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Medicine Year 1 > Case 11 SAP > Flashcards

Case 11 SAP Flashcards

1
Q

Prevalence dysphagia

A

General 20%, affects up to 50% over 60s

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2
Q

Types of dysphagia

A

Oropharyngeal and oesophageal

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3
Q

Neurological causes of oropharyngeal dysphagia

A

Stroke, head trauma, neurodegenerative disease

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4
Q

Muscular causes oropharyngeal dysphagia

A

Polymyositis/dermatomyositis, myasthenia gravies, metabolic myopathy, muscular dystrophies, Kearns-Sayre syndrome

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5
Q

Structural causes oropharyngeal dysphagia

A

Zenker diverticulum, surgical resection, tumours, cricopharyngeal achalasia, extrinsic compression

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6
Q

Zenker diverticulum

A

Outpouching of the pharynx, occurs at weak spot in muscular wall just above the cricopharyngeal muscle. May result in coughing or aspiration as bolus can be regurgitated

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7
Q

Oesophageal dysphagia with solids only

A

Likely structural
Intermittent - oesophageal ring/web or eosinophilic oesophagitis
Slow progressive - stricture oesophagitis
Rapid progressive with weight loss - cancer

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8
Q

Oesophageal dysphagia with liquids and solids

A

Dysmotility
Intermittent - with chest pain, distal oesophageal spasm
Progressive - either with chronic heartburn (scleroderma, absent contractility) or regurgitation (achalasia)

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9
Q

Scleroderma oesophagus

A

Autoimmune, connective tissue fibrosis. Oesophageal atrophy, fibrosis, strictures, smooth muscle atrophy (weak peristalsis and LOS), decreased excitatory neural input

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10
Q

Scleroderma oesophagus symptoms

A

Dysphagia, heartburn, regurgitation

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11
Q

Oesophageal webs and strictures description and association

A

Thin membranous folds that form in the oesophagus. Narrow and block either partially or fully. No clear cause but linked to chronic iron deficiency anaemia

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12
Q

Symptoms dysphagia

A

Food spillages, drooling, regurgitation, avoidance certain consistencies, nasal regurgitation, coughing/choking, food getting stuck/sensation of getting stuck, weight loss, prolonged meal duration, repeated chest infections, posture changes, changes in voice, articulations, speech, and language

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13
Q

Complications dysphagia

A

Increased risk of inhaling food leading to choking or infection (aspiration pneumonia), avoidance of eating and drinking leading to malnutrition and dehydration, and decreased quality of life

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14
Q

Warning signs to consider OGD endoscopy

A

DOC ALARM
Dysphagia, odynophagia, choking, anaemia, loss of weight, age over 55, recent onset/progressive symptoms, melaena/haematemesis

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15
Q

Oesophageal cancer epidemiology

A

3x higher in men than women
highest rates in Middle East, South Africa, Northern China, Southern Russia, and India

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16
Q

Upper GI neoplasms

A

Squamous cell carcinoma, usually upper or mid oesophagus

17
Q

Lower GI carcinomas

A

Most adenocarcinomas, lower oesophagus downwards. Gastrointestinal stromatolites tumours (GIST) ad lymphoma are rare

18
Q

Oesophageal cancer tumour types

A

Most are malignant (<1% benign)
Squamous cell carcinoma 90%
Adenocarcinoma

19
Q

Where do oesophageal adenocarcinomas arise from?

A

Superficial and deep glands of the oesophagus, mainly lower third especially near the gastroesophageal junction

20
Q

Risk factors for oesophageal cancer

A

Tobacco, alcohol, Peutz-Jeghers syndrome, Cowden syndrome, genetic mutations (PTEN tumour suppressor genes), family history, vitamin deficiencies, caustic injury, webs, achalasia, Barrett’s oesophagus, oesophageal diverticula, exposure to DNA damaging agents

21
Q

Which vitamin deficiencies are linked with oesophageal cancer?

A

A, B, C, magnesium, niacin, zinc

22
Q

Peutz-Jeghers syndrome

A

Autosomal dominant syndrome characterised by multiple hamartomatous polyps in the GI tract, mucocutaneous pigmentation, and increased risk of GI and non-GI cancer

23
Q

Clinical symptoms oesophageal cancer

A

Dysphagia, odynophagia, weight loss, substernal heartburn/acid reflux, dyspnoea, cough, hoarseness, pain in retro-eternal, back, or right upper abdomen

24
Q

Morphology oesophageal adenocarcinoma

A

Normal epithelium —> Barrett’s oesophagus —> dysplastic Barrett’s oesophagus —> oesophageal adenocarcinoma

25
Q

Gastric tumour types

A

Poor prognosis
90% adenocarcinomas that develop in the cells of the glandular stomach lining
Less common include GIST, MALT, gastric lymphoma

26
Q

GIST

A

Gastrointestinal stromal tumours. Arise from muscle or connective tissue in stomach wall

27
Q

Gastric tumours epidemiology

A

2x higher in men
Eastern Asia, Eastern Europe, South America, high frequency in Japan
Incidence increased with age

28
Q

Symptoms gastric cancers

A

No symptoms until late stages so poor prognosis
Bloating, fatigue, indigestion, heartburn, stomach pain, nausea, vomiting, unexplained weight loss. ALARM for warning signs

29
Q

Risk factors gastric cancer

A

Smoking, alcohol, h pylori, poor diet, genetics/family history (FAP), DNA damaging agents, predisposing conditions like ulceration, adenomatous gastric polyps, chronic atrophic gastritis, dysplasia, intestinal metaplasia, Menetrier’s disease

30
Q

Where do most gastric tumours arise from?

A

Antrum 50%
Body 30%
Fungus/cardia 20%

31
Q

What are the two microscopic gastric cancer pathologies

A

Diffuse and intestinal

32
Q

Describe diffuse gastric cancers

A

Discohesive cells infiltrating through all layers of the stomach wall, extensive fibrosis and inflammation, large intracytoplasmic vacuoles that push the nucleus to the periphery creating a signet ring appearance. No known precursor.

33
Q

Describe intestinal (microscopic type) gastric cancer

A

Papillary growth, step-wise progression : chronic gastritis —> intestinal metaplasia —> dysplasia —> CIS —> invasive carcinoma

34
Q

Causes of oesophagitis

A

GORD
Others include chemical injury, radiation therapy, physical injury, vomiting, medications (NSAIDs, antibiotics, steroids)

Medicine Year 1 (23 decks)

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