66 - dysphagia, 67 - haematemesis Flashcards
dysphagia DDx
Oral: abscess, tonsillitis, cancer, Bell’s palsy, diphtheria
Pharyngeal: foreign body, cancer, abscess,
Oesophageal: foreign body, cancer, abscess, atresia, strictures, achalasia, bulbar palsy, MG, Crohn’s, candida,
oesophageal ca sx
dysphagia, pain, hoarse voice, lymphadenopathy, haemoptysis, cough.
Rfs oesophageal ca
smoking, obesity, GORD, poor diet, alcohol
rfs for gord
pregancy, obesity, smoking, hernia, stress
Mx of GORD
Lifestyle
PPI Then double it or switch to an alternate PPI, then add a H2 receptor antagonist (ranitidine).
what should you consider in GORD
H pylori
GORD can progress to?
barretts / neoplasia
What is achalasia ?
Dx?
Failure of smooth muscle relaxation. Lower oesophageal sphincter relaxation incomplete and peristalsis is uncoordinated or absent.
Barium swallow
Mx of achalasia
Nifedipine Botox may manage.
Nothing is curative.
Surgery.
Cell types and function in stomach
Foveolar cells produce mucus
Parietal cells secrete HCl and intrinsic factor, which is needed for B12 absorption.
Chief cells secrete digestive enzymes.
G cells secrete gastrin, which promotes HCl secretion.
Where are oesophageal varices found?
Dilated sub-mucosal veins in the lower 1/3 of the oesophagus
usual cause of varices?
portal HTN secondary to cirrhosis
Dx of varices
endoscopy
Mx of varices
sclerotherapy and banding
What is portal HTN? signs?
High blood pressure in hepatic portal system.
Signs: ascities, dilated veins, splenomegaly, jaundice, tenderness
Causes of portal HTN
Pre / intra / post hepatic
Thrombus formation, atresia, liver cirrhosis, fibrosis, sarcoid, TB, pericarditis.
Mx of portal HTN
portosystemic shunt.
Portal HTN -> risk of
varices and bleeding, also hepatorenal syndrome and encephalopathy.
What is a mallory weiss tear
Laceration in stomach and oesophageal lining following protracted vomiting.
Causes of mallory weiss
alcoholism, bulimia, hyperemesis gravidarum.
How deep is tear in mallory weiss
submucosa but not muscular layer (Boerhaave syndrome)
Mx of serious mallory weiss
Endoscopy + cauterisation / adrenaline injections
surgical if needed
How is a upper GI blled different to normal haemorrhage
transfusion worsens outcomes (unless Pt shocked)
Mx of upper GI bleed
terlipressin and PPIs instead.
DDx gastritis
autoimmune (pernicious anaemia), H Pylori, NSAIDs, radiotherapy
Mx of gastritis
Lifestyle changes, treat underlying disease.
H2, PPIs,
antacids are mainstay of symptom reduction
