Dyspepsia Flashcards
lining of oesophagus
stratified squamous
upper 1/3 oesophagus layers=
outer longitudinal layer and inner circular layer muscle layers
lower 2/3 oesophagus layers =
both smooth muscle
activity of lower oesophageal sphincter
high resting tone assisted by the diaphragm
benign oesophageal sphincter=
narrowing of the oesophagus
what is the most common cause of benign oesophageal sphincters
gastroesophageal reflux disease
other causes of benign oesophageal sphincters
oesophagitis
GORD
achalasia
hiatus hernia
symptoms of benign oesophageal sphincter
dysphagia food regurgitation dyspepsia heartburn frequent burping
treatment for benign oesophageal stricture=
treat the underlying cause
symptoms of pharyngeal pouch
cough
regurgitation
halitosis (bad breath)
dysphagia
pharyngeal pouch also called
zenker’s diverticulum
where is a pharyngeal pouch
immediately above the upper stricture
in a pharyngeal pouch where does the wall herniate through
the point of least resistance= killian’s triangle
is a pharyngeal pouch a real diverticulum
no its a pseudodiverticulum not all layers of the wall herniate
investigations for pharyngeal pouch (2)
barium swallow
contrast CT
achalasia=
lower oesophageal motility disorder -hypertensive non-relaxed oesophageal sphincter
symptoms of achalasia (4)
- dysphagia
- regurgitation
- unintentional weight loss
- coughing when lying down
1st line treatment of achalasia
endoscopic balloon dilation
alternative treatment of achalasia (4)
- cardiomyotomy
- verapamil / nitrates
- botulinum toxin injection
- gastrostomy
what causes GORD
failure of the lower oesophageal sphincter
what angle in the oesophagus becomes larger in GORD
angle of his
risk factors for GORD (4)
obesity
pregnancy
smoking
hiatus hernia
complications of GORD (4)
oesophagitis
oesophageal strictures
barretts oesophagus
symptoms of GORD (4)
heartburn
acid regurgitation
indigestion
dysphagia
first method treatment of GORD
8 weeks PPI trial
what happens if no GORD symptom improvement after PPI
OGD
investigations for GORD (5)
- OGD
- ambulatory pH monitoring
- oesophageal manometry
- barium swallow
- capsule endoscopy
treatment lifestyles changes in GORD
-weight loss
-head-of-bed elevation
-avoidance of late-night eating
avoiding specific foods
what is functional dyspepsia
gut hypersensitivity and motility disturbances
other word for functional dyspepsia
non-ulcer dyspepsia
what is normally the cause of functional dyspepsia
H.pylori iinfection causing non-erosive reflux disease
clinical presentation of functional dyspepsia
bloating
abdominal pain
nausea and vomiting
heartburn and indigestion
treatment of functional dyspepsia
dietary modifications
PPIs
H2 antagonist
investigations for peptic ulcer
H.pylori breath test
OGD
FBC
stool haem test
active bleeding ulcer management
- resuscitation
- endoscopy dual therapy
- mechanical clips/ cauterization
- PPIs
red flag symptoms with upper abdo pain
- haematemesis
- unintentional weight loss
- nausea and vomiting
- dysphagia
- > 55 years
- family history
cholelithiasis=
gallstones
what can gallstones be made from (3)
cholesterol
bilirubin
mixed substances from bile
presentation of cholelithiasis (5)
- colicky pain in RUQ
- N&V
- indigestion
- bloating
- heartburn
when do symptoms and complications occur in cholelithiasis
when stones tranverse and obstructs cystic duct
what can chronic obstruction of the biliary duct result in
cholecystitis
what can happen if a calculi becomes blocked at the ampulla of vater
acute biliary pancreatitis
investigations of cholelithiasis (4)
FBC
LFTs
Serum lipase/ amylase
abdominal ultrasound
what is cholecystitis
acute inflammation of the gallbladder walls
acalculous cholecystitis =
inflammation of the gallbladder without evidence of gallstones
symptoms of cholecystitis
RUQ abdo pain
positive murphy sign
palpable abdominal mass
choledocholithiasis=
gallstones in bile ducts
what can gallstones in bile ducts cause (3)
- biliary colic /obstruction
- acute pancreatitis
- acute cholangitis
cholangitis=
bile duct infection and inflammation
which causes jaundice ascending cholangitis or acute cholecystitis
ascending cholangitis
ascending cholangitis =
obstruction of common bile duct causing bacterial infection
as the obstruction & infection in ascending cholangitis advances what happens in the bile duct
pressure increases forcing extravasation of bacteria into blood stream
symptoms of ascending cholangitis
fever leukocytosis obstructive jaundice RUQ colicky pain pruitus
primary sclerosing chongitis-= (PSC)
skin lesions of inflammation along the biliary tree
where is inflammation most common in PSC
larger bile ducts higher up
what does the inflammation in PSC cause
progressive fibrosis forming strictures
what can PSC lead to in the liver
cirrhosis
consequence of PSC in biliary tree
bile duct stones
risk factors for PSC
male gender
IBD
symptoms of PSC (7)
abdominal pain pruitus jaundice fatigue fever weight loss steatorrhea
primary biliary cholangitis =(PBC)
interlobular duct damage by autoimmune granulomatous formation
consequence of PBC
cholestasis
fibrosis
cirrhosis
portal hypertension
cholestasis=
stoppage of bile flow
symptoms of primary biliary cholangitis (6)
pruitus fatigue dry eyes dry mouth hepatomegaly syncope
risk of PBC
female
other autoimmune disease
I GET SMASHED acute pancreatitis
idiopathic gallstones ethanol Trauma Scorpion/ spider Malignancy/mumps Autoimmune Steroids Hyperlipidaemia/ hypercalcaemia/ hyperparathyroidism/ hypothermia ERCP Drugs
main cause of acute pancreatitis
excessive alcohol abuse
what is the pancreas is alcohol a direct toxic insult to
acinar cells
symptoms of acute pancreatitis (5)
- N&V
- anorexia
- epigastric abdominal pain
- tachycardia
- grey-turners sign
what is grey-turners sign
bilateral flank blue discolouration
treatment for acute pancreatitis (6)
resuscitation opioid pain relief nil by mouth initially insulin ondansetron ERCP
chronic pancreatitis caused by
continual insults on the acinar cells
what can cause chronic pancreatitis (7)
alcohol biliary tract disease hypercalcaemia hyperlipidaemia haemochromatosis cystic fibrosis idiopathic
symptoms of chronic pancreatitis (5)
- epigastric pain radiates to back
- steatorrhea
- obstructive jaundice
- weight loss
- N&V
symptoms of gastric carcinoma (7)
dyspepsia weight loss anorexia N&V dysphagia epigastric mass/pain virchows node
risk factors for gastric cancer (5)
H.pylori pernicious anaemia male 50-70 family history
investigations for gastric cancer
OGD + biopsies
endoscopic ultrasound
CT/MRI
