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TCD Cases > Diseases of the Upper GI System > Flashcards

Diseases of the Upper GI System Flashcards

1
Q

Define Barrett’s Oesophagus

A

Asymptomatic of normal squamous epithelia of the oesophagus by metaplastic columnar epithelium

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2
Q

Barret’s oesophagus is a precursor for what other condition?

A

Oesophageal adenocarcinoma

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3
Q

What is the strongest known risk factor for Barrett’s oesophagus?

A

GORD

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4
Q

Name 4 medical conditions that have an association with Barrett’s oesophagus

A
  1. Chronic GORD
  2. Hiatus hernia
  3. Smoking
  4. Obesity
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5
Q

What is the clinical test used to detect dysplasia in the investigation of Barrett’s oesophagus?

A

High resolution white light endoscopy with biopsies

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6
Q

Name a form of anti-reflux surgery

A

Nissen’s fundoplication

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7
Q

Name 4 important differentials of progressive dysphagia to solids i.e. a mechanical obstruction or stricture

A
  1. Barrett’s oesophagus
  2. Oesophageal cancer
  3. Peptic stricture
  4. Extrinsic compression of the oesophagus
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8
Q

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?

A
  1. Upper abdominal pain
  2. Reflux
  3. Dyspepsia
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9
Q

On average, for patients that undergo endoscopy for dysphagia, what is the % breakdown of resulting diagnoses?

A 
~ 40% have functional/ non ulcer dyspepsia 
40 % GORD
13% gastric or duodenal ulcers
2% gastric cancer 
1% oesophageal cancer
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10
Q

Suggest 4 important potential differentials for peptic ulceration

A
  1. Gastritis
  2. Non-ulcer dyspepsia
  3. Pancreatitis
  4. Cholecystitis
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11
Q

What are the 2 most common causes of peptic ulcer disease?

A
  1. H. Pylori infection

2. NSAIDS

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12
Q

What are the 3 methods of testing for a H Pylori infection?

A
  1. Urea breath test
  2. Stool antigen test
  3. Blood test for antibodies to the bacteria
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13
Q

Outline the 3 mechanisms by which NSAIDS lead to gastric ulceration

A
  1. Inhibition of COX 1 - decrease blood flow
  2. Topical irritation - Epithelial damage
  3. Inhibition COX 2 - Neutrophil adherence
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14
Q

Suggest 5 risk factors for the development of peptic ulcer disease

A
  1. Smoking
  2. Alcohol excess
  3. Family history of peptic ulcer disease
  4. Physical stress
  5. Hyperesecretory syndromes of stomach acid e.g. Zollinger- Ellison syndrome.
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15
Q

Name 3 potential complications of peptic ulcer disease

A
  1. Internal bleeding
  2. Perforation
  3. Gastric outlet syndrome
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16
Q

What are the 2 main clinical characteristics of gastric outlet syndrome?

A
  1. Epigastric abdominal pain

2. Postprandial vomiting due to mechanical obstruction

17
Q

What is the most common cause of gastric outlet syndrome?

A

Pancreatic cancer

18
Q

Which Rockall score cut off is associated with good prognosis for patients with upper GI bleeding?

A

Less than 3

19
Q

Name 6 medications which may lead to the formation of a peptic ulcer

A
  1. Potassium channel activators e.g. Nicorandil
  2. Corticosteriods
  3. NSAIDS
  4. SSRIs
  5. Anticoagulants
  6. Antiplatelets
20
Q

Dysphagia combined with any of which 4 symptoms is sufficient indication for an urgent 2 week referral?

A
  1. Weight loss
  2. Anemia
  3. Anorexia
  4. Persistant vomiting
21
Q

Name the enzyme secreted by the chief cells of the stomach

A

Pepsinogen

22
Q

Name the cell type that releases HCl into the stomach

A

Parietal cells

23
Q

ECl cells of the stomach produce what substance?

A

Histamine

24
Q

Which cell type secretes somatostatin?

A

Delta cells

25
Q

Describe the the action of somatostatin on acid secretion in the stomach

A

Down-regulates parasympathetic stimulation of the parietal cells thus reducing volume of acid secretion.

26
Q

In what area of the stomach are G and delta cells found?

A

Antrum

27
Q

What is the function of the G cell in the stomach?

A

Secretion of gastrin which in turn stimulates acid production by parietal cells.

28
Q

Name the 3 pathological mechanisms by which NSAIDS lead to the formation or gastric ulcers

A
  1. Mucosal barrier disruption
  2. Inhibition of repair mechanism
  3. Increased secretion of gastric acid
29
Q

What are the 5 broad categories of causes of haemoptysis?

A
  1. Infective
  2. Neoplastic
  3. Vascular
  4. Autoimmune
  5. Drug related

TCD Cases (25 decks)

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