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HUMAN HEALTH AND DISEASE > Gastroenterology I: Dysphagia, Oesophagus & Peptic Ulceration > Flashcards

Gastroenterology I: Dysphagia, Oesophagus & Peptic Ulceration Flashcards

1
Q

What are some symptoms of gastrointestinal diseases?

A

Abdominal pain
Dysphagia
Heartburn
Dyspepsia
Flatulence
Vomiting
Constipation
Diarrhoea
Steatorrhoea

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2
Q

What is dysphagia?

A

Difficulty swallowing

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3
Q

What is heartburn?

A

Retrosternal burning discomfort which spreads up towards the throat & is a common symptom of acid reflux

Pain can sometimes be difficult to differentiate from IHD but a careful history will differentiate between the two

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4
Q

What is dyspepsia?

A

It describes a range of symptoms referable to the upper GI tract (e.g. nausea, heartburn, acidity, pain, distension) but patients are more likely to use the term ‘indigestion’ for these symptoms.

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5
Q

What is flatulence?

A

Flatulence describes excessive wind, presenting as belching, abdominal distention & passage of flatus per rectum.

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6
Q

What is vomiting?

A

Vomiting occurs as a result of stimulation of the vomiting centres in the lateral reticular formation of the medulla.

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7
Q

What might vomiting specifically result from?

A

Stimulation of the chemoreceptor trigger zones in the floor of the fourth ventricle or from vagal afferents from the gut

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8
Q

What is diarrhoea?

A

Passage of increased amounts of loose stool (stool weight> 250g/24hr)

This must be differentiated from the frequent passage of small amounts of stool (which patients often refer to as diarrhoea), which is often seen in functional bowel disorders.

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9
Q

What is constipation?

A

Infrequent passage of stool (<twice weekly) or difficult passage of hard stools.

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10
Q

What is steatorrhoea?

A

Passage of pale bulky stools that contain fat (>18mmol/24hr) & indicates fat malabsorptions a result of small bowel, pancreatic or biliary disease

The stools often float because of increased air content & are difficult to flush away.

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11
Q

What does the upper digestive tract look like?

A

muska flashcards

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12
Q

Where does the oesophagus pass through?

A

Through the chest via the mediastinum & lies posterior to the trachea.

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13
Q

What is the oesophagus?

A

Musculotendinous tube connecting the pharynx to the stomach.

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14
Q

What are some symptoms of oesophageal problems and what are the important diseases to consider?

A

Dysphagia, pain, cough or vomiting

Important diseases to consider:
Pharyngeal pouch

Achalasia - muscles of the lower part of the oesophagus fail to relax.

Oesophageal spasm - painful contractions

Oesophageal web - Thin membranes that grow across the inside of the upper part of the oesophagus

Peptic ulcer disease/reflux

Carcinoma

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15
Q

How many overlapping constrictor muscles does the pharynx have and what are they called?

A

3 overlapping constrictor muscles :

superior, middle, inferior

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16
Q

What is a potential weakness in the structure of the pharynx?

A

Killian’s dehiscence- the meeting point of 2 parts of inferior constrictor:

thyropharyngeus & cricopharyngeus

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17
Q

What is Zenker’s diverticulum?

A

Out pouching of the posterior hypopharynx that causes regurgitation of undigested food several hours after eating.

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18
Q

How might a posterior mucosal herniation take place?

A

During swallowing, the thyropharyngeus is propulsive & the cricopharyngeus is sphincteric.

If the cricopharyngeus fails to relax at the right time, a posterior mucosal herniation may take place via Killian’s dehiscence.

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19
Q

Describe the histology of the oesophagus.

A

It has an outer longitudinal muscle coat & an inner circular muscle coat

Upper 1/3 of oesophagus = striated muscle

Lower 1/3 of oesophagus = non-striated muscle

So the middle 1/3 is mixed

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20
Q

Where does the motor & sensory nerve innervation come from for the oesophagus?

A

It’s derived from the vagus (X) nerve forming something called the oesophageal plexus.

(plexus of nerves within the muscle wall of the oesophagus, controlling its function & regulating its activity, & also coordinating peristalsis).

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21
Q

Where does the nerve plexus lie in the oesophagus?

A

Between outer longitudinal & inner circular muscle planes & also submucosally.

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22
Q

What is the mucosal lining of the oesophagus?

A

Stratified squamous non-keratinising epithelium but the lower part can be lined by ectopic gastric (columnar) mucosal.

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23
Q

Describe how swallowing happens.

A
  1. Initial phase of swallowing = voluntary
  2. Triggers peristaltic wave = pushes food bolus to the stomach.
  3. Wave progresses by reflex activity at 2-4 seconds.
  4. Stretching get causes depolarisation and action potential
  5. This propagates and creates waves of muscle relaxation and contraction = peristalsis
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24
Q

What is the cardiac sphincter at the gastro-oesophageal junction?

A

It’s not a clearly defined anatomical structure (can’t see it in endoscopy) so it’s described as physiological but it prevents reflux of gastric contents into oesophagus.

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25
Q

Does the oesophagus have a temperature sense?

A

Yes, it’s perceived as a dull pain

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26
Q

Is pain from the oesophagus well localised?

A

No, it’s poorly localised & may also be confused with pain from other mediastinal structures e.g. the heart

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27
Q

What is a pharyngeal pouch?

A

A herniation of mucosa through a weakness in the pharyngeal constrictor muscles

The pouch hangs down due to gravity

28
Q

What are some causes of dysphagia?

A
  • A sensation of difficulty in swallowing

look on slide

29
Q

What is haemoptysis?

A

Coughing up blood

30
Q

What is haematemesis?

A

Vomiting blood

31
Q

What will the patient complain about if they have a pharyngeal pouch?

A

Dysphagia combined with swelling developing in the lower neck, usually left side

32
Q

What are some potential complications of a pharyngeal pouch?

A

Undigested food may be regurgitated into the mouth hours after eating

Overflow into lungs may cause respiratory symptoms

33
Q

What is the most common cause of oesophagitis?

A

GORD - short for gastro-oesophageal reflux disease.

34
Q

What is candida oesophagitis?

A

Candida infection in oesophagus

35
Q

What is achalasia (of the cardia)?

A

This refers to a condition where there has been a loss of ganglia from the intramural plexus, and therefore a failure of relaxation of the gastro-oesophageal sphincter.

This then leads to functional obstruction to oesophageal emptying with dysphagia for solids & liquids.

Failure of peristalsis leads to progressive dilatation of the oesophagus and retained oesophageal contents may be regurgitated, causing respiratory problems

36
Q

What is a corkscrew oesophagus?

A

A classic manifestation of an oesophageal spasm

The pain can resemble reflux & heartburn and it should be managed with muscle relaxants

It is diagnosed by radiological appearance

37
Q

What are some potential causes of oesophageal spasm?

A

-Atypical achalasia
-Gastro-oesophageal reflux
-Motor disorders
-Symptomatic peristalsis
-Obstruction at the cardia
-Neuromuscular disorders

38
Q

What is an oesophageal spasm?

A

A descriptive term for spasm due to variety of causes leading to attacks of dysphagia & pain.

39
Q

What is an oesophageal web?

A

It’s classically seen in middle-aged women and consists of:

-glossitis
-iron deficiency anaemia
-dysphagia
-koilonychia - spoon nails

Although rare, it is important as it is premaligna

40
Q

What are possible treatments for achalasia?

A

Drugs e.g:

nifedipine (Ca channel blocker) to relax the sphincter

Balloon dilatation

Cardiomyotomy

41
Q

How do you treat an oesophageal web?

A

Dilatation of structure and correction of iron deficiency

42
Q

What happens to the oesophagus in an oesophageal web?

A

The mucosa becomes atrophic

Fibrous structure forms at the upper end of the oesophagus

The structure is described as forming a ‘web’ on barium swallow.

43
Q

What is a post cricoid web?

A

An oesophageal web typically reflecting iron deficiency anaemia and this is considered a pre-malignant risk lesion.

44
Q

Where is the regurgitation limit?

A

The first part of the duodenum (so bile can be vomited here) and this defines the limits of haemoptysis.

45
Q

What is peptic ulcer disease?

A

Failure of the upper cardiac sphincter leads to acid refluxing into the oesophagus which may cause pain.

Ulceration & spasm and peptic ulcers can develop which can affect the oesophagus, stomach or duodenum.

A peptic ulcer happens because of mucosal inflammation due to acid & pepsin destruction of mucosal lining.

46
Q

What is removal of the mucus protection coat driven by?

A

Aspirin & NSAIDs- block cyclooxygenase & prostaglandin production

Steroids (similar)

Smoking

Helicobacter pylori infection- colonises mucus

Dental relevance : avoid NSAIDs and Steroids

47
Q

What does peptic mean?

A

Acidic aetiology - ulcers can affect the oesophagus, stomach or duodenum.

48
Q

What are the two types of ulcers?

A

Acute and Chronic ulcers:

Acute Ulcer: Smaller and penetrates the muscularis mucosae

Chronic Ulcer: Larger and penetrates the submucosa

49
Q

What is the incidence of peptic ulcer disease

A

10% (any age)

More predominant in males than females

50
Q

What are the signs, symptoms, & sites of upper GI bleeding?

A

pain
vomiting
haematemesis = increased bleeding
ulcer with scarring

51
Q

What are the possible outcomes when GI bleeding happens?

A

Healing (which can lead to scarring)

OR

bleeding site can progress & it can spread through the gut wall which could lead to perforations, possibly peritonitis ( inflammation of the peritoneum )

Left untreated, it can quickly spread and be life-threatening

52
Q

What is the prognosis nowadays for conditions such as peritonitis, and what kinds of investigations & treatments would you do

A

good prognosis

investigation:
-endoscopy
-barium meal

treatment:
-antacids
-h-2 blockers (ranitidine) or prion pump inhibitors (omeprazole)
- treat h.pylori with antibiotics

surgery

53
Q

What is gastritis?

A

Inflammation of the stomach

54
Q

What are the consequences of gastritis?

A

Chronic inflammation/irritation has risks (e.g. ulceration, bleeding, etc.)

Inflammation reduces function- reduced parietal cell

function induces:

Reduced acid production (achlorhydria);reduced potential ferric to ferrous conversion of iron (only ferrous Fe can be absorbed effectively so there’s risk of iron deficiency)

Reduced intrinsic factor production- can’t bind Vitamin B12 therefore can’t reabsorb the complexed B12 in the terminal ileum (consequences of this are macrocytic anaemia so look for oral manifestations of it)

55
Q

What is Barrett’s oesophagus?

A

A condition where longstanding reflux acid from the stomach has caused a change from squamous epithelium of the oesophagus to columnar metaplasia from the chronic irritation from reflux.

56
Q

Describe the incidence, promoting factors, & macro/microscopic signs of carcinoma of the oesophagus.

A

Incidence : 3% cancer deaths in UK

Age: uncommon for people below 50 years old

Affects more males

High incidence in china due to fungal contamination of food

Alcohol, smoking, peptic disease, food toxins, Ach Achalasia of cardia, pharyngeal pouch, Fe deficiency etc can promote carcinoma of the oesophagus.

57
Q

what are the signs of carcinoma of the oesophagus

A

signs:
-dysphagia

microscopic: squamous cell carcinoma

58
Q

what are the effects of local spread?

A
59
Q

how does it spread?

A
60
Q

How might a carcinoma in the lower 1/3 of the oesophagus differ from the rest?

A

It may be an adenocarcinoma, derived from the ectopic gastric mucosa.

61
Q

What is the prognosis for oesophageal carcinoma?

A

These conditions tend to present extremely late so the 5 yr survival post diagnosis is only 3-6% & 75% are dead within a year.

62
Q

How is carcinoma of the oesophagus diagnosed?

A

-Barium swallow/CT/MRI/PET
-Endoscopy & biopsy
-CT scan to stage & plan treatment

63
Q

What is pyloric stenosis?

A

Narrowing and obstruction of the pyloric sphincter so the passage between the stomach & duodenum becomes narrower

This can cause vomiting leading to dehydration

64
Q

What GI condition can paediatric patients suffer from that results in them projectile vomiting?

A

Pyloric stenosis

Vomiting without nausea = projectile vomiting

65
Q

What is Ramstedt’s myotomy?

A

The surgery used in treatment of infantile pyloric stenosis.

HUMAN HEALTH AND DISEASE (58 decks)

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