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YEAR 3 Manchester Medicine > 19 - upper GI pathology > Flashcards

19 - upper GI pathology Flashcards

1
Q

What is dysphagia?

A

Swallowing difficulties

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2
Q

What neuromuscular causes of dysphagia?

A

myathenia graves

achalasia

muscular dystrophy

Sroke

parkinsons

CN IX, X XII lessions

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3
Q

Occulsion causes of dysphagia?

A

Throat cancer

esophageal cancer

GORD

Pharyngeal pouch

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4
Q

What does a progressive dysphagia for solids suggest?

A

Mechanical obstruction or stricture

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5
Q

Features which surgest malignancy is dysphgia?

A

Progressive

retrosternal pain

Regurgitation

weight loss

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6
Q

What is pulmmer Vinson syndrome?

A

Triad of:

Dysphagia

Iron deficiency aneamia

Glossitis

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7
Q

Patient has aggressive vomiting which then results vomiting in blood, What is the likely diagnosis?

A

Mallory-Weiss syndrome

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8
Q

What is Boerhave syndrome?

A

Severe vomiting resulting in oesophageal rupture.

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9
Q

Questions to ask duringa history of dysphagia?

A

Weightloss - intentional and timescale

Vomiting - blood, coffee granuels, contineuos or single heamatesis?

Bowel habit - malaena

Pain

anaemia symptoms

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10
Q

What to ask if you suspect Peptic ulcer?

A

Previous ulcers

OGD

NSAIDS

Drinking and smoking

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11
Q

What is barrettes oesophagus?

A

Metaplasias of squamous to columnar epithilium.

Pre-cancerous

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12
Q

Criteria for OGD?

A

GORD for > 5 years, 2 times a week

+ 3 of : > 50 years, male, white, obese, smoker

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13
Q

How often is surverillande for barrettes oesphagus?

A

OGD every 3-5 years

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14
Q

How is adenocarcinoma of the oesophagus treated?

A

PET and CT
oesopahgealectomy if appropriate

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15
Q

What is the most common cause of peptic uclers?

A

H. pylori in LEDC

NSAISD in MEDC

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16
Q

What is Zollinger-Ellison syndrome?

A

a gastrin releasing tumour, can lead to peptic ulceration

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17
Q

How to treat H. pylori?

A

7 days oral PPI

Amoxycillin + clarthromycin/ matronidazole

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18
Q

How is NSAID peptic ulcer treated?

A

Stop NSIADS

offer 8 weeks PPI or H2RA

H. pylori test if appropriate

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19
Q

What medication can cause upper GI bleed/ gastritis/ peptic ulcer?

A

anti-platelets

SSRIs

corticosteroids

NSIADS
Anticoagulants

Nicorandil - K channel activator leading to vasodilation

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20
Q

What is the Glasgow batchford score used for?

A

GI bleeding risk, indicates who can be managed as an outpatient. Doesn’t require endoscopic evaluation.

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21
Q

What does the Rockall score indicate?

A

Risk of upper GI risk (score > 3) after endoscopic evaluation.

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22
Q

What questions to ask about an upper GI bleed?

A

1 - Quantity of blood

2 - Is it still bleeding

3 - Where is it comming from

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23
Q

Where does a bleed stop being an upper GI bleed and become a lower GI bleed?

A

Ligament of Triatz - this is where OGD evaluation stops

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24
Q

What deos streaks and clots during heamatemesis surgest?

A

smaller bleed

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25
Q

Why is urea raised in GI bleeds?

A

blood is broken down and reabsorbed as urea

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26
Q

Management of variceal bleed?

A

Telipressin

Omeprazole IV

Band ligation - temporarily

Prophylatic antibiotics

27
Q

What should be done before the addministation of tellipressin?

A

ECG to exclude ischaemia

28
Q

At what platelet count has a big risk of a major bleed?

A

< 30

29
Q

What is transjugular intrahepatic portal system shunt?

A

Radiological intervention resulting in a shunt being produced from the hepatic portal vein to the hepatic vein leading to reduction of hepatic portal vein hypotensions and therefore helping to reduce variceal bleed.

30
Q

Relook over case on medlea

A
31
Q

What is the difference between regurgitation and vomiting?

A

Vomiting has mechanical propulsion and regugitation does not require any effort from the patient.

32
Q

What are the symptoms of salivary gland lumps?

A

Pain associated with meals

Persistant or rapid growth

Diagnosis by needle biopsy

33
Q

What are the deferentials for bilarteral hylar markings?

A

Disseminanted malignancy

lymphoma

Sarcoid

TB - > immunosupressed patients

Glandular fever

34
Q

What histological cell character indicates Hodgkins lymphoma?

A

Reid sternberg cells

35
Q

What do Reid sternberg cells look like?

A

muiltinucleated, bi-lobed cells

36
Q

What is the cure rate for Hodgkins lymphoma?

A

80%

37
Q

After treatment for Hodkins lymphoma, how many years does it take where there is no relapse until the risk of the cancer re-occuring is the same as normal?

A

5 years - at this point the patient is discharged from clinic.

38
Q

What is Ann arbour staging?

A

A way of staging Hodgkins and non-Hodgkins lymphoma by the spread of the cancer.

39
Q

What imaging is needed for Ann Arbour staging?

A

Contrast CT, ofter CT-PET is also used

40
Q

On imaging there are enlarged lymph nodes in the axillary and the inguinal nodes. They are shown to be non/Hodgkins lymphoma. What stage is this?

A

3 - lymphadenopathy is found both below and above the diaphragm

41
Q

What is neutropenic spesis?

A

Low neutrophil count resulting in sepsis. Often due to chemotherapy. Most commonly presents 10 days post chemotherapy.

42
Q

How is neutropenic sepsis diagnosed?

A

Antibiotics (as per local guilines) given within 1 hour

43
Q

What age is Hodgkins lymphoma most common at?

A

15-40 the +70 years

44
Q

What median age does non-Hodgkins occur?

A

median age of 55

45
Q

What are the features of T cell Non-hodgkins lymphoma?

A

Aggresive

Responsive to treatment however poor prognosis and is considered incurable

46
Q

What are the features of B cell Non-hodgkins lymphoma

A

Common (95% of lymphoma)

Good prognosis

Can be treated with Rituximab

47
Q

What are the features of indolent B cell Non-hodgkins lymphoma?

A

incurable

slow growing

responds to treatmetn

median survival of 10 years

Follicular lympoma is the most common

48
Q

What are the features of aggressive B cell Non-hodgkins lymphoma?

A

Grows quicjkly

symptomatic

good prognosis

examples: Birkitts and diffuse large B cell lymphoma

49
Q

What is Eccymosis?

A

Dyscolouration under the skin from bleeding > 1 cm

50
Q

What is Pupura?

A

Discolouration under the skin due to blood which is < 1 cm

51
Q

Differential for Eccchymosis and pupura

A

TTP

HUS

meningococcal septiceamia

Haematological malignancies

52
Q

Anaemia + hypercalcaemia with persistant back pain should raise suspiscion for what?

A

muiltiple myeloma

53
Q

What is the most common lymphoma?

A

Diffuse B cell non-Hodgkins lymphoma?

54
Q

What is the 2nd most common lymphoma?

A

Follicular non-Hodgkins lymphoma is 2nd most common.

It is incurable however responds well to treatement.

55
Q

What are side effect are there from haematological malignancies?

A

Infertility

Heart failure arrythmias etc.

2nd malignancies

Alopecia

Neurtopenic sepsis

56
Q

A paitent undergoes a core biopsy where pressure cannot be appplied afterwards in case of bleeding. How many days sould clopidogrel/ aspirin be stopped for before carring out the investigation.

A

5 days

57
Q

A T2 DM undergoes a contrast CT. How much time does metformin need to eb stopped for before giving contrast?

A

48 hours

Interaction can result in reduced renal function

58
Q

What viral causes for axillary + inguinal lymphadenopathy?

A

mononucleosis

CMV

HIV
Hep B/C

59
Q

What can cause lymphadenopathy in the axillary and inguinal regions?

A

Mets

infection - viral + bacterial

Autoimmune

Sarcoidosis

Drug reactions

60
Q

What treatment should be done for lymphadenopathy in the axillary and inguinal lymph nodes?

A

Viral screen - exclude some infective causes

Biopsy

CT contrast + PET

61
Q

What is Rituximab?

A

CD20 antibodies immuno therapy

For the treatment of non-Hodgkins B cell lymphoma and other autoimmuno causes.

Targets B cells

62
Q

What is Bendamustine?

A

An alkylolytic agent give with Rituximab.

Used for CLL, MM and non-Hodgkins lymphoma

63
Q
A
64
Q
A

YEAR 3 Manchester Medicine (34 decks)

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