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Gastrointestinal System Flashcards

1
Q

Difficulty swallowing solids only is probably a __________ disorder.

A

structural

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2
Q

Difficulty swallowing both liquids and solids is probably a ________ disorder

A

motility

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3
Q

A progressive history of dysphagia points towards ______, with foods that were initially manageable becoming increasingly difficult to swallow over time.

A

cancer

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4
Q

True or False: GORD causes dysphagia

A

False.

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5
Q

Dysphagia associated with Oesophageal cancer

A

Dysphagia may be associated with weight loss, anorexia or vomiting during eating
Past history may include Barrett’s oesophagus, GORD, excessive smoking or alcohol use

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6
Q

Dysphagia associated with Oesophagitis

A

There may be a history of heartburn
Odynophagia but no weight loss and systemically well

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7
Q

Dysphagia associated with Oesophageal candidiasis

A

There may be a history of HIV or other risk factors such as steroid inhaler use

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8
Q

Dysphagia associated with Achalasia

A

Dysphagia of both liquids and solids from the start
Heartburn
Regurgitation of food - may lead to cough, aspiration pneumonia etc

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9
Q

Dysphagia associated with Pharyngeal pouch

A

More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough. Halitosis may occasionally be seen

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10
Q

Dysphagia associated with Systemic sclerosis

A

Other features of CREST syndrome may be present, namely Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia

As well as oesophageal dysmotility the lower oesophageal sphincter (LES) pressure is decreased. This contrasts to achalasia where the LES pressure is increased

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11
Q

Dysphagia associated with Myasthenia gravis

A

Other symptoms may include extraocular muscle weakness or ptosis
Dysphagia with liquids as well as solids

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12
Q

Dysphagia associated with Globus hystericus

A

There may be a history of anxiety
Symptoms are often intermittent and relieved by swallowing
Usually painless - the presence of pain should warrant further investigation for organic causes

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12
Q

Extrinsic Causes of Dysphagia

A

Mediastinal masses
Cervical spondylosis

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13
Q

Oesophageal Wall Causes of Dysphagia

A

Achalasia
Diffuse oesophageal spasm
Hypertensive lower oesophageal sphincter

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14
Q

Intrinsic Causes of Dysphagia

A

Tumours
Strictures
Oesophageal web
Schatzki rings

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15
Q

Neurological Causes of Dysphagia

A

CVA
Parkinson’s disease
Multiple Sclerosis
Brainstem pathology
Myasthenia Gravis

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16
Q

Ix for Dysphagia

A

All patients require an upper GI endoscopy unless there are compelling reasons for this not to be performed. Motility disorders may be best appreciated by undertaking fluoroscopic swallowing studies.

A full blood count should be performed.

Ambulatory oesophageal pH and manometry studies will be required to evaluate conditions such as achalasia and patients with GORD being considered for fundoplication surgery.

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17
Q

Signet ring cells are a histological sign of _____________________

A

gastric adenocarcinoma

[The sign is named as it is because the cytoplasm of these cancerous cells compresses the nuclei to the peripheries of the cells, causing the resemblance to a signet ring.]

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18
Q

How common is gastric adenocarcinoma and who does it commonly affect?

A

accounts for 90-95% of stomach cancers and is more common in males.

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19
Q

_______ are classically present in ulcerative colitis, but may also be seen in Crohn’s colitis and infectious colitis.

A

Crypt abscesses

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20
Q

Gastric cancer accounts for _____ % of all cancer diagnoses in the developed world, making it much less common than colorectal and slightly less common than oesophageal cancer

A

around 2

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21
Q

Epidemiology of gastric cancer

A

It is a cancer of older people (half of patients are > 75 years) and has a male predominance (2:1).

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22
Q

Where does gastric adenocarcinoma arise from?

A

Gastric adenocarcinoma, the most prevalent type of gastric cancer, arises from the glandular epithelium of the stomach lining.

23
Q

Risk Factors of gastric cancer

A

Helicobacer pylori
triggers inflammation of the mucosa → atrophy and intestinal metaplasia → dysplasia
pernicious anaemia, atrophic gastritis
diet
salt and salt-preserved foods
nitrates
ethnicity: Japan, China
smoking
blood group A

24
Features of Gastric Cancer
abdominal pain typically vague, epigastric pain may present as dyspepsia weight loss and anorexia nausea and vomiting dysphagia: particularly if the cancer arises in the proximal stomach overt upper gastrointestinal bleeding is seen only in a minority of patients if lymphatic spread: left supraclavicular lymph node (Virchow's node) periumbilical nodule (Sister Mary Joseph's node)
25
Dx of gastric cancer
oesophago-gastro-duodenoscopy with biopsy signet ring cells may be seen in gastric cancer. They contain a large vacuole of mucin which displaces the nucleus to one side. Higher numbers of signet ring cells are associated with a worse prognosis
26
Staging of gastric cancer
CT scan of the chest, abdomen, and pelvis is indicated in all patients to look for metastatic disease other modalities they may be used for staging include endoscopic ultrasound, (FDG)-PET scanning and pre-operative staging laparoscopy
27
Management of gastric cancer
surgical options depend on the extent and site but include: endoscopic mucosal resection partial gastrectomy total gastrectomy chemotherapy
28
The ________ is the most accurate measure of the synthetic function of the liver.
prothrombin time
29
Why is PT prolonged in liver disease?
Prolongation of PT can occur in liver disease as cirrhosis impairs the liver's ability to produce clotting factors.
30
ALT is an enzyme which is found in high concentrations in _____
hepatocytes [When hepatocytes are damaged, ALT is released into the systemic circulation and can be used as a marker of liver injury.]
31
ALP originates from both ______ and ________.
biliary epithelial cells and bone tissue.
32
GGT is present within both __________ and __________ is a sensitive but non-specific biomarker for hepatic damage and cholestasis.
hepatocytes and biliary epithelial cells
33
Causes of acute liver failure
paracetamol overdose alcohol viral hepatitis (usually A or B) acute fatty liver of pregnancy
34
Features of Acute Liver Failure
jaundice coagulopathy: raised prothrombin time hypoalbuminaemia hepatic encephalopathy renal failure is common ('hepatorenal syndrome')
35
The _________________ supplies the transverse colon and requires high ligation during cancer resections. It is a branch of the superior mesenteric artery.
middle colic artery
36
Loss of _____ is one of the key features in the development of steatorrhoea which typically consists of pale and offensive stools that are difficult to flush away.
lipase
37
Over 80% of pancreatic tumours are ________ which typically occur at the head of the pancreas.
adenocarcinomas
38
Risk Factors for pancreatic cancer
increasing age smoking diabetes chronic pancreatitis (alcohol does not appear an independent risk factor though) hereditary non-polyposis colorectal carcinoma multiple endocrine neoplasia BRCA2 gene KRAS gene mutation
39
Features of Pancreatic Cancer
classically painless jaundice pale stools, dark urine, and pruritus cholestatic liver function tests the following abdominal masses may be found (in decreasing order of frequency) hepatomegaly: due to metastases gallbladder: Courvoisier's law states that in the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones epigastric mass: from the primary tumour many patients present in a non-specific way with anorexia, weight loss, epigastric pain loss of exocrine function (e.g. steatorrhoea) loss of endocrine function (e.g. diabetes mellitus) atypical back pain is often seen migratory thrombophlebitis (Trousseau sign) is more common than with other cancers
40
Ix for Pancreatic cancer
ultrasound has a sensitivity of around 60-90% high-resolution CT scanning is the investigation of choice if the diagnosis is suspected imaging may demonstrate the 'double duct' sign - the presence of simultaneous dilatation of the common bile and pancreatic ducts
40
Management of Pancreatic Cancer
less than 20% are suitable for surgery at diagnosis a Whipple's resection (pancreaticoduodenectomy) is performed for resectable lesions in the head of pancreas. Side-effects of a Whipple's include dumping syndrome and peptic ulcer disease adjuvant chemotherapy is usually given following surgery ERCP with stenting is often used for palliation
41
Retroperitoneal Structures:
SAD PUCKER Suprarenal (adrenal) glands Aorta/inferior vena cava Duodenum (2nd and 3rd parts) Pancreas (except tail) Ureters Colon (ascending and descending) Kidneys (o)Esophagus Rectum
42
_____ is the single strongest risk factor for the development of Barrett's oesophagus
GORD
43
C. difficile is a ___________ which is the causative organism in pseudomembranous colitis following recent broad-spectrum antibiotic use
gram positive + bacillus
44
An easy mnemonic that can be used to remember the structures that are retroperitoneal is as follows;
SAD PUCKER S: suprarenal (adrenal) gland A: aorta/IVC D: duodenum (second and third part) P: pancreas (except tail) U: ureters C: colon (ascending and descending) K: kidneys E: oesophagus R: rectum
45
Secretin _________ gastric H+ secretion
decreases
46
The ______ is the most common site affected by Crohn's disease
ileum
47
The ______ is the most common site affected by Coeliac's disease
duodenum
48
Crohn's disease is linked to a a genetic defect in the ____ gene.
NOD-2
49
Carcinoid syndrome
usually occurs when metastases are present in the liver and release serotonin into the systemic circulation may also occur with lung carcinoid as mediators are not 'cleared' by the liver
50
Features of Carcinoid Tumours
flushing (often the earliest symptom) diarrhoea bronchospasm hypotension right heart valvular stenosis (left heart can be affected in bronchial carcinoid) other molecules such as ACTH and GHRH may also be secreted resulting in, for example, Cushing's syndrome pellagra can rarely develop as dietary tryptophan is diverted to serotonin by the tumour
51
Ix for Carcinoid Tumours
urinary 5-HIAA plasma chromogranin A y
52
Management of Carcinoid Tumors
somatostatin analogues e.g. octreotide diarrhoea: cyproheptadine may help
53
An isolated rise in bilirubin in response to physiological stress is typical of ___________
Gilbert's syndrome
54

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