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Year 3 > Case 19 - Diseases Of The Upper GI Tract > Flashcards

Case 19 - Diseases Of The Upper GI Tract Flashcards

1
Q

What are the common causes of dysphagia?

A

CNS causes: Muscular dystrophy, Myasthenia gravis, Stroke
Cancer of the throat/Oesophagus
Oesophageal strictures, peptic strictures
GORD
Achalasia
Extrinsic compression of Oesophagus

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2
Q

What is Barrett’s Oesophagus?

A

Where there is metaplasia of squamous epithelium of the Oesophagus which changes to columnar epithelium (that which is found in the stomach)

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3
Q

What is the management of Barretts Oesophagus?

A

Drug treatment: PPI
Lifestyle treatment: weight, smoking, alcohol
Surveillance: endoscopy every 2-5 years to check for dysplasia. If dysplasia found then increase surveillance to every 6 months

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4
Q

What type of oesophgeal cancer does barretts Oesophagus make you more of risk of?

A

Adenocarcinoma

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5
Q

What are the two main types of oesophgeal cancer?

A

Small cell carcinoma (found in middle third)

Adenocarcinoma (found in lower third)

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6
Q

What are the major risk factors for developing oesophgeal cancer?

A 
Diet lacking in veg/fruit
Alcohol excess 
Smoking 
Achalasia 
Barretts Oesophagus 
Reflux disease
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7
Q

What are the red flags for oesophageal/gastric cancer?

A 
Over the age of 55 with weight loss
Upper abdominal pain 
Recent onset/progressive symptoms 
Reflux 
Dyspepsia/dysphagia (difficulty swallowing)
Iron deficiency Anaemia
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8
Q

How are oesophgeal cancers treated?

A

Surgery

Palliative therapy if metastatic or stage 4 cancer

  • stent to restore swallowing
  • NG feeding tube or PEG tube
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9
Q

What are the differentials for dyspepsia?

A 
GORD
Peptic ulcer
Gastric malignancy 
Oesophageal malignancy 
Gastritis 
Duodenitis
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10
Q

What are the common symptoms of peptic ulcer disease?

A 
Epigastric pain - related to hunger, specific foods or time of day
Bloating 
Fullness after meals
Heartburn (retrosternal pain and reflux)
Tender epigastrium
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11
Q

What are the risk factors for peptic ulcer disease?

A 
Smoking/drinking 
Family history 
Zollinger ellison syndrome 
H-pylori infection
Use of NSAIDs/steroids
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12
Q

What is Zollinger Ellison syndrome (ZES) and how does it increase the risk of peptic ulcer disease?

A

Where tumours develop in the pancreas and duodenum which secrete the hormone gastrin

Gastrin produces excessive stomach acid, so 90% of patients with ZES develop peptic ulcers

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13
Q

How is H.Pylori tested for?

A

Urea breath test
Stool antigen test
Blood test (not commonly used)

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14
Q

What is the H.Pylori eradication therapy?

A

Triple therapy: PPI + 2 antibiotics

PPI: either omeprazole or lansoprazole
2 antibiotics: Clarithromycin and Amoxicillin (metronidazole)

Treatment is for 7 days

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15
Q

What are the complications of peptic ulcers?

A

Bleeding peptic ulcer - can cause iron deficiency anaemia
Perforation - can cause acute abdomen and peritonitis
Gastric outlet obstruction

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16
Q

What is the Rockwell score?

A

A score to Calculate the risk of an upper GI bleed in a patient who has already undergone endoscopy

17
Q

What is the Glasgow-blatchford score?

A

A score to calculate the risk of an upper GI bleed in a patient

18
Q

Why is urea raised in an upper GI bleed?

A

Because digested blood is a source of urea

19
Q

What are the most common causes of an upper GI bleed?

A 
Peptic ulcer 
Oesophatitis 
Gastritis 
Oesophageal varices 
Mallory Weiss tears (tear in the mucosal layer at the junction between Oesophagus and stomach)
Malignancy
20
Q

What are the common causes of a lower GI bleed?

A

IBD
IBS
Malignancy

21
Q

What is the acute management of an upper GI bleed?

A

Insert 2 large bore cannula
Bloods - FBC, U&E, LFT
Cross match 4 units of blood - transfuse if necessary
Give IV fluids
Insert catheter and monitor hourly urine output
Prepare for urgent OGD (nil by mouth, consent)

22
Q

What is the treatment for oesophageal varices?

A

IV terlipressin - reduces portal blood flow due to vasoconstrictive effect on the splanchnic vascular system
Prophylactic antibiotic
Band ligation in endoscopy
TIPS procedure - if band ligation fails

23
Q

How would you differentiate between a mechanical cause of dysphagia and a neurological cause?

A

Mechanical cause - solids get stuck, but okay to swallow liquids
Neurological cause - difficulties swallowing both solids and liquids

24
Q

What are the differentials for peptic ulcer disease?

A

Gastritis
Non-ulcer dyspepsia
Pancreatitis
Cholecystitis

25
Q

What are the lifestyle managements of GORD?

A 
Sleep with head raised
Weight loss
Quit smoking 
Small regular meals 
Avoid hot drinks, alcohol, citrus fruits, fizzy drinks, spicy foods, chocolate 
Avoid eating <3hrs before bed
26
Q

What is the drug treatment for GORD?

A

Antacids e.g, magnesium trisilicate mixture
Alginates e/g, gaviscon

Omeprazole, lansoprazole or ranitidine (to reduce stomach acid)

27
Q

Which medications are linked with the formation of peptic ulcers or GI bleeds?

A 
NSAIDS
Steroids
Antiplatelet 
Anticoagulants
Potassium channel activators (e.g, nicorandil)
SSRIs
28
Q

Why should a PPI be given to patients who are taking long term aspirin or clopidogrel?

A

To prevent the formation of peptic ulcers

29
Q

What is the conversion rate of barretts to adenocarcinoma?

A

1-2% over 25-30 years

30
Q

Which type of oesophageal cancer is strongly linked to smoking and drinking?

A

Small cell carcinoma (SCC)

31
Q

What percentage of GORD patients go on to develop barretts Oesophagus?

A

6-14%

32
Q

Who should be screened for barretts?

A

People with chronic or severe GORD (duration > 5 years or at least twice weekly symptoms)

At least 3 of: age>50, male sex, white race, obese, smoker

Patients with a family history of barretts oesophagus or oesophageal adenocarcinoma

33
Q

What is the recommended treatment for a peptic ulcer when H.pylori is negative?

A

PPI or H2 antagonist for 4-8 weeks

Stop taking NSAIDS

Year 3 (24 decks)

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