24- Upper GIT Explains 2 Flashcards
What are the main risk factors for pancreatic adenocarcinoma?
Smoking, diabetes, adenoma, familial adenomatous polyposis
In which part of the pancreas does adenocarcinoma mainly occur?
Head of the pancreas (70%)
How does pancreatic adenocarcinoma spread?
It spreads locally and metastasizes to the liver
Why is it important to differentiate carcinoma of the pancreas from other periampullary tumors?
Pancreatic carcinoma has a worse prognosis compared to other periampullary tumors
What are the clinical features of pancreatic adenocarcinoma?
Weight loss, painless jaundice, epigastric discomfort (late feature due to invasion of the coeliac plexus), pancreatitis, Trousseau’s sign (migratory superficial thrombophlebitis)
What imaging studies are used to investigate pancreatic adenocarcinoma?
Ultrasonography (may miss small lesions), CT scanning (pancreatic protocol), PET/CT (for operable disease), ERCP/MRI (bile duct assessment), staging laparoscopy (to exclude peritoneal disease)
How can jaundice in pancreatic adenocarcinoma be managed?
ERCP and stent placement for palliation
What is the management approach for adenocarcinoma in the head of the pancreas?
Whipple’s resection (with the possibility of dumping syndrome and ulcers). Pylorus preservation and SMA/SMV resection are newer techniques.
What is the management approach for adenocarcinoma in the body and tail of the pancreas?
Distal pancreatectomy, with a poor prognosis
What is the usual treatment for resectable pancreatic adenocarcinoma?
Adjuvant chemotherapy
What procedure may be necessary for duodenal obstruction caused by pancreatic adenocarcinoma?
Surgical bypass
What are some extrinsic causes of dysphagia?
Mediastinal masses and cervical spondylosis
What are some examples of intrinsic causes of dysphagia?
Tumours, strictures, oesophageal web, and Schatzki rings
What is an example of an oesophageal wall cause of dysphagia?
Achalasia
Which neurological conditions can cause dysphagia?
CVA (cerebrovascular accident), Parkinson’s disease, multiple sclerosis, brainstem pathology, and myasthenia gravis
What is the recommended investigation for all patients with dysphagia?
Upper GI endoscopy, unless there are compelling reasons not to perform it
How can motility disorders be best appreciated in dysphagia patients?
Fluoroscopic swallowing studies
What blood test should be performed in patients with dysphagia?
Full blood count
What additional studies may be required to evaluate conditions like achalasia and GERD in dysphagia patients being considered for fundoplication surgery?
Ambulatory esophageal pH and manometry studies
What causes benign prostatic hyperplasia (BPH)?
An increase in the epithelial and stromal cell numbers in the peri-urethral zone of the prostate
How common is BPH in men over 80 years old?
90% of men aged over 80 will have at least microscopic evidence of BPH
What are the common lower urinary tract symptoms associated with BPH?
Poor flow, nocturia, hesitancy, incomplete and double voiding, terminal dribbling, urgency, incontinence
What are the medical therapy options for BPH?
Alpha blockers and 5 α reductase inhibitors
What examinations and tests are done to investigate BPH?
Digital rectal examination (to assess prostatic size and morphology), urine dipstick (for infections and haematuria), uroflowmetry (to assess flow rate and exclude BOO), bladder pressure studies (for detrusor failure, in atypical symptoms or prior to redo surgery), bladder scanning (to measure residual volumes), ultrasound (if high pressure chronic retention)