Esophagus and Stomach - Peptic ulcer, Gastritis, Hiatus hernia, Pernicious anemia, GERD, Cancer, Achalasia. Pharyngeal pouch Flashcards
Peptic ulcer disease (uncomplicated)
-pathophysiology
-risk factors and causes
-presentation
-management
-complications
Imbalance between protective mucus and blood flow and damaging factors (HPylori, acid) => open sores in stomach lining
HPylori
NSAIDs, SSRIs, CS, bisphosphonates
Zollinger-Ellison syndrome
Smoking, drinking, stress may make symptoms worse
Epigastric pain, nausea
Duodenal - pain when hungry, relieved by eating
Gastric - worse when eating
HPylori test - urea breath//stool antigen
UGI endoscopy, biopsy
Stop any causative meds
HPylori negative - PPI
HPylori positive -PPI + amox+clari/metro
-if penicillin allergic => clarithromycin + metronidazole for 2wks
-if symptom free, no test of cure needed
Perforation => peritonitis
Peptic ulcer bleed
Gastritis
-pathophysiology
-risk factors and causes
-investigations
-management
Inflammation of stomach lining
Risk factors and causes v similar to peptic ulcers
-HPylori
-NSAIDs
-smoking, alcohol
-AI atrophic gastritis
Epigastric pain - associated with irregular meals
N+V
Indigestion
HPylori test - urea breath/urease test/stool antigen
UGI endoscopy, biopsy
Stop any causative meds
HPylori negative - PPI
HPylori positive -PPI + amox+clarithromycin/metronidazole
-if penicillin allergic => clarithromycin + metronidazole for 2wks
Pernicious anemia
-pathophysiology
-risk factors
-presentation
-investigations
-management
AI to intrinsic factor, parietal cells => block B12 production and binding to IF
-reduced absorption in terminal ileum => megaloblastic anemia, neuropathy
Middle age female
AI - thyroid disease, T1DM, Addisons, RA
Anemia
-tired, SOB, pale
-glossitis
Neuro
-peripheral symmetrical neuropathy (numb legs more than arms)
-subacute combined degeneration of SC (dorsal + corticospinal) - weakness, ataxia, parasthesia
FBC - macrocytic anemia
Low B12
AB - AntiIF
IM B12
-if no neuro features - 3per week for 2wks, 3 monthly injections afterwards
-more frequent doses for neuro features
Hiatus hernia
-types
-risk factors
-presentation
-investigation
-management
Sliding - GEJ moves above diaphragm
Rolling - GEJ below diaphragm but stomach herniates up
Obesity
High intraabdo pressure (ascities, multiparity)
Heartburn
Dysphagia
Regurgitation
Chest pain
Endoscopy - often incidental finding
Weight loss
PPI
If symptomatic rolling => surgical (fundoplication)
GERD
-pathophysiology
-risk factors
-presentation
-investigations
-management
-complications
Reflux of acid and bile => esophagus
Increased intraabdominal pressure
-obesity, pregnancy, overeating esp fatty foods
Lower esophageal sphincter dysfunction
-smoking, alcohol, coffee, TCAs, anticholinergics, nitrates, CCB, hiatus hernia
NO ASSOCIATION WITH HPYLORI
Dyspepsia, chest pain
-worsened by straining
-relieved by antacids
Acid regurg
Painful swallow
Nocturnal asthma, night cough
Clinical diagnosis unless worried about cancer, bleeds
Lifestyle
-weight loss, smoking cessation, reduce alcohol
-avoid contributing meds
Meds - PPI 4wks
Surgery - fundoplication
Esophagitis, strictures - exposure to acid
Barrett’s => adenocarcinoma
Resp => cough, asthma exacerbation, bronchospasm
Esophageal and stomach cancer
-2wk referral criteria
Stomach only
2wk suspected cancer
-upper abdo mass consistent with stomach cancer
Stomach and esophagus
2wk UGI endoscopy
-dysphagia OR
-55+, weight loss AND
-Upper abdo pain
-reflux
-dyspepsia
Esophageal cancer
-types and differences
-presentation
-investigations
-management
Adeno - lower 1/3d
-most common in developed world
-GERD, Barretts, smoking, obesity
Squamous - upper 2/3d
-most common in developing world
-smoking, alcohol, nitrosamines, achalasia
Dysphagia, painful swallow - solids => liquids
Hoarse voice
Regurg/vomit
Weight loss
UGI endoscopy - biopsy
PETCT - mets
Surgery - esopagectomy +- lymphadenectomy
-video-assisted/robot assisted thoracoscopic surgery
Chemo/RT - neo/adjuvant/palliative
Immuno
Palliative - stenting, laser ablation
Stomach cancer
-type and risk factors
-presentation
-investigations
-management
Adeno
MAIN RISK FACTOR - HPylori
-high salt, smoked/preserved foods
-low fruits, veg
-smoking, alcohol
-FHx, genetics
Dyspepsia, epigastric pain
Early satiety
GI bleeds, anemia
N+V
Weight loss
Palpable abdo mass
Virchow’s node
UGI endoscopy - biopsy (signet ring cells)
PETCT - mets
FBC - high platelets
Surgery - gastrectomy +- lymphadenectomy
-video-assisted/robot assisted thoracoscopic surgery
Chemo/RT - neo/adjuvant/palliative
Immuno - nivolumab
Palliative - stenting, laser ablation
Barretts esophagus
-pathophysiology
-risk factors
-presentation
-investigations
-management
Metaplasia of lower esophageal mucosa
-squamous => columnar
GERD
Male, smoker, obese
Found on endoscopy
High dose PPI
Endoscopic surveillance with biopsy
-dysplasia found => radiofrequency ablation/endoscopic mucosal resection
Achalasia
-what is it
-presentation
-investigations
-management
Failure of esophageal peristalsis and relaxation of LOS
-often in middle age
Dysphagia of LIQUIDS+ SOLIDS
Heartburn
Regurgitation of food => cough, aspiration pneumonia
Esophageal manometry - MOST IMPORTANT DIAGNOSTIC TEST
-excessive LOS tone which doesn’t relax on swallowing
Barium swallow - bird beak appearance
CXR - widened mediastinum + fluid level
1st line - pneumatic balloon dilation
2nd line - Heller cardiomyotomy if recurrent/persistent symptoms
Pharyngeal pouch
-what is it
-presentation
-investigations
-management
Pocket forms between lower part of pharynx and upper esophagus
-an area of natural weakness in the muscles of the lower pharynx
-presents in older adults
Dysphagia
Regurgitation
Aspiration
Neck swallowing, gurgles on palpation
Halitosis
Barium swallow with dynamic video fluoroscopy
Surgery
