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BDS 2: CHHD > Gastroenterology: Upper GIT diseases > Flashcards

Gastroenterology: Upper GIT diseases Flashcards

1
Q

What is Dysphagia?

A

Difficulty in swallowing

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2
Q

Why does Dysphagia always need urgent investigation?

A

To rule out malignancy

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3
Q

If patient is finding swallowing painful, this can suggest? (4)

A
  • Oesophageal cancer
  • Ulcer
  • Spasm
  • Candidiasis
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4
Q

If patient finds it difficult to make a swallowing movement, this can suggest?

A

Suspect bulbar palsy

esp if swallowing causes coughing

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5
Q

If patient has always found it difficult to swallow solids and liquids, this can suggest? (2)

A
  • Motility disorder

- Pharyngeal cause

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6
Q

Intermittent dysphagia can suggest?

A

Oesophageal spasm

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7
Q

Constant/worsening dysphagia can suggest?

A

Malignant structure

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8
Q

If patients neck bulges or gurgles upon swallowing this can suggest?

A

Pharyngeal pouch

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9
Q

What needs to be examined in a patient showing dysphagia? (5)

A
  • Cachexia
  • Anaemia
  • Oral examination
  • Virchow’s node
  • Other signs of systemic disease
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10
Q

What are the 2 main causes of dysphagia?

A
  • Mechanical block

- Motility disorders

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11
Q

Name 4 types of mechanical blocks that cause dysphagia

A
  • Malignant structure
  • Benign structure
  • Extrinsic pressure
  • Pharyngeal pouch
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12
Q

Name some motility disorders that cause dysphagia (5)

A
  • Achalasia
  • Diffuse oesophageal spasm
  • Systemic sclerosis
  • Myasthenia gravis
  • Bulbar palsy
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13
Q

What is Myasthenia gravis?

A

Autoimmune condition involving antibodies to ACh receptors

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14
Q

What are some clinical features of someone with MG? (3)

A
  • Ptosis (eye drooping)
  • Myasthenic snarl on smiling
  • Whilst counting to 50 voice deteriorates
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15
Q

What is bulbar palsy?

A

Presentation of diseases involving cranial nuclei of IX-XII

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16
Q

What structures in the head and neck does bulbar palsy affect?

A

LMN lesion of tongue and muscles of talking and swallowing

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17
Q

What are some of the causes of bulbar palsy? (3)

A
  • Motor neurone disease
  • MG
  • Syringobulbia
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18
Q

What is Achalasia?

A

Lower oesophageal sphincter fails to relax

regurgitation

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19
Q

What is Gastro-oesophageal reflux (GORD)?

A

Reflux of stomach contents causing troublesome symptoms with at least two heartburn episodes each week

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20
Q

GORD is related to the dysfunction of what?

A

Lower oesophageal sphincter

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21
Q

Name some predisposing factors for GORD

A
  • Smoking
  • Alcohol
  • Pregnancy
  • Overeating
  • Obesity
  • Hiatus hernia
  • Oesophageal problems
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22
Q

What are some Oesophageal GORD symptoms? (4)

A
  • Heart burn
  • Belching
  • Acid brash/Water brash
  • Odynophagia (painful swallowing)
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23
Q

What some Extra-Oesophageal GORD symptoms? (4)

A
  • Nocturnal asthma
  • Chronic cough
  • Laryngitis
  • Sinusitis
24
Q

What are some complications of GORD?

A
  • Oesophagitis
  • Ulcers
  • Benign stricture
  • Barrett’s oesophagus
  • Oesophageal adenocarcinoma
  • Iron deficiency anaemia
25
Q

What lifestyle advice would be given to someone with GORD? (5)

A
  • Weight loss
  • Smoking cessation
  • Raise bedhead
  • Small regular meals
  • Avoid hot/spicy/caffeinated food before bed
26
Q

What medication can be given to someone with GORD? (2)

A
  • Antacids (gaviscon)

- Proton pump inhibitors (lansoprazole)

27
Q

What is the dental relevance of GORD?

A
  • Unpleasant taste
  • Enamel erosion
  • Worsened by NSAIDs
28
Q

What are the two types of Hiatus hernia?

A
  • Sliding (80%)

- Rolling

29
Q

What is sliding hiatus hernia?

A

Gastro-oesophageal junction slides into chest

30
Q

What is rolling hiatus hernia?

A

Bulge of stomach herniates into chest alongside oesophagus

31
Q

In which type of hiatus hernia does an acid reflux occur?

A

Sliding

32
Q

How is hiatus hernia treated?

A
  • Lose weight
  • Reflux symptoms treated
  • Surgical repair if serious
33
Q

What is Barret’s Oesophagus?

A

Chronic reflux oesophagitis

34
Q

In terms of malignancy what type of lesion is Barret’s Oesophagus?

A

Premalignant lesion so need to be checked immediately

35
Q

Oesophageal carcinoma;

UK death/year?
M:F?

A
  • 6000 deaths/year

- 5:1

36
Q

What are some risk factors of Oesophageal carcinoma?

A
  • Smoking
  • Alcohol abuse
  • Achalasia
  • Obesity
  • Low vitamin A/C
  • GORD
  • Barret’s
37
Q

Symptoms of Oesophageal carcinoma (5)

A
  • Hoarse cough
  • Dysphagia
  • Weight loss
  • Chest pain
  • Lymphadenopathy
38
Q

What are the percentages of Oesophageal carcinoma for each site and what type of carcinoma?

  • Upper third?
  • Middle third?
  • Lower third?
A
  • 20% squamous cell carcinoma
  • 50% squamous cell carcinoma
  • 30% adenocarcinoma
39
Q

What is Dyspepsia?

A

Nonspecific group of symptoms related to upper GI tract

Synonym to indigestion

40
Q

What does the ALARMS acronym to remember dyspepsia symptoms stand for?

A
  • Anaemia
  • Loss of weight
  • Anorexia
  • Recent onset with progressive symptoms
  • Melaena or haematemesis
  • Swallowing difficulty
41
Q

What is melaena?

A

Producing sticky faeces which may contain blood

42
Q

What is peptic ulcer disease (PUD)?

A

A break in the inner lining of the stomach

43
Q

What are some risk factors for peptic ulcers?

A
  • H. pylori
  • Drugs (E.g NSAIDs)
  • Smoking
  • Stress (maybe)
44
Q

What are the two types of ulceration?

A
  • Gastric ulceration

- Duodenal ulceration

45
Q

Gastric ulceration;

Vulnerable group?
Symptoms?
Pain?
Relief?

A
  • Mainly elderly
  • Asymptomatic (maybe weight loss)
  • Epigastric pain
  • Antacids
46
Q

Duodenal ulceration;

Likelihood?
Symptoms?
Pain?
Relief?

A
  • 4 times more common that gastric
  • Maybe asymptomatic
  • Epigastric
  • Drinking milk
47
Q

What are adenocarcinomas?

A

A malignant tumor formed from glandular structures in epithelial tissue.

48
Q

What is the most common type of gastric cancer?

A

Gastric adenocarcinomas (more than 90%)

49
Q

Gastric cancer;

  • M:F
  • Peak incidence age
  • Vulnerable groups
A
  • 2:1
  • 60-84
  • Eastern Asia/Europe and South America
50
Q

What are some risk factors of Gastric cancer? (6)

A
  • H. pylori infection
  • Smoking
  • Alcohol
  • Not enough fruit/veg
  • Excess salt diet
  • Pernicious anaemia
51
Q

Clinical representations of gastric cancer? (5)

A
  • Nausea
  • Melaena
  • Anaemia
  • Virchows node
  • Sister Mary Josephs nodule
52
Q

List some alarming features that suggest gastric cancer

A
  • 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
53
Q

How would you investigate gastric cancer?

A
  • Endoscopy

- Biopsy

54
Q

What is a Biopsy?

A

An examination of tissue removed from a living body to discover the presence, cause, or extent of a disease.

55
Q

What is Haematemesis?

A

Vomiting of blood

56
Q

What are some common causes of Haematemesis?

A
  • Gastric erosion
  • Duodenitis
  • Oesophagitis
  • Peptic ulcers
  • Drugs (ie NSAIDs)
  • Malignancy
57
Q

What are some rare causes of Haematemesis?

A
  • Bleeding disorders
  • Peutz-Jeghers syndrome
  • Portal hypertensive gastropathy

BDS 2: CHHD (28 decks)

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