Upper GI pathology and disease Flashcards by Ella Maxwell

What upper GI pathology are hiatus hernias associated with ?

GORD

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What are the 2 types of hiatus hernia ?

Sliding and paraoesophagheal

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What happens to mucosa when acid refluxes up ?

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

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What pre-malignant cancer is GORD linked to ?

Barrett’s oesophagus

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What are the phases of cancer cell formation ?

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

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What are the two types of oesophageal cancer ?

Squamous cells carcinoma and adenocarcinoma

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What are squamous cells carcinoma linked to ?

2 risk factors

Alcohol and smoking

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What is adenocarcinoma linked to ? (2 risk factors)

Obesity and Barrett’s oesophagus

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What can oesophageal cancer lead to ?

Obstruction, perforation and ulceration.

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

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

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What is the 5 year survival % for oesophageal cancer ?

15 %

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What are the 3 types of Gastritis ?

A - Autoimmune
B - Bacterial
C - Chemical injury

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What occurs in autoimmune gastritis to the parietal cells ?

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

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What bacterium is bacterial gastritis associated with ?

H . pylori

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Is H . pylori gram +ve pr -ve ?

Gram -ve

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Does H .pylori increase or decrease acid production ?

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

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What causes chemical gastritis ?

Drugs (NSAID’s)
Alcohol
Bile reflux

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What is the impact of acute bleeding ?

Haemorrhage

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What is the impact of chronic bleeding ?

Anemia

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What type of cancer is stomach cancer ?

Adenocarcinoma

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

Indigestion > more than 4 weeks

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What symptoms are group into the ‘dyspepsia’ umbrella ?

N/V
Abdominal pain
Abdominal bloating
Heartburn
Weight loss
Anorexia
Early satiety

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What are the red flag symptoms ?

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

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Define melana

Black tarry stools

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Define haematemesis

Vomiting of blood

What are the 3 risks of endoscopy ?

1) Perforation 2) Bleeding 3) Infection

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

Body and Antrum

Which enzyme does H . pylori produce ?

Urease

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

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

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

Acid levels are high but gastric cancer risk decreases

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

Acid levels are low but gastric cancer risk is increased

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

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

What should be stopped 2 weeks prior to investigations ?

PPI's

What test can be done from the gastric biopsy ?

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.

In which two locations can peptic ulcers be found ?

Stomach and duodenum

How might patient present with peptic ulcers ?

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

How is H . pylori treated ?

Eradication therapy (7 days) - Amoxicillin - Clarithromycin - PPI's

How does gastric outlet obstruction present ? (5)

- Vomiting of fermented foodstuff without bile - Weight loss - Early satiety - Distension - Dehydration

How is gastric outlet obstruction treated ?

- Endoscopic balloon dilation/stenting - Vagotomy - May remove antrum

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

Gastric cancer

How would you diagnose gastric cancer ?

Endoscopy and biopsy

What investigations are used to stage gastric cancer ?

- CT chest and abdomen | - PET scans

What is the treatment for gastric cancer ?

Chemotherapy and surgery

Define Achalasia

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

What vertebral level does the oesophagus begin and terminate at ?

C6 - T12

Which muscle layer produces peristalsis in the oesophagus ?

Circular muscle layer

Which nerve controls the LOS ?

The vagus nerve

Define Heartburn

Retrosternal discomfort or burning

Define Dysphagia

Difficulty swallowing

Define Odynophagia

Pain on swallowing

What investigations are done to investigate heartburn symptoms ?

- UGIE - Barium swallow - excludes pharyngeal poncho or post-cricoid web - pH studies/manometry

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

Corkscrew appearance | Exaggerated uncoordinated hypertensive contractions

How do you treat hyper-motility ?

Give muscle relaxants

How does hypo-motility present ?

Heartburn and reflux symptoms

How does hyper-motility present ?

Dysphagia and pain on eating

What is hypo-motility associated with ?

- Diabetes - Connective tissue disorders - Neuropathy

Which plexus is lost to cause achalasia ?

Myenteric

How do you treat achalasia ?

- CCB's - Nitrates - Botulinum toxin - Pneumatic balloon dilation - Myotomy

What are the risk factors for GORD ?

- Obesity - Alcohol - Smoking - Pregnancy

What 3 treatments are used for Barrett's Oesophagus ?

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

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

- PPI's, H2 receptor antagonists and antacids

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

- Chemo/radiotherapy - Stent placement - Laser treatments

What is Eosinophilic Oesophagitis ?

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

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

> 15

What population is Eosinophilic Oesophagitis commonly found in ?

Children and young adults

What is the treatment for Eosinophilic Oesophagitis ?

- Endoscopic dilation - Topical and oral steroids - If dietary cause should eliminate

How does non-ulcer dyspepsia present ?

- Dyspepsia - No ulcers present - Usually other functional problems are present - Treat symptomatically

Define nausea

The feeling of sickness

Define retching

Dry heaves, glottis is closed when the antrum contracts

Define vomiting

Contents is expelled from the stomach through the mouth.

What does immediate vomiting after food suggest ?

Psychogenic causes

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

Pyloric obstruction or motility disorders

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

Obstruction further down the GI tract

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

- FBC - Colonscopy - FIT testig - Coeliac screening

How does IBS present ?

- Altered bowel habit - Constipation/diarrhoea - Bloating - Abdominal/back pain

Which score is used to diagnose IBS ?

Rome 3

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

IBS with - Constipation - Diarrhoea - Both

What does calprotectin show ?

If levels in blood are high shows inflammation gut mucosa

How to treat IBS ?

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

Where is adenocarcinoma found in the oesophagus ?

The distal 1/3rd

Where is squamous cell carcinoma found ?

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

What is the gold standard for oesophageal cancer ?

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

How is T/N staging done in Oesophageal cancer ?

EUS

How is M staging done in Oesophageal cancer ?

PET CT

What is the palliative therapy for Oesophageal cancer ?

Stenting Chemotherapy Radiotherapy

What is the 5 year survival percentage for Gastric cancer ?

30%

What are the risk factors for gastric cancer ?

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

How do you stage gastric cancer ?

CT chest/abdomen

How do you treat gastric cancer ?

Gastrectomy Radiotherapy Chemotherapy Immunotherapy

How do you surgically treat reflux and a hiatus hernia ?

Laparoscopic hiatus hernia repair and fundoplication

What are the side effects of a hiatus hernia repair ?

Bloating Dysphagia Difficulty coughing or vomiting Diarrhoea

What BMI is classes as the obese marker ?

What BMI marks morbidly obese ?

What is done to treat morbidly obese patients ?

Lifestyle advice and medication interventions | Surgery if it will improve another health condition

What is done to treat patients with a BMI >40

Surgery

What surgeries are available to treat obesity ? (3)

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

Upper GI pathology and disease Flashcards

(96 cards)