Upper GI tract diseases

Question 1

what is dysphagia

Answer 1

swallowing disorder, red flag for any other symptoms

Question 2

what are the 2 classes of dysphagia

Answer 2

neuromuscular: myasthenia gravis, stroke, MS etc (Weakened muscles) = struggle liquids and solids

narrowing of oesophagus (food gets stuck) = cancer, GORD, barretts, sacs/ring in oesophagus = problems swallowing just solid

Question 3

what is progressive dysphagia

Answer 3

suggestive of mechanical obstruction or peptic stricture

Question 4

what questions do you ask in dysphagia?

Answer 4

PC: problems swallowing hard food, soft food, drinks or the progression through all these? Odynophagia? (this is panful swallowing)

HPC: weight loss, vomiting, bleeding anywhere and how much blood??, bowel habit changes, pain, anaemia symptoms

Background: taken any NSAIDs? Omeprazole? Prev abdo surgery? FH?
• Smoking/drinking?

Question 5

what is barretts oesophagus

Answer 5

constant reflux of acid in lower oesophageal epithelium changing from sqaumous –> columnar

= typically develops after GORD of 5 years

middle aged, caucasian man

premalignant condition for aenocarcinoma

Question 6

what would you see on clinical examination of barretts oesophagus

Answer 6

weight loss
abdo exam: scaphoid abdomen, abdominal tenderness, hepatomegaly

candida, dry mouth

may have virchows node

Question 7

what investigations would you do for barretts oesophagus

Answer 7

upper GI endoscopy 
FBC for anaemia
U&Es for renal function for CT contrast 
LFTs for metastases
barium swallow - site of stricture but does not allow biopsy

Question 8

how do you monitor barrett’s?

Answer 8

• regular endoscopy

no dysplasia = low grade = dysplasia = high grade = adenocarcinoma

Question 9

how do you treat barrett’s

Answer 9

• PPI’s

- ablation therapy

Question 10

what are the risk factors for oesophageal cancer?

Answer 10

male, age, smoking, alcohol, consumption of pickles, high BMI for reflux, GORD (once a week for 5 years = 8x risk)

Question 11

how does oesophageal cancer?

Answer 11

dysphagia, weight loss and anorexia, persistent vomiting, maleana, hoarse voice

Question 12

how do you investigate for oesophogeal cancer?

Answer 12

2 week wait endoscopy, bloods, u&es, LFTs, CT/PET scan if positive for it

Question 13

what is the management for oesophageal cancer?

Answer 13

surgical resection
chemo
radio for squamous cell carcinoma
palliative: PEG, PEJ, jejunal feeding, surgical bypass

Question 14

what are the types of feeding tubes?

Answer 14

NG tube: bypasses stricture, used to increase nutrition before surgery or chemo

(pass through nose, into oeseophagus and stomach)

PEG tube = through skin into stomach

Question 15

what are the NICE guidelines for 2 week wait?

Answer 15

2 week wait for people with dysphagia, OR people >55 with weight loss and pain, reflux or dyspepsia, OR treatment resistant dyspepsia, or pain with low Hb

Question 16

what is the normal physiology of the stomach?

Answer 16

pareital cells release HCL
chief cells secrete pepsinogen
mucous cells in gastric pits = mucin which coats stomach lining

G cells produce gastrin
D cells produce somatostatin

Question 17

what is a peptic ulcer

Answer 17

involves ulceration of mucosa of stomach or duodenum

Question 18

what are the differentials for peptic ulcers

Answer 18

inflammation of mucosa
dyspepsia,
>1 week of symptoms = pancreatitis or cholecystitis

Question 19

what is the pathophysiology of a peptic ulcer

Answer 19

breakdown of mucosa/lining due to NSAIDs or H.pylori

and increase in stomach acid due to stress, alcohol, caffeine, smoking, spicy foods or hypersecretory syndromes like zollinger-ellison

Question 20

how does a peptic ulcer present

Answer 20

epigastric pain, dyspepsia, nausea and vomiting, haematemesis or malaena

Question 21

what causes peptic ulcers

Answer 21

H.pylori or NSAIDs

stress, spicy foods, caffeine, smoking, alcohol

Question 22

how do you investigate a peptic ulcer

Answer 22

endoscopy

bloods for haemodynamic instability, Hb, BP, etc

Question 23

how do you treat a peptic ulcer

Answer 23

stop NSAIDs and give 4-8w of PPI

Question 24

what are the complications of a peptic ulcer?

Answer 24

bleeding = inject adrenaline and haemoclips

perforation = surgery, can lead to acute abdomen and pneumoperitoneum

scarring of mucosa leading to stasis of food in stomach, presents with distention and abdo pain

Question 25

what is H.pylori

Answer 25

gram negative bacteria that burrows in lining, causes increased acid production = peptic ulcer

Question 26

how do you investigate for HP?

Answer 26

UREA breath test

stool antigen

Question 27

how do you treat HP infection and peptic ulcers?

Answer 27

triple therapy: PPI, clarithromycin and amoxicillin

Question 28

what are the other causes of upper GI bleeds

Answer 28

MW tear
oesophageal varices
ulcers
cancer of stomach or duodenum

Question 29

how does a GI bleed present

Answer 29

coffee ground vomit/haematemesis
malaena
haemodynamic instability eg tachycardia or low BP

Question 30

what are the GB and rockall scores?

Answer 30

GB: score to check if endoscopy is needed= risk of upper GI bleed

includes: urea, Hb, BP, malaena, syncopy, HR
rockall: risk of re-bleed after endoscopy

Question 31

how do you manage a major bleed?

Answer 31

major haemorrhage protocol

ABCDE
Bloods = Hb, crossmatch 2 units, platelets 
Access 2 large bore cannulas
Tranfuse 6 units
Endoscopy within 24h
Drugs = stop anti-coag and NSAIDs