplasia
4) High grade dysplasia
5) Adenocarcinoma

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6
Q

What are the two types of oesophageal cancer ?

A

Squamous cells carcinoma and adenocarcinoma

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7
Q

What are squamous cells carcinoma linked to ?

2 risk factors

A

Alcohol and smoking

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8
Q

What is adenocarcinoma linked to ? (2 risk factors)

A

Obesity and Barrett’s oesophagus

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9
Q

What can oesophageal cancer lead to ?

A

Obstruction, perforation and ulceration.

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10
Q

What are the 4 ways cancer can spread within the peritoneum ?

A

1) Blood spread
2) Lymphatic spread
3) Direct spread
4) Trans-coelomic

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11
Q

What is the 5 year survival % for oesophageal cancer ?

A

15 %

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12
Q

What are the 3 types of Gastritis ?

A

A - Autoimmune
B - Bacterial
C - Chemical injury

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13
Q

What occurs in autoimmune gastritis to the parietal cells ?

A

They are attacked and damaged, they not longer cancer produce intrinsic factor. Patients usually suffer from pernicious anaemia.

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14
Q

What bacterium is bacterial gastritis associated with ?

A

H . pylori

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15
Q

Is H . pylori gram +ve pr -ve ?

A

Gram -ve

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16
Q

Does H .pylori increase or decrease acid production ?

A

Increases acid production, mucus layer is damaged and so more acid produced

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17
Q

What causes chemical gastritis ?

A

Drugs (NSAID’s)
Alcohol
Bile reflux

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18
Q

What is the impact of acute bleeding ?

A

Haemorrhage

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19
Q

What is the impact of chronic bleeding ?

A

Anemia

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20
Q

What type of cancer is stomach cancer ?

A

Adenocarcinoma

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21
Q

Define dyspepsia (how long does it need to have occurred for)

A

Indigestion > more than 4 weeks

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22
Q

What symptoms are group into the ‘dyspepsia’ umbrella ?

A
  • N/V
  • Abdominal pain
  • Abdominal bloating
  • Heartburn
  • Weight loss
  • Anorexia
  • Early satiety
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23
Q

What are the red flag symptoms ?

A 
A - Anaemia 
L - Weight loss
A - Anorexia 
R - Recent onset >55
M - Melana/Haematemesis or mass
S - Swallowing problems
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24
Q

Define melana

A

Black tarry stools

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25
Q

Define haematemesis

A

Vomiting of blood

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26
Q

What are the 3 risks of endoscopy ?

A

1) Perforation
2) Bleeding
3) Infection

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27
Q

Which 2 parts of the stomach is H . pylori usually found ?

A

Body and Antrum

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28
Q

Which enzyme does H . pylori produce ?

A

Urease

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29
Q

How can we test for H . pylori using urease knowledge ?

A

We can give the patient a urea tablet and if H . pylori is present Co2 will be produced which can be detected in breath.

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30
Q

What happens to acid levels/cancer risk if H . pylori is in the antrum of the stomach ?

A

Acid levels are high but gastric cancer risk decreases

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31
Q

What happens to acid levels/cancer risk if H . pylori is in the cardiac region/body of the stomach ?

A

Acid levels are low but gastric cancer risk is increased

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32
Q

What other tests than the breath test can be carried out ? (3)

A
  • Serology (IgG found against H . pylori)
  • Stool test - ELISA
  • Endoscopy and biopsy
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33
Q

What should be stopped 2 weeks prior to investigations ?

A

PPI’s

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34
Q

What test can be done from the gastric biopsy ?

A

CLO urease test, ammonia is produced alongside the CO2 when urea is broken down and due to alkalinity it turns the slide purple from red.

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35
Q

In which two locations can peptic ulcers be found ?

A

Stomach and duodenum

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36
Q

How might patient present with peptic ulcers ?

A
  • Weight loss
  • Anemia/bleeding
  • Epigastric pain - Hunger pain seen in DU
  • Early satiety
  • N/V
  • Back pain
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37
Q

How is H . pylori treated ?

A

Eradication therapy (7 days)

  • Amoxicillin
  • Clarithromycin
  • PPI’s
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38
Q

How does gastric outlet obstruction present ? (5)

A
  • Vomiting of fermented foodstuff without bile
  • Weight loss
  • Early satiety
  • Distension
  • Dehydration
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39
Q

How is gastric outlet obstruction treated ?

A
  • Endoscopic balloon dilation/stenting
  • Vagotomy
  • May remove antrum
40
Q

What type of cancer are the following genes associated with - HDGC, AD, CHD - 1 (E Cadherin) ?

A

Gastric cancer

41
Q

How would you diagnose gastric cancer ?

A

Endoscopy and biopsy

42
Q

What investigations are used to stage gastric cancer ?

A
  • CT chest and abdomen

- PET scans

43
Q

What is the treatment for gastric cancer ?

A

Chemotherapy and surgery

44
Q

Define Achalasia

A

Muscles of the LOS don’t contract properly and the hole fails to open

45
Q

What vertebral level does the oesophagus begin and terminate at ?

A

C6 - T12

46
Q

Which muscle layer produces peristalsis in the oesophagus ?

A

Circular muscle layer

47
Q

Which nerve controls the LOS ?

A

The vagus nerve

48
Q

Define Heartburn

A

Retrosternal discomfort or burning

49
Q

Define Dysphagia

A

Difficulty swallowing

50
Q

Define Odynophagia

A

Pain on swallowing

51
Q

What investigations are done to investigate heartburn symptoms ?

A
  • UGIE
  • Barium swallow - excludes pharyngeal poncho or post-cricoid web
  • pH studies/manometry
52
Q

How does hyper-motility present on a barium swallow/manometry ?

A

Corkscrew appearance

Exaggerated uncoordinated hypertensive contractions

53
Q

How do you treat hyper-motility ?

A

Give muscle relaxants

54
Q

How does hypo-motility present ?

A

Heartburn and reflux symptoms

55
Q

How does hyper-motility present ?

A

Dysphagia and pain on eating

56
Q

What is hypo-motility associated with ?

A
  • Diabetes
  • Connective tissue disorders
  • Neuropathy
57
Q

Which plexus is lost to cause achalasia ?

A

Myenteric

58
Q

How do you treat achalasia ?

A
  • CCB’s
  • Nitrates
  • Botulinum toxin
  • Pneumatic balloon dilation
  • Myotomy
59
Q

What are the risk factors for GORD ?

A
  • Obesity
  • Alcohol
  • Smoking
  • Pregnancy
60
Q

What 3 treatments are used for Barrett’s Oesophagus ?

A

1) Radio-Frequency ablation
2) Endoscopic mucosal resection
3) Oesophagectomy

61
Q

What 3 medications can be used to treat GORD after lifestyle advice ?

A
  • PPI’s, H2 receptor antagonists and antacids
62
Q

What can be done for palliation when people have oesophageal cancer ?

A
  • Chemo/radiotherapy
  • Stent placement
  • Laser treatments
63
Q

What is Eosinophilic Oesophagitis ?

A

A chronic immune mediated condition what results in oesophageal dysfunction due to eosinophilic infiltration.

64
Q

How many eosinophils must be found per high power microscopy field ?

A

> 15

65
Q

What population is Eosinophilic Oesophagitis commonly found in ?

A

Children and young adults

66
Q

What is the treatment for Eosinophilic Oesophagitis ?

A
  • Endoscopic dilation
  • Topical and oral steroids
  • If dietary cause should eliminate
67
Q

How does non-ulcer dyspepsia present ?

A
  • Dyspepsia
  • No ulcers present
  • Usually other functional problems are present
  • Treat symptomatically
68
Q

Define nausea

A

The feeling of sickness

69
Q

Define retching

A

Dry heaves, glottis is closed when the antrum contracts

70
Q

Define vomiting

A

Contents is expelled from the stomach through the mouth.

71
Q

What does immediate vomiting after food suggest ?

A

Psychogenic causes

72
Q

If vomiting is more than an hour after food then what does this suggest ?

A

Pyloric obstruction or motility disorders

73
Q

If the vomiting occurs after hours and hours what does this suggest ?

A

Obstruction further down the GI tract

74
Q

How would you assess a patient with functional disorder presentation but alarm symptoms ?

A
  • FBC
  • Colonscopy
  • FIT testig
  • Coeliac screening
75
Q

How does IBS present ?

A
  • Altered bowel habit
  • Constipation/diarrhoea
  • Bloating
  • Abdominal/back pain
76
Q

Which score is used to diagnose IBS ?

A

Rome 3

77
Q

What does IBS-C, IBS D and IBS-M stand for ?

A

IBS with

  • Constipation
  • Diarrhoea
  • Both
78
Q

What does calprotectin show ?

A

If levels in blood are high shows inflammation gut mucosa

79
Q

How to treat IBS ?

A 
Lifestyle - weight, alcohol, smoking
Diet - FODMAP
Laxatives or antidiarrhoeals/ORS
Antispasmodics and antidepressants 
Relaxation therapy/CBT
80
Q

Where is adenocarcinoma found in the oesophagus ?

A

The distal 1/3rd

81
Q

Where is squamous cell carcinoma found ?

A

In the proximal and middle 1/3rd of the oesophagus

82
Q

What is the gold standard for oesophageal cancer ?

A

Endoscopy

Contrast swallow may be done if thinking pharyngeal pouch/post-cricoid web

83
Q

How is T/N staging done in Oesophageal cancer ?

A

EUS

84
Q

How is M staging done in Oesophageal cancer ?

A

PET CT

85
Q

What is the palliative therapy for Oesophageal cancer ?

A

Stenting
Chemotherapy
Radiotherapy

86
Q

What is the 5 year survival percentage for Gastric cancer ?

A

30%

87
Q

What are the risk factors for gastric cancer ?

A

Alcohol, smoking, salted fish, red meat, H.pylori

88
Q

How do you stage gastric cancer ?

A

CT chest/abdomen

89
Q

How do you treat gastric cancer ?

A

Gastrectomy
Radiotherapy
Chemotherapy
Immunotherapy

90
Q

How do you surgically treat reflux and a hiatus hernia ?

A

Laparoscopic hiatus hernia repair and fundoplication

91
Q

What are the side effects of a hiatus hernia repair ?

A

Bloating
Dysphagia
Difficulty coughing or vomiting
Diarrhoea

92
Q

What BMI is classes as the obese marker ?

A

25

93
Q

What BMI marks morbidly obese ?

A

35

94
Q

What is done to treat morbidly obese patients ?

A

Lifestyle advice and medication interventions

Surgery if it will improve another health condition

95
Q

What is done to treat patients with a BMI >40

A

Surgery

96
Q

What surgeries are available to treat obesity ? (3)

A

Gastric band - Band is placed around the stomach
Gastric bypass - Top of stomach is joined to small intestine
Sleeve gastrectomy - Some of stomach is removed

Alimentary (12 decks)

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