Gastroenterology: Upper GI Flashcards
What 4 conditions present with a progressive dysphagia?
Oesophageal cancer (adenocarcinoma and SCC)
Achlasia
Pharyngeal pouch
Bulbar palsy
What is the main risk factor present in adenocarcinoma but not SCC
GORD/Barrett’s
What is the significance of a left supraclavicular node with regards to GI conditions
Virchow’s node: Suggests an intra-abdominal malignancy
How does adeno and Squamous carcinoma differ in their location in oesophageal cancer?
Adeno: Lower 1/3
Squamous: Upper 2/3
What is the first line investigation for suspected oesophageal malignancy?
1st line: Upper endoscopy
What is the treatment for oesophageal cancer?
Resection + adjuvant chemo if operable
Palliative chemoradiotherapy if not
What are the 2 conditions that present with non-progressive dysphagia
Benign stricture
Benign oesophageal spasm
How does a benign stricture present differently to oesophageal carcinoma?
Non-progressive
Longer standing GORD symptoms
No systemic symptoms
How does achalasia differ from oesophageal cancer given the fact they all have progressive dysphagia?
Achalasia can present with regurgitation of food rather than vomiting
How is achalasia treated?
Endoscopic balloon dilatation/Heller’s cardiotomy
How can the dysphagia in benign oesophageal spasm be distinguished from malignancy?
Tends to be episodic and non-progressive
Solids and liquids (motor issue instead of mechanical)
What investigation can confirm benign oesophageal spasm?
Contrast swallow/manometry will reveal abnormal contractions
How can a pharyngeal pouch be distinguished from other casues of dysphagia?
Regurgitation of food
Aspiration
Neck swelling that gurgles on palpation
How do you treat a pharyngeal pouch?
Surgical resection
What are the ALARMS symptoms in dyspepsia?
Anaemia
Loss of weight
Anorexia
Recent history of progressive symptoms
Masses
Swallowing difficulties
(or Vomiting, Bleeding/Anaemia, Anorexia/loss of weight, Dysphagia)
What are the indications for UGI endoscopy in dyspepsia?
All with dysphagia
All with suspected malignancy
>55 years with ALARMS symptoms
What is the treatment pathway for a patient with GORD?
1 month trial high dose PPI
If response: commence low dose longer term
No response + Endoscopy +ve: double dose 1 month
No response + ES -ve: Trial H2RA or prokinetic
What is the management of suspected peptic ulcer disease?
UGI endoscopy if dysphagia/>55 with ALARM symptoms
Lifestyle changes with OTC antacids for 1 month
Test for H.Pylori
+ve test: Commence PPI + Amoxicillin + metronidazole/clarithromycin
-ve test or eradicated: PPIs/H2RA for 1 month
If no improvement: low dose PPI 1 month and consider endoscopy
If oesophageal endoscopy finds goblet cells and brush border in the columnar epithelium, what does this indicate?
Barrett’s Oesophagus
How is barrett’s oesophagus managed?
Metaplastic: Surveillance every 3-5 years
Dysplastic: Resect/ablate
How can you determine if a peptic ulcer is gastric or duodenal?
Duodenal: RELIEVED on eating
Gastric: WORSENED on eating
Which two groups of people is gastric cancer more common in?
Over 75s
Males
What are the features of gastric cancer?
Epigastric pain, vague
Weight loss and anorexia
Dysphagia
Nodes: Left supraclavicular (Virchow’s) and periumbilical (Sister Mary Joseph)
What are the risk factors for developing gastric cancer?
think SHADO
Smoking
H. Pylori
Atrophic gastritis
Diet high in salt and nitrates (smoked food)
O blood group
What 2 investigations confirm a diagnosis of gastric cancer?
Endoscopy with biopsy: signet ring cells (more rings = worse prognosis)
CT for staging
How is gastric cancer managed?
Surgical resection or gastrectomy
Chemotherapy
What are the 5 physical complications of a gastrectomy?
Abdominal fullness: Improves with time, consume small regular meals
Afferent loop syndrome: bilious vomiting after a meal, should improve with time
Diarrhoea: Give codeine phosphate
Gastric tumour: reduces acid production
Increased amylase: urgent surgery if abdo pain also present
What are the 5 metabolic complications from a gastrectomy?
Dumping syndrome: Fainting and sweating from highly osmolar foods being dumped in the jejunum, causing hypovolaemia. Late dumping due to hypoglycaemia 1-3 hours after a meal
- Eat less, consume guar gum + pectin
Weight loss: Often due to poor calorie intake
Bacterial overgrowth +/- malabsorption
Anaemia
Osteomalacia
What are the 3 typical features of an upper GI bleed?
Vomiting fresh/’coffee ground’ blood
Melaena
Abdominal tenderness
Outline the management of an upper GI bleed
Resuscitate via ABCDE
If variceal: Terlipressin + Prophylactic IV broad spec antibiotics
Endoscopy to investigate and treat
- Immediate if severe bleed
- Otherwise within 24 hours
Give PPIs post-endoscopy if needed
How can you tell the difference between oesophageal varices and Mallory weiss tear?
Malaena: More common in OVs
Prior vomiting: More common in MW tears
What 3 historical features are typical in an oesophageal varices patient?
Previous ulcers
Liver cirrhosis
Heavy alcohol use
What artery may be at risk of rupture in a duodenal ulcer
Gastroduodenal artery
A patient presents with haematemesis. They appear to have pigmented lesions on the face, lips, palms and soles. they mention a history of consitpation due to ‘blocked bowels’. What diagnosis do you have to bear in mind?
Peutz-Jegher’s syndrome
AD mutation of LKB1/STK1
Bleeding prone polyps in GI tract
Pigmented lesions on face, palms and soles
Conservative management
What AV malformation causes UGI bleeding without prior symptoms?
Dieulafoy lesion
