Gastroenterology: Upper GIT diseases Flashcards
What is Dysphagia?
Difficulty in swallowing
Why does Dysphagia always need urgent investigation?
To rule out malignancy
If patient is finding swallowing painful, this can suggest? (4)
- Oesophageal cancer
- Ulcer
- Spasm
- Candidiasis
If patient finds it difficult to make a swallowing movement, this can suggest?
Suspect bulbar palsy
esp if swallowing causes coughing
If patient has always found it difficult to swallow solids and liquids, this can suggest? (2)
- Motility disorder
- Pharyngeal cause
Intermittent dysphagia can suggest?
Oesophageal spasm
Constant/worsening dysphagia can suggest?
Malignant structure
If patients neck bulges or gurgles upon swallowing this can suggest?
Pharyngeal pouch
What needs to be examined in a patient showing dysphagia? (5)
- Cachexia
- Anaemia
- Oral examination
- Virchow’s node
- Other signs of systemic disease
What are the 2 main causes of dysphagia?
- Mechanical block
- Motility disorders
Name 4 types of mechanical blocks that cause dysphagia
- Malignant structure
- Benign structure
- Extrinsic pressure
- Pharyngeal pouch
Name some motility disorders that cause dysphagia (5)
- Achalasia
- Diffuse oesophageal spasm
- Systemic sclerosis
- Myasthenia gravis
- Bulbar palsy
What is Myasthenia gravis?
Autoimmune condition involving antibodies to ACh receptors
What are some clinical features of someone with MG? (3)
- Ptosis (eye drooping)
- Myasthenic snarl on smiling
- Whilst counting to 50 voice deteriorates
What is bulbar palsy?
Presentation of diseases involving cranial nuclei of IX-XII
What structures in the head and neck does bulbar palsy affect?
LMN lesion of tongue and muscles of talking and swallowing
What are some of the causes of bulbar palsy? (3)
- Motor neurone disease
- MG
- Syringobulbia
What is Achalasia?
Lower oesophageal sphincter fails to relax
regurgitation
What is Gastro-oesophageal reflux (GORD)?
Reflux of stomach contents causing troublesome symptoms with at least two heartburn episodes each week
GORD is related to the dysfunction of what?
Lower oesophageal sphincter
Name some predisposing factors for GORD
- Smoking
- Alcohol
- Pregnancy
- Overeating
- Obesity
- Hiatus hernia
- Oesophageal problems
What are some Oesophageal GORD symptoms? (4)
- Heart burn
- Belching
- Acid brash/Water brash
- Odynophagia (painful swallowing)
What some Extra-Oesophageal GORD symptoms? (4)
- Nocturnal asthma
- Chronic cough
- Laryngitis
- Sinusitis
What are some complications of GORD?
- Oesophagitis
- Ulcers
- Benign stricture
- Barrett’s oesophagus
- Oesophageal adenocarcinoma
- Iron deficiency anaemia
What lifestyle advice would be given to someone with GORD? (5)
- Weight loss
- Smoking cessation
- Raise bedhead
- Small regular meals
- Avoid hot/spicy/caffeinated food before bed
What medication can be given to someone with GORD? (2)
- Antacids (gaviscon)
- Proton pump inhibitors (lansoprazole)
What is the dental relevance of GORD?
- Unpleasant taste
- Enamel erosion
- Worsened by NSAIDs
What are the two types of Hiatus hernia?
- Sliding (80%)
- Rolling
What is sliding hiatus hernia?
Gastro-oesophageal junction slides into chest
What is rolling hiatus hernia?
Bulge of stomach herniates into chest alongside oesophagus
In which type of hiatus hernia does an acid reflux occur?
Sliding
How is hiatus hernia treated?
- Lose weight
- Reflux symptoms treated
- Surgical repair if serious
What is Barret’s Oesophagus?
Chronic reflux oesophagitis
In terms of malignancy what type of lesion is Barret’s Oesophagus?
Premalignant lesion so need to be checked immediately
Oesophageal carcinoma;
UK death/year?
M:F?
- 6000 deaths/year
- 5:1
What are some risk factors of Oesophageal carcinoma?
- Smoking
- Alcohol abuse
- Achalasia
- Obesity
- Low vitamin A/C
- GORD
- Barret’s
Symptoms of Oesophageal carcinoma (5)
- Hoarse cough
- Dysphagia
- Weight loss
- Chest pain
- Lymphadenopathy
What are the percentages of Oesophageal carcinoma for each site and what type of carcinoma?
- Upper third?
- Middle third?
- Lower third?
- 20% squamous cell carcinoma
- 50% squamous cell carcinoma
- 30% adenocarcinoma
What is Dyspepsia?
Nonspecific group of symptoms related to upper GI tract
Synonym to indigestion
What does the ALARMS acronym to remember dyspepsia symptoms stand for?
- Anaemia
- Loss of weight
- Anorexia
- Recent onset with progressive symptoms
- Melaena or haematemesis
- Swallowing difficulty
What is melaena?
Producing sticky faeces which may contain blood
What is peptic ulcer disease (PUD)?
A break in the inner lining of the stomach
What are some risk factors for peptic ulcers?
- H. pylori
- Drugs (E.g NSAIDs)
- Smoking
- Stress (maybe)
What are the two types of ulceration?
- Gastric ulceration
- Duodenal ulceration
Gastric ulceration;
Vulnerable group?
Symptoms?
Pain?
Relief?
- Mainly elderly
- Asymptomatic (maybe weight loss)
- Epigastric pain
- Antacids
Duodenal ulceration;
Likelihood?
Symptoms?
Pain?
Relief?
- 4 times more common that gastric
- Maybe asymptomatic
- Epigastric
- Drinking milk
What are adenocarcinomas?
A malignant tumor formed from glandular structures in epithelial tissue.
What is the most common type of gastric cancer?
Gastric adenocarcinomas (more than 90%)
Gastric cancer;
- M:F
- Peak incidence age
- Vulnerable groups
- 2:1
- 60-84
- Eastern Asia/Europe and South America
What are some risk factors of Gastric cancer? (6)
- H. pylori infection
- Smoking
- Alcohol
- Not enough fruit/veg
- Excess salt diet
- Pernicious anaemia
Clinical representations of gastric cancer? (5)
- Nausea
- Melaena
- Anaemia
- Virchows node
- Sister Mary Josephs nodule
List some alarming features that suggest gastric cancer
- New onset dyspepsia in patients > 55 years
- FH upper GIT cancer
- Unintended weight loss
- Upper or lower GI bleeding
- Progressive dysphagia
- Odynophagia
- Unexplained iron deficiency anaemia
- Persistent vomiting
- Palpable mass or lymphadenopathy
- Jaundice
How would you investigate gastric cancer?
- Endoscopy
- Biopsy
What is a Biopsy?
An examination of tissue removed from a living body to discover the presence, cause, or extent of a disease.
What is Haematemesis?
Vomiting of blood
What are some common causes of Haematemesis?
- Gastric erosion
- Duodenitis
- Oesophagitis
- Peptic ulcers
- Drugs (ie NSAIDs)
- Malignancy
What are some rare causes of Haematemesis?
- Bleeding disorders
- Peutz-Jeghers syndrome
- Portal hypertensive gastropathy
