Gastroenterology COPY Flashcards
What is dyspepsia?
Describes a range of upper gastrointestinal tract including epigastric pain/burning, nausea, heartburn and fullness
What is dysphagia?
Difficulty swallowing
Where are they vomiting centres located in the brain?
Medulla
Nausea and vomiting are most commonly associated with the GI system with concurrent abdominal pain.
But in the absence of abdominal pain, pathology of what other systems may cause nausea/vomiting?
Central nervous system (e.g. raised ICP)
Excess alcohol
Drugs (e.g. chemotherapy agents)
Metabolic disease (uraemia, diabetic ketoacidosis)
Persistent nausea/vomiting with no other symptoms may also be ________ in nature
Functional
Causes of dysphagia may be divided into what categories related to aetiology
Disorders of mouth and tongue
Oesophageal motility disorder
Extrinsic lesions (e.g. mediastinal glands or goitre)
Intrinsic lesions (strictures, foriegn body)
What is the definition of diarrhoea?
Increased amount of loose stool (stool weight >250g/day)
What is steatorrhoea?
Passage of pale, bulky and foul-smelling stools
What is the pathophysiology of steatorrhoea?
Fat malabsorption due to pancreatic/biliary pathology leads to increased fat in the stools.
Name a faecal marker of inflammation
Faecal calprotectin
Endoscopy is an essential investigation in the diagnosis of GI pathology. It can look at different parts of the GI tract. Name a few types of endoscopy
(6)
Oesophagogastroduodenoscopy (a.k.a. gastroscopy) Sigmoidoscopy (flexible or rigid) Colonoscopy ERCP Endoscopic ultrasound Capsule endoscopy
What is PET scanning used for in the investigation of GI pathology?
Staging of oesophageal, gastric and colorectal cancers
Outline the different types of contrast studies
Barium swallow - outline oesphagus
Barium meal - outline stomach and duodenum
Barium follow-through - outline small intestine
Outline the function of oesophageal physiology testing
Probes lowered into the oesophagus via the nose to measure:
- 24-hour monitoring of pH
- Volume reflux of gastric contents
What is oesophageal manometery?
Used for the investigation of oesophageal motility disorders
What is the most common type of non-infectious mouth ulcers?
Recurrent apthous ulcer
What are recurrent apthous ulcers?
Recurrent episodes of self-limiting, painful ulcers (rarely on the palate)
What treatment, if any, is indicated for recurrent apthous ulcers?
Topical corticosteroids for symptomatic relief
How does squamous cell carcinoma present in the oral cavity?
Painless ulcer, usually on the lateral borders of the tongue or floor of the mouth
If a patient presents with oral white patches in the mouth, what is the most impotant distinction to make in the history?
Are they transient or persistent
What is the most likley diagnosis with transient white oral patches?
Oral candida
What is the most likley diagnosis with persistent white oral patches?
Leucoplakia
What is leucoplakia?
Persisteny white patches in the oral cavity most storngly associated with smoking or alcohol consumption.
They are premalignant changes
What is glossitis?
Inflammation of the tongue.
Smooth, sore and red.
Most stongly assocaited with B12, folate or iron deficiency
What is the cause of a hairy black tongue?
Proliferation of chromogenic microorganisms causing stainig of elongated filiform papillae
Causes include heavy smoking
Gum bleeding is most commonly caused by what condition?
Gingivitis (inflammatory condition of the gums associated with denta plaque)
What is GORD?
Gastro-oesophageal reflux disorder
Reflux of gastric acid, pepsin, bile and duodenal back into the oesophagus
What is the pathophysiology of GORD?
GORD prevalence and severity is influenced by many factors.
Primarily due to overcoming the lower oesophageal sphincter
What physiological property of the lower oesophageal sphincter (LOS) prevents GORD in most people?
LOS remains clonsed until the swallowing reflex is triggered causing Transient Lower Oesophageal Sphincter Relaxations (TLOSRs) to allow transmission of foodstuffs/liquids.
What are the symptoms of GORD?
Dydpesia (heartburn)
Regurgitation
Odynophagia (painful swallowing)
Outline the investigations of GORD
Simple cases are diagnosed clinically
Any patient over the age of 55 with concurrent alarm symptoms (weight loss, dysphagia, haematemesis etc.) will undergo investigation e.g. OGD or pH monitoring
How is GORD treated?
First line - conservative measures (weight loss, avaoidance of triggers e.g. alcohol)
Second line - simple antacids/proton-pump inhibitors/H2-receptor antagonists
Third line - Surgery (Nissan Fundoplication)
Outline two complications of untreated GORD
Peptic stricture
Barrett’s Oesophagus - pre-malignant metaplasia
What is achalasia?
Condition of unknown aetiology characterised by oesophageal aperistalsis and impaired relaxation of the LOS
What are the clinical features of achalasia?
Long history of dysphagia of both liquids and solids with potential association with regurgitation
What investigations might you order in the suspected case of achalasia and why?
Chest X-ray - may see dialtion of oesphagus
Barium swallow - shows aperistalsis (bird beak sign)
CT scan - exlcude cancer
How is achalasia managed?
Medical - nitrates e.g. nefidipine (20mg sublingually)
Surgeical - Endoscopic balloon dilatation or surgical division of the LOS (Hellers cardiotomy)
What is a hiatus hernia?
When part of the stomach herniates through the oesophageal hiatus of the diaphragm
What are the two types of hiatus hernia?
Sliding (most common) - no serious complications
Para-oesophageal - serious risk of gastric volvulus and haemorrhage
What are the two most common types of oesophageal cancer?
Sqaumous cell and adenocarcinoma
Extremely rarely primary small cell
What is the precursor to adenocarcinoma of the oesophagus?
Barrett’s metaplsia
What are the typical clinical features of oesophagela malignancy?
Progressive dysphagia
Weight loss
Chest pain caused by food impaction/local infiltration
How is oesophageal malignancy investigated?
Diagnosis is by gastroscopy and biopsy
Initial staging is done by CT scan of chest and abdomen
Furhter assessment for metastesis is done by PET scna
How is oesophageal malignancy treated?
Surgical resection provides best chance of cure. Often combined with pre-operative chemotherapy with or without neo-aduvant radiotherapy
Palliation may be given in terminal cases including stenting to relieve symptoms of dysphagia
Gastric acid is secreted by what cell in the stomach?
Parietal cells
What hormone signals the release of gastric acid from parietal cells?
Histamine (also in turn under control from acetylcholine and gastrin)
What hormone is inhibitory to the secretion of histamine and gastrin?
Somatostatin
What is H. Pylori?
Gram-negative urease-producing spiral-shaped bacterium found mainly in the gastric antrum
What serious pathologies are at least in part attributed to H. Pylori infection?
Chronic gastritis, peptic ulcer disease, gastric cancer, gastric B cell lymphoma
How is H. Pylori infection diagnosed?
Non-invasive - serrology, breath test or stool antigen
Invasive - anteral biospy or rapid urease (CLO) test
How is H. Pylori infection managed?
Eradication is indicated in all symptomatic patients with PPI-based triple therapy e.g.
Omeprazole (20mg), metronidazole (400mg) and clarithromycin (500mg) all twice per day
What is a peptic ulcer?
An ulcer of the mucosa in or adjacent to an acid-bearing area. Most occur in the proximal stomach or the proximal duodenum
What are the clinical features of peptic ulcer disease?
Burning epigastric pain is typical
Nausea, heartburn and flatulence
What are the most common complications of peptic ulcer disease?
(3)
Perforation
Painless haemorrhage
Gastric outflow obstruction
How is peptic ulcer disease treated?
H.pylori is tested for (non-invasive method preferred) and eradicated if present
If not sufficient then PPI treatment is commenced
Unless there are complications, surgery is rarely needed
What is the most likely cause of a non-H. Pylori peptic ulcer?
NSAID or aspirin overuse
What type of ulcer is most likely to perforate?
Duodenal ulcers perforate more often than gastric ulcers
List the ALARM symptoms
Dysphagia Weight loss Vomiting GI bleeding (haematemesis or melaena) Epigastric mass
List some other causes of gastritis other than H. Pylori infection
Autoimmune gastritis
Viral gastritis
Duodeno-gastric reflux
What is autoimmune gastritis?
Immune-mediated destruction of gastric parietal cells leading to perniscious anaemia
What are the histological diffferences between acute and chronic gastritis?
Acute - neutrophil invasion
Chronic - mononuclear (mostly lymphocytes), macroghages and plasma cell infiltration
What anatomical region of the stomach do gastric tumours most commonly arise?
The antrum
What are the clinical features are common for gastric cancer?
Pain siminlar to peptic ulcer disease
Nausea, anorexia and weight loss are common in more advanced disease
What findings may be present on examination in a case of gastric cancer?
Palpable epigastric mass
Palpable Virchow’s node (left supraclavicular fossa)
Skin manifestations (dermatomyositis and acthanosis nigrans)
What common sites of metastasis occurin gastric cancer?
Peritoneum and liver
How is gastric cancer investigated?
Gastroscopy and biospy for diangosis
CT/PET scan for staging
How is gastric cancer treated?
Surgical resection with aduvant chemotherapy
Palliative chemotherapy may be offered with inoperable pathology
Whatis the most common histological type of gastric cancer?
Adenocarcinoma
What is haematemesis?
Vomiting blood
What is malaena?
The passage of black tarry stools indicative of altered blood from a bleed proximal to the jejenum
How does acute massive upper GI bleed present?
Fresh rectal bleeding and shock
How is acute upper GI haemorrrhage managed in the immediate setting?
Two large-bore (16 gauge) IV cannulas
Group, save and cross match at least 4L of blood
What evidence suggesting a large GI bleed may be found on examination?
Blood pressure <100mmHg systolic >100 bpm Cold extremities Slow capillary refill Haemoglobin <100g/L
How is a persons risk for a recurrent or life-threatening bleed?
Using the Rockall Score
What is a Mallory-Weiss tear?
Linear mucosal tear at the oesophagogastric junction
How are bleeding oesophageal varices treated?
Banding or glue sclerotherapy
What are the most common causes of massive lower GI bleeding?
DIverticular disease or ischaemic colitis
List some common causes of colonic GI bleeding
Haemorrhoids
Anal fissure
Neoplasms
Diverticular disease
List some common causes of small intestine GI bleeding
Neoplasms
Ulcerative disease: Crohn’s disease, NSAIDs