Diseases Of The Upper GI Tract Flashcards
What ducts form the common bile duct?
Cystic duct
Common hepatic duct
What do the right hepatic and left hepatic duct combine to form?
Common hepatic duct
Where do the common bile duct and pancreatic duct meet?
Ampulla of vater
Through what do the common bile duct and pancreatic duct empty their contents?
Major duodenal papilla - has the sphincter of Oddi
What is ERCP and what does it do?
Endoscopic Retrograde Cholangiopancreatography
Studies biliary tree and pancreas
What can cause posthepatic jaundice and how?
Gallstones
Pancreas head carcinoma
Bile flows back to liver - overspill into blood - increased blood bilirubin
What are the 4(/5) parts of the pancreas?
Head (with Uncinate process)
Neck
Body
Tail
What is the role of the pancreas?
Exocrine
- Acinar cells - Secrete pancreatic enzymes into pancreatic duct
Endocrine
- Islets of Langerhans - Secrete insulin and glucagon into blood
What is the blood supply to the pancreas?
Pancreatic branches of the splenic artery
Sup. pancreaticoduodenal artery (from gastroduodenal a.)
Inf. pancreaticoduodenal artery (from sup. mesenteric a.)
What are the four parts of the duodenum?
- Superior - intraperitoneal
- Descending
- Horizontal
- Ascending
(The rest are retroperitoneal)
What is the name of the folds in the jejunum?
Plicae circularis
When fat is absorbed into enterocytes where does it go?
Into chylomicrons Into lacteals (special lymph vessels) Drains into venous system at left venous angle
What lesions can be present in the mouth?
Ulcer
Lump
White patch
Red patch
What is Sjögren’s syndrome?
Salivary gland disease - dry mouth
What haematological disorders have oral signs?
Deficiencies of
- Vitamin B12
- Folate
- Iron
What oral signs are present in iron deficiency?
Recurrent ulceration Oral dysaesthesia Oral candida Angular chelitis Smooth tongue
Hairy leukoplakia, Kaposi’s sarcoma and candidosis are oral manifestations of what?
HIV/AIDS
How does the Oesophagus appear in reflux disease?
Red
Ulcerated
Barrett’s oesophagus is a metaplasia of what cells to what?
Simple squamous to columnar epithelium
How does Barrett’s oesophagus appear?
Red
Velvety
Shifted z line
A 21 year old man presents with dysphagia. He has asthma and has a family history of allergy. He has no symptoms or signs of reflux disease. On endoscopy his Oesophagus appears corrugated. What is the likely diagnosis and treatment?
Eosinophilic oesophagitis
Steroids/Chromoglycate/Montelukast
A 62 year old man presents with dysphagia. He has smoked for 45 years and drinks 40 units of alcohol a week. He has noticed unplanned weight loss over the past number of weeks. He has some lymphadenopathy in his neck. What is the likely diagnosis?
Squamous cell carcinoma
In what areas of the mouth is squamous cell carcinoma most likely?
Non-keratinised
Where is a peptic ulcer more common, stomach or duodenum?
Duodenum
On endoscopy, a lesion appears clear cut and almost like it has been ‘punched out’. Is it more likely to be cancer or an ulcer?
Ulcer
What type of gastric cancer is linked to H. pylori infection?
Adenocarcinoma
What are common presentations of oesophageal cancer?
Dysphagia Odynophagia Haematemesis Dysphonia Weight loss
Alarm features of upper GI disease
>55 years Dysphagia GI blood loss Persistent vomiting Unexplained weight loss Upper abdo mass Anaemia (iron deficient)
What are the two types of gastric adenocarcinoma and how can they be distinguished?
Intestinal - Irregular gland tubules - Intestinal metaplasia Diffuse - Secrete mucus - Poorly differentiated - Signet ring cells
Typical clinical presentations of gastric cancer
Dyspepsia Upper GI bleed Weight loss Abdo mass Jaundice
In what type of lesion is a total gastrectomy performed?
Proximal
Treatment options for Variceal bleeding
Injection scleropathy - Ethanolamine
Banding
Histocryl glue
Treatments for arterial bleeding in the GI tract
Injection therapy - Adrenaline
Heater probe
Clips
What surgery is available for sufferers of GORD?
Nissen fundoplication
What is gastroparesis and what are its symptoms?
Delayed gastric emptying
- Feeling full
- Nausea
- Vomiting
- Weight loss
- Upper abdo pain
What is achalasia?
LOS in spasm
Lack of oesophageal peristalsis
(Treatment is balloon dilation or injection of Botox)
What are the Rome III criteria for dyspepsia?
Epigastric pain
Postprandial fullness
Early satiety
How do we test f or H. pylori infection?
Urease breath test
- C13 labelled urea eaten
- If C13 CO2 exhaled then H. pylori present
Faecal antigen test also possible
Treatment for H. pylori infection
Omeprazole 20mg twice daily AND
Clarithromycin 500mg twice daily AND
Amoxicillin 1g twice daily
What are the four types of tongue papillae?
Filiform (no taste buds)
Fungiform
Foliate
Circumvalate
What classes of anti-emetic drugs exist and give examples?
5-HT3 receptor antagonists - Ondansetron - Palonosetron Muscarinic ACh receptor antagonists - Hyosine - Scopolamine Histamine H1 receptor antagonists - Cyclizine - Cinnarizine Dopamine receptor antagonists - Domperidone - Metoclopramide
When are 5-HT3 receptor antagonists used?
Suppress chemotherapy and radiation-induced emetics and postoperative vomiting
What drugs are used for the prophylaxis and treatment of motion sickness?
Muscarinic acetylcholine receptor antagonists
Histamine H1 receptor antagonists
What are the side effects of hyosine?
Blurred vision
Urinary retention
Dry mouth
Central sedation
If vomiting has been induced by irritants, what drugs can be used?
Histamine H1 receptor antagonists
When are dopamine receptor antagonists used?
Drug induced emesis
GI disorders
What is nabilone?
Cannaboid (CB1) receptor agonist
Give an example of NK1 receptor antagonist and when it is used?
Aprepitant
Acute phase of highly emetogenic chemotherapy
