19 - upper GI pathology Flashcards
What is dysphagia?
Swallowing difficulties
What neuromuscular causes of dysphagia?
myathenia graves
achalasia
muscular dystrophy
Sroke
parkinsons
CN IX, X XII lessions
Occulsion causes of dysphagia?
Throat cancer
esophageal cancer
GORD
Pharyngeal pouch
What does a progressive dysphagia for solids suggest?
Mechanical obstruction or stricture
Features which surgest malignancy is dysphgia?
Progressive
retrosternal pain
Regurgitation
weight loss
What is pulmmer Vinson syndrome?
Triad of:
Dysphagia
Iron deficiency aneamia
Glossitis
Patient has aggressive vomiting which then results vomiting in blood, What is the likely diagnosis?
Mallory-Weiss syndrome
What is Boerhave syndrome?
Severe vomiting resulting in oesophageal rupture.
Questions to ask duringa history of dysphagia?
Weightloss - intentional and timescale
Vomiting - blood, coffee granuels, contineuos or single heamatesis?
Bowel habit - malaena
Pain
anaemia symptoms
What to ask if you suspect Peptic ulcer?
Previous ulcers
OGD
NSAIDS
Drinking and smoking
What is barrettes oesophagus?
Metaplasias of squamous to columnar epithilium.
Pre-cancerous
Criteria for OGD?
GORD for > 5 years, 2 times a week
+ 3 of : > 50 years, male, white, obese, smoker
How often is surverillande for barrettes oesphagus?
OGD every 3-5 years
How is adenocarcinoma of the oesophagus treated?
PET and CT
oesopahgealectomy if appropriate
What is the most common cause of peptic uclers?
H. pylori in LEDC
NSAISD in MEDC
What is Zollinger-Ellison syndrome?
a gastrin releasing tumour, can lead to peptic ulceration
How to treat H. pylori?
7 days oral PPI
Amoxycillin + clarthromycin/ matronidazole
How is NSAID peptic ulcer treated?
Stop NSIADS
offer 8 weeks PPI or H2RA
H. pylori test if appropriate
What medication can cause upper GI bleed/ gastritis/ peptic ulcer?
anti-platelets
SSRIs
corticosteroids
NSIADS
Anticoagulants
Nicorandil - K channel activator leading to vasodilation
What is the Glasgow batchford score used for?
GI bleeding risk, indicates who can be managed as an outpatient. Doesn’t require endoscopic evaluation.
What does the Rockall score indicate?
Risk of upper GI risk (score > 3) after endoscopic evaluation.
What questions to ask about an upper GI bleed?
1 - Quantity of blood
2 - Is it still bleeding
3 - Where is it comming from
Where does a bleed stop being an upper GI bleed and become a lower GI bleed?
Ligament of Triatz - this is where OGD evaluation stops
What deos streaks and clots during heamatemesis surgest?
smaller bleed
Why is urea raised in GI bleeds?
blood is broken down and reabsorbed as urea
Management of variceal bleed?
Telipressin
Omeprazole IV
Band ligation - temporarily
Prophylatic antibiotics
What should be done before the addministation of tellipressin?
ECG to exclude ischaemia
At what platelet count has a big risk of a major bleed?
< 30
What is transjugular intrahepatic portal system shunt?
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.
Relook over case on medlea
What is the difference between regurgitation and vomiting?
Vomiting has mechanical propulsion and regugitation does not require any effort from the patient.
What are the symptoms of salivary gland lumps?
Pain associated with meals
Persistant or rapid growth
Diagnosis by needle biopsy
What are the deferentials for bilarteral hylar markings?
Disseminanted malignancy
lymphoma
Sarcoid
TB - > immunosupressed patients
Glandular fever
What histological cell character indicates Hodgkins lymphoma?
Reid sternberg cells
What do Reid sternberg cells look like?
muiltinucleated, bi-lobed cells
What is the cure rate for Hodgkins lymphoma?
80%
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?
5 years - at this point the patient is discharged from clinic.
What is Ann arbour staging?
A way of staging Hodgkins and non-Hodgkins lymphoma by the spread of the cancer.
What imaging is needed for Ann Arbour staging?
Contrast CT, ofter CT-PET is also used
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?
3 - lymphadenopathy is found both below and above the diaphragm
What is neutropenic spesis?
Low neutrophil count resulting in sepsis. Often due to chemotherapy. Most commonly presents 10 days post chemotherapy.
How is neutropenic sepsis diagnosed?
Antibiotics (as per local guilines) given within 1 hour
What age is Hodgkins lymphoma most common at?
15-40 the +70 years
What median age does non-Hodgkins occur?
median age of 55
What are the features of T cell Non-hodgkins lymphoma?
Aggresive
Responsive to treatment however poor prognosis and is considered incurable
What are the features of B cell Non-hodgkins lymphoma
Common (95% of lymphoma)
Good prognosis
Can be treated with Rituximab
What are the features of indolent B cell Non-hodgkins lymphoma?
incurable
slow growing
responds to treatmetn
median survival of 10 years
Follicular lympoma is the most common
What are the features of aggressive B cell Non-hodgkins lymphoma?
Grows quicjkly
symptomatic
good prognosis
examples: Birkitts and diffuse large B cell lymphoma
What is Eccymosis?
Dyscolouration under the skin from bleeding > 1 cm
What is Pupura?
Discolouration under the skin due to blood which is < 1 cm
Differential for Eccchymosis and pupura
TTP
HUS
meningococcal septiceamia
Haematological malignancies
Anaemia + hypercalcaemia with persistant back pain should raise suspiscion for what?
muiltiple myeloma
What is the most common lymphoma?
Diffuse B cell non-Hodgkins lymphoma?
What is the 2nd most common lymphoma?
Follicular non-Hodgkins lymphoma is 2nd most common.
It is incurable however responds well to treatement.
What are side effect are there from haematological malignancies?
Infertility
Heart failure arrythmias etc.
2nd malignancies
Alopecia
Neurtopenic sepsis
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.
5 days
A T2 DM undergoes a contrast CT. How much time does metformin need to eb stopped for before giving contrast?
48 hours
Interaction can result in reduced renal function
What viral causes for axillary + inguinal lymphadenopathy?
mononucleosis
CMV
HIV
Hep B/C
What can cause lymphadenopathy in the axillary and inguinal regions?
Mets
infection - viral + bacterial
Autoimmune
Sarcoidosis
Drug reactions
What treatment should be done for lymphadenopathy in the axillary and inguinal lymph nodes?
Viral screen - exclude some infective causes
Biopsy
CT contrast + PET
What is Rituximab?
CD20 antibodies immuno therapy
For the treatment of non-Hodgkins B cell lymphoma and other autoimmuno causes.
Targets B cells
What is Bendamustine?
An alkylolytic agent give with Rituximab.
Used for CLL, MM and non-Hodgkins lymphoma
