8. Upper GI Flashcards
What is achalasia?
Failure of the LOS to relax as well as aperistalsis. Caused by degeneration of myenteric plexus.
Can be secondary to chagas disease (trypanosoma cruzi)
How does achalasia present?
Dysphagia of both solids and liquids
Regurgitation due to trapped food
Gradual weight loss due to lack of food ingestion
Investigations in achalasia?
Gold-standard - high-resolution oesophageal manometry to demonstrate relaxation
Other - upper GI endoscopy (often first line to rule out cancer) and barium swallow (birds beak appearance)
What is GORD?
Complication or symptoms of gastric contents into the oesophagus.
Can be caused by a hernia, obesity, LOS hypotension, pregnancy etc.
How does GORD present?
Heartburn, pain retrosternally
Acid regurg leaving bitter taste in mouth
Waterbrash (increase salivation)
Odynophagia if ulceration or oesophagitis
Chronic cough or nocturnal asthma.
Investigations and treatment for GORD?
Resolution of symptoms after 8 weeks of PPI.
Treat with PPI and lifestyle modification, consider adding histamine blocker and antacids. Nissen fundoplication to increase LOS
What is peptic ulcer disease?
A break in the lining of the stomach with obvious depth through the submucosa.
Risk factors for PUD?
H.Pylori
NSAIDs
Smoking
Increased/decreased gastric emptying
Zollinger-ellison syndrome?
Multiple gastric ulcers due to increase bicarbonate and acid levels from high gastrin. Associated with MEN.
PUD presentation?
Epigastric pain directly after meals - duodenal is a few hours later.
Sometimes N&V and weight loss
PUD investigations?
Gold - upper GI endoscopy (biopsy too)
H.Pylori tests
Serum fastin gastrin for zollinger ellison
How to manage PUD?
Reduce smoking and alcohol intake.
If H.pylori then triple therapy of PPI and 2 abx
If not then stop drug causing ulcer and offer 4-8 weeks of PPI therapy.
What is gastritis?
Inflammation of stomach mucosa, do all stuff for ulcers with same risk factors.
What is a hiatus hernia?
A protrusion of abdo contents into thorax, usually stomach
Two types, sliding (mostly) and rarely rolling .
Risk factors are obesity and anything that increases intra-abdo pressure
How do hiatus hernias present?
Often GORD, asymptomatic.
Maybe GORD is worse lying down.
Palpitations or hiccups.
Investigations for hiatus hernia?
Gold - upper GI endoscopy
CXR isn’t as specific but is done.
Treatment of hiatus hernia?
Weight loss and PPI to treat GORD.
Fundoplication can be surgical if unresolving.
What is barrett’s?
Metaplasia of normal stratified squamous epithelium to columnar epithelium.
GORD biggest risk factor and presents with this.
Investigations and treatment for barrett’s?
Upper GI endoscopy with biopsy is gold and first line.
Treatment -
Non-dysplastic/low grade dysplasia relies on PPI and surveillance
Radiofrequency ablation or endoscopic resection if dysplastic
Oesophageal cancer types and risk factors?
Squamous is upper 2/3rd - alcohol, smoking, strictures, achalasia, nitrosamines
Adenocarcinoma is lower 1/3rd - GORD, barretts, obesity, achalasia
Presentation of oesophageal cancer?
First solids and then liquid dysphagia
Rapid weight loss from lack of intake and cancer
Hoarseness if recurrent laryngeal pressed on (upper so squamous only)
Investigations for oesophageal cancer?
CT/MRI for staging
Upper GI endoscopy with biopsy is gold
What is gastric cancer?
Neoplasm of stomach, mainly adenocarcinoma.
Intestinal type - h.pylori associated
Diffuse - e-cadherin mutation associated
Pernicious anaemia, h.pyori, nitrosamines, smoking, high salt and low vit c and blood type a are risk factors
How does gastric cancer present?
Epigastric pain Weight loss Lymphadenopathy!!! (remember this!!!) Offer to do lymph exam when doing abdo. Causing virchow's node and sister mary joseph nodule.
