Cancers of GI Tract Tutorial Flashcards
What are abdominal causes of upper dysphagia?
- Structural causes: Pharyngeal cancer, pharyngeal pouch
2. Neurological causes: Parkinson’s, stroke, motor neuron disease
What are abdominal causes of lower dysphagia?
•Structural causes:
1. Inside (mural and luminal): oesophageal or gastric cancer, stricture, Schatzki ring
2. Outside (extrinsic compression): lung cancer
•Neurological causes: Achalasia, diffuse oesophageal spasm
What are cardiac causes of dysphagia?
Post-prandial angina
What are other causes of dysphagia?
Globus sensation/anxiety
How do you decide if it is cardiac pain or dysphagia?
- Angina can occur after meals (blood shifts to bowel for digestion, limiting blood supply through narrowed coronaries).
- However, history of discomfort seconds after swallowing is inconsistent
- Unusual for angina to occur only after eating: ask about exertional chest pain
How do you determine if this is of oesophageal origin?
- Is food painful on swallowing? (upper)
2. Is food easy to swallow but feels stuck seconds later? (lower)
How do you determine if mechanical or neurological cause?
Are both solids and liquids hard to swallow (likely neurological)
How do you know if a mechanical cause is the patient at risk of strictures
Ask about history of reflux
What would it suggest if there is blood in stool that the patient has not noticed
- Would suggest a GI malignancy.
* Perform a digital rectal examination.
What investigations would you order?
- Bedside: ECG (are there signs of cardiac ischaemia?)
- Blood tests: Full blood count (iron deficiency anaemia from chronic GI bleed?), urea and electrolytes (dehydration from poor oral intake?)
- Imaging: CXR (basal crepitations Rt LL)
- Microbiology: None required.
- Special/invasive: He qualifies for an urgent upper GI endoscopy through the 2-week-wait suspected cancer pathway.
What are microcytic causes of anaemia by mean corpuscular volume (MCV)?
- Microcytic (MCV<80)
1. Iron deficiency anaemia
2. Anaemia of chronic disease
3. Thalassaemia
4. Sideroblastic anaemia
What are macrocytic causes of anaemia by mean corpuscular volume (MCV)?
- Macrocytic (MCV>96)
- FAT RBC
1. Foetus (pregnancy)
2. Alcohol excess
3. Thyroid disorders
4. Reticulocytosis
5. B12/Folate deficiency
6. Cirrhosis
What are normo cytic causes of anaemia by mean corpuscular volume (MCV)?
-Normocytic (80-96)
-ABCDE
1. Aplastic anaemia
2. Bleeding
3. Chronic disease
4. Destruction (haemolysis)
5. Endocrine disorders
•Hypothyroidism
•Hypoadrenalism
How does blood loss cause iron deficiency anaemia (IDA)?
- Increased demand (growth, pregnancy)
* Decreased absorption
What are GI causes of IDA in order of frequency?
- Aspirin/NSAID use
- Colonic adenocarcinoma
- Gastric carcinoma
- Benign gastric ulcer
- Angiodysplasia
- Coeliac disease
- Gastrectomy (decreased absorption)
- H.pylori
What are Non-GI causes of IDA in order of frequency
- Menstruation
- Blood donation
- Haematuria (1% of iron deficiency anaemias)
- Epistaxis
What would any overt bleeding noticed include?
- Blood in stool
- Haematuria
- Epistaxis
- Haemoptysis
What would you ask for generic symptoms of malignancy?
•Weight loss, anorexia, malaise
What symptoms might suggest colorectal cancer?
- Change in bowel habit
- Blood or mucus in stool
- Faecal incontinence
- Feeling of incomplete emptying of bowels (tenesmus)
What symptoms might suggest an upper GI cancer?
- Dysphagia
* Dyspepsia
How do you know Is there blood in the stool or urine that the patient has not noticed?
- Perform a digital rectal examination.
* Dip the urine to check for blood.
What investigations would you request?
- Bedside: Urine dipstick (haematuria?)
- Blood tests: Iron studies (needed to confirm iron deficiency as the cause of microcytic anaemia), anti-TTG (a screening test for coeliac disease)
- Imaging: Unlikely to order any from the GP clinic.
- Microbiology: None required.
- Special/invasive: She qualifies for an urgent colonoscopy through the 2-week-wait suspected cancer pathway. If this is negative, an upper GI endoscopy will be organised.
