Gastro: Oesophageal + stomach Flashcards
Common in north Aficans , hx of atropy
Endoscopic Biopsy:
> 15 eosinophils per high power microscopy field.
-reduced vasculature, -thick mucosa,
- mucosal furrows,
-strictures &laryngeal oedema
Eosinophilic oesophagitis
rx Eosinophilic oesophagitis
RX:
Diet - ppi
If diet fails Topical steroids e.g. fluticasone and budesonide
Oesophageal dilatation
Complications: strictures, Mallory Weiss tears
Barium swallow: shows irreg filling defect
Endoscopy: white patches
With a hx of immunosuppression
Oesophageal candidiasis
oesophageal manometry (most important diagnostic test)=
excessive LOS tone which doesn’t relax on swallowing
Barium swallow
expanded oesophagus, fluid level
‘bird’s beak’ appearance
chest x-ray
wide mediastinum
fluid level
Achalasia
Rx Achalasia
1st line
High risk
recurrent
Rx: 1st ln- pneumatic (balloon) dilation
Recurrent = Heller myotomy
High risk injection of botulinum toxin
What causes
Sx: are dysphagia, regurgitation, aspiration & chronic cough. Halitosis
Might have midline lump in the neck that gurgles on palpation
Pharyngeal pouch
Zenker’s diverticulum
IX & RX for
Pharyngeal pouch
Zenker’s diverticulum
Barrett’s oesophagus
Risk factor & define
Risk factors: GORD, male, smoking, Central obesity NOT alcohol
metaplasia of the lower oesophageal mucosa, with the usual squamous epithelium being replaced by columnar epithelium.
Rx Barrett’s oesophagus
What is the largest complication
Rx: ALL high-dose PPI
Pt w/ metaplasia (but not dysplasia) endoscopy every 3-5 years
Pt w/ dysplasia = 1st ln : radiofrequency ablation:
endoscopic mucosal resection
Increased risk oesophageal adenocarcinoma (50-100%)
Indications for upper GI endoscopy:
age > 55 years
symptoms > 4 weeks or persistent symptoms despite treatment
dysphagia
relapsing symptoms
weight loss
Most common type of Oesophageal cancer in the world, in the UK
Adenocarcinoma most common found in UK gastroesophageal junction
-Squamous cell tumours most common in the world found in the upper 2/3 of the oesophagus.the world is square
Dysphasia for solids then liquids indicates
Oesophageal cancer
IX& Rx Oesophageal cancer
-Upper GI endoscopy with biopsy
-Endoscopic ultrasound is the preferred method for locoregional staging
CT scanning of the chest, abdomen and pelvis is used for initial staging
Rx surgical resection; complication anastomotic leak
What cause (DIE)
* Dysphagia (2dary to oesophageal webs)
* Iron-deficiency anaemia/Glossitis
* Esophageal webs
Plummer-Vinson syndrome
Plummer-Vinson syndrome
Increases risk to
RX
Squamous cell carcinoma
RX iron & dilatation of webs
What is caused by severe vomiting & is
Common in alcoholics
Mallory-Weiss syndrome
What causes the Mackler triad
1. Severe /repeated vomiting,
2. sudden onset CP
- Subcutaneous emphysema
Boerhaave syndrome
Acute treatment of variceal haemorrhage (4)
- correct clotting: FFP, vitamin K
2.Terlipressin -benefit in initial haemostasis and prevents rebleeding
- prophylactic IV antibiotics :Quinolones - reduce mortality in patients with liver cirrhosis
- endoscopic variceal band ligation is superior to endoscopic sclerotherapy.
* Sengstaken-Blakemore tube if uncontrolled haemorrhage
* Transjugular Intrahepatic Portosystemic Shunt (TIPSS) if above measures fail- connects the hepatic vein to the portal vein
o exacerbation of hepatic encephalopathy
Prophylaxis of variceal haemorrhage
- propranolol: reduced rebleeding and mortality compared to placebo
- endoscopic variceal band ligation (EVL) is superior to endoscopic sclerotherapy. It should be performed at two-weekly intervals until all varices have been eradicated. PPI is given to prevent EVL-induced ulceration..’
2 causes of gastritis
-
Autoimmune Gastritis - Type 4 hypersensitivity
Type A (Fundus to Body) -
H-Pylori -MOST Common Helicobacter pylori is a Gram-negative bacteria; secretes urease = alkalinization
Type B (Antrum to Body)
What is impaired Autoimmune Gastritis
Decrease in intrinsic factor B1
Decrease Fe2+ absorption
Risks associated with H-Pylori
MALT
Neuroendocrine tumours
duodenal ulcers
Dx Autoimmune Gastritis
biopsy
antibodies to IF & parietal cells
test for eradication of H-pylori
Urea breath test
should not be performed within 4 wks of rx w/ an antibacterial or within 2 weeks PPI
tests for H-pylori
Urea breath test- sensitivity 95-98%, specificity 97-98%; not before 2wks after PPI use or 4 abx
Rapid urease test (e.g. CLO test)- sensitivity 90-95%, specificity 95-98%
Stool antigen test- sensitivity 90%, specificity 95%
Rx h pylori
- 7 days: PPI + amoxicillin + (clarithromycin OR metronidazole)
- if penicillin allergic: a PPi + metronidazole + clarithromycin
Duodenal Ulcer relationship to h. Pylori
How is pain relieved
- More common
90% due to H-Pylori - pain when hungry, relieved by eating
What worsens Gastric ulcer pain
70% due to H-Pylori
-worsened by eating
H- pylori makes acid more basic and induces inflammation
-NSAIDS- Stop production of prostaglandins (normally promote H+ production and mucus secretion)= decreased mucosal protection
Acid difference in Gastric and duodenal ca
duodenal = increase H more acidic
Gastric = more basic
Where do gastric ulcers tend to bleed from
left gastric artery on the the lesser curvature
gastric ulcers what are they a risk factor for
MALT
gastric adenocarcinoma
Where do duodenal ulcers tend to bleed from
gastroduodenal artery
posterior wall of the duodenum
What is the most common type of gastric ca and where is it most likely to form ?
Gastric Adenocarcinoma
lesser curvature of the antrum
Common sign of adenocarcinoma
Sign of gastric adenocarcinoma and mer
Pathology of Acute Pancreatitis
Autodigestion of the pancreas= Inflammation & Haemorrhaging
Pathology of chronic Pancreatitis
Chronic Pancreatitis
Most common type of pancreatic insufficiency lack digestive enzymes = malabsorption, steatorrhea, DM, Vit deficiency E, A, D
Common caused of acute Pancreatitis
Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia, Hypertriglyceridemia, ERCP and Drugs.
Inflammation causes enzymes released Proteases, lipase and amylase
Causes of Chronic Pancreatitis
Sx of chronic pancreatitis
Signs of acute pancreatitis
