David Morton Flashcards
Give a differential diagnosis for upper abdominal pain
Gastro-oesophageal reflux Functional dyspepsia Gastric or duodenal ulcer Cholelithiasis (gallstone formation) Acute or chronic pancreatitis Irritable bowel syndrome Musculoskeletal pain Neuralgic pain Cardiac pain e.g. myocardial infarction
List the main risk factors for GORD
FHx of heartburn or GORD Older age (>55 years) Hiatus hernia Obesity LOS tone reducing drugs e.g. nitrates, CCBs, alpha and beta agonists, theophylline and anticholinergics Psychological stress Asthma NSAIDs Smoking Alcohol consumption Dietary factors e.g. high fat, spicy, citric
Major risk factors for the formation of gastric and duodenal ulcers
Helicobacter pylori infection and prolonged NSAID use
Smoking
Increasing age
History/FHx of peptic ulcer disease
Patient in intensive care - mechanical ventilation or coagulopathy
Diagnostic investigations used for GORD
8 week PPI trial OGD Ambulatory pH/impedance monitoring Oesophageal manometry Barium swallow Oesophageal capsule endoscopy
Diagnostic investigations for peptic ulcers
Urease breath test H. Pylori antigen stool test Upper GI endoscopy FBC (microcytic anaemia) Stool haem test
List and briefly explain the possible sequelae of peptic ulceration in the upper GI tract
Upper GI bleeding due to erosion into wall of stomach/duodenum
Perforation due to erosion into peritoneal cavity (shock and peritonitis)
Penetration due to erosion of entire thickness of stomach/duodenum into adjacent organs e.g. pancreas
Gastric outlet obstruction due to chronic pyloric stenosis (healing of pyloric channel ulcers = scarring and oedema = nausea, vomiting and weight loss)
Diagnostic investigations for oesophageal cancer
OGD with biopsy Comprehensive metabolic profile CT thorax and abdomen MRI thorax and abdomen FDG-PET scan Endoscopic ultrasound and fine needle aspiration Thoracoscopy and laparoscopy Lung function tests Cardiac stress test Echocardiogram
