Diseases of the Upper GI System Flashcards
Define Barrett’s Oesophagus
Asymptomatic of normal squamous epithelia of the oesophagus by metaplastic columnar epithelium
Barret’s oesophagus is a precursor for what other condition?
Oesophageal adenocarcinoma
What is the strongest known risk factor for Barrett’s oesophagus?
GORD
Name 4 medical conditions that have an association with Barrett’s oesophagus
- Chronic GORD
- Hiatus hernia
- Smoking
- Obesity
What is the clinical test used to detect dysplasia in the investigation of Barrett’s oesophagus?
High resolution white light endoscopy with biopsies
Name a form of anti-reflux surgery
Nissen’s fundoplication
Name 4 important differentials of progressive dysphagia to solids i.e. a mechanical obstruction or stricture
- Barrett’s oesophagus
- Oesophageal cancer
- Peptic stricture
- Extrinsic compression of the oesophagus
In patients aged over 55 with weight loss, those with any of which 3 factors should be referred for urgent direct access upper GI endoscopy?
- Upper abdominal pain
- Reflux
- Dyspepsia
On average, for patients that undergo endoscopy for dysphagia, what is the % breakdown of resulting diagnoses?
~ 40% have functional/ non ulcer dyspepsia 40 % GORD 13% gastric or duodenal ulcers 2% gastric cancer 1% oesophageal cancer
Suggest 4 important potential differentials for peptic ulceration
- Gastritis
- Non-ulcer dyspepsia
- Pancreatitis
- Cholecystitis
What are the 2 most common causes of peptic ulcer disease?
- H. Pylori infection
2. NSAIDS
What are the 3 methods of testing for a H Pylori infection?
- Urea breath test
- Stool antigen test
- Blood test for antibodies to the bacteria
Outline the 3 mechanisms by which NSAIDS lead to gastric ulceration
- Inhibition of COX 1 - decrease blood flow
- Topical irritation - Epithelial damage
- Inhibition COX 2 - Neutrophil adherence
Suggest 5 risk factors for the development of peptic ulcer disease
- Smoking
- Alcohol excess
- Family history of peptic ulcer disease
- Physical stress
- Hyperesecretory syndromes of stomach acid e.g. Zollinger- Ellison syndrome.
Name 3 potential complications of peptic ulcer disease
- Internal bleeding
- Perforation
- Gastric outlet syndrome
What are the 2 main clinical characteristics of gastric outlet syndrome?
- Epigastric abdominal pain
2. Postprandial vomiting due to mechanical obstruction
What is the most common cause of gastric outlet syndrome?
Pancreatic cancer
Which Rockall score cut off is associated with good prognosis for patients with upper GI bleeding?
Less than 3
Name 6 medications which may lead to the formation of a peptic ulcer
- Potassium channel activators e.g. Nicorandil
- Corticosteriods
- NSAIDS
- SSRIs
- Anticoagulants
- Antiplatelets
Dysphagia combined with any of which 4 symptoms is sufficient indication for an urgent 2 week referral?
- Weight loss
- Anemia
- Anorexia
- Persistant vomiting
Name the enzyme secreted by the chief cells of the stomach
Pepsinogen
Name the cell type that releases HCl into the stomach
Parietal cells
ECl cells of the stomach produce what substance?
Histamine
Which cell type secretes somatostatin?
Delta cells
Describe the the action of somatostatin on acid secretion in the stomach
Down-regulates parasympathetic stimulation of the parietal cells thus reducing volume of acid secretion.
In what area of the stomach are G and delta cells found?
Antrum
What is the function of the G cell in the stomach?
Secretion of gastrin which in turn stimulates acid production by parietal cells.
Name the 3 pathological mechanisms by which NSAIDS lead to the formation or gastric ulcers
- Mucosal barrier disruption
- Inhibition of repair mechanism
- Increased secretion of gastric acid
What are the 5 broad categories of causes of haemoptysis?
- Infective
- Neoplastic
- Vascular
- Autoimmune
- Drug related
