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YR3 HUD > GI 1 > Flashcards

GI 1 Flashcards

1
Q

What are the main symptoms associated with GI disease?

A
  • Dysphagia
  • Heartburn
  • Abdominal pain
  • Dyspepsia (nausea, heartburn, acidity, pain or distention)
  • Flatulence (excessive wind leading to abdominal distention)
  • Vomiting (return of food up to the first part of the duodenum)
  • Constipation (<2 stools a week)
  • Diarrhoea
  • Steatorrhoea (pale bulky stools)
  • Coughing up blood
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2
Q

How many cm is the oesopahgus?

A

25cm

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3
Q

What are the 3 muscles that the pharynx is made of?

A
  • Superior
  • Middle
  • Inferior
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4
Q

What is the potential weakness in the pharynx muscles?

A

Killians dehiscence - meeting point of the 2 parts of the inferior constrictor muscle

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5
Q

When food is being swallowed, if the cricopharyngeus fails to relax at the right time, what can happen?

A

Posterior mucosal herniation

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6
Q

Where does the vagus nerve plexus that supplies the oesophagus lie?

A

Between the outer longitudinal and inner circular muscles of the oesophagus.

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7
Q

What is the name of the mucosa that lines the oesophagus?

A

Stratified squamous non keratinised epithelium

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8
Q

How do waves travel down the oesophagus?

A

Wave of depolarisation leading to muscle waves of contraction and relaxation.

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9
Q

What sphincter stops food from going back up to the oesophagus?

A

Cardiac sphincter

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10
Q

What are the main reasons as to why blood may be vomited?

A

Ulcers of GI tract, tears in oesophageal mucosa, tumours of the oesophagus

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11
Q

What happens to food once the the pharyngeal pouch has formed?

A

u

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11
Q

What happens to food once the the pharyngeal pouch has formed?

A

Undigested food can get caught and then regurgitated into the upper airway

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12
Q

Why does pharyngeal pouch cause respiratory stridor?

A

Regurgitated food into esophagus lead to an inspiratory noise

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13
Q

What are the symptoms of pharyngeal pouch?

A 
Stridor
Difficulty breathing 
Regurgitation of food
Swelling of neck
Chronic cough
Weight loss
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14
Q

What is achalasia?

A

Failure of the lower sphincter to relax due to loss of ganglia from the intramural plexus

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15
Q

What are the 3 main treatments for Achalalsia?

A

1) Calcium channel blockers to relax the sphincter
2) Balloon dilatation
3) Cardiomyotomy (cut the muscle sphincter to allow for drainage)

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16
Q

What are the symptoms of alchalasia?

A
  • Dysphagia
  • Respiratory problems
  • Regurgitating food
  • Heart burn
  • Chest pain
  • Weight loss
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17
Q

What are the main causes of oesophageal spasm?

A
  • Achalasia
  • Gastro oesophageal reflux disease
  • Motor disorders
  • Peristalsis
  • Obstruction at the cardia
  • Neuromuscular disorders (MS)
18
Q

What is the main complication of oesophageal spasm?

A

Corkscrew oesophagus as the muscular tube tries to force food down.

19
Q

What is the treatment for corkscrew oesophagus?

A

Beta blockers

20
Q

What happens in oesophageal web?

A

The mucosa becomes atrophic and a fibrous stricture forms at the end of the oesophagus.

21
Q

What is one of the main reasons for oesophageal web?

A

Iron deficiency anaemia

22
Q

Which two of the GI conditions mentioned are pre malignant?

A

Esophageal web

Barretts oesophagus

23
Q

Why does acid reflux into the oesophagus happen?

A

Constant relaxation of the lower sphincter

24
Q

What does acid reflux do to the oesophagus?

A
  • Mucosal inflammation due to acid destruction

- Removal of mucus protection coat

25
Q

What causes acid reflux to occur?

A
  • Aspirin and NSAIDS
  • Steroids
  • Smoking
  • Stress
  • Helicobacter pylori
26
Q

What is the treatment for acid relfux?

A
  • H2 blockers e.g. ranitidine

- Proton pump inhibitors e.g. omeprazole

27
Q

What are the symptoms of acid reflux?

A
  • Pain
  • Ulceration
  • Heart burn
  • Sour taste in mouth due to acid coming up
  • Feeling sick
28
Q

What is the difference between an acute and chronic ulcer?

A

Acute ulcer : fairly small, penetrated muscularis mucosae but not into the submucosa or outer muscular wall

Chronic ulcer : further into the muscular wall and the muscular wall can rupture - risk of peritonitis

29
Q

What are the sites of upper GI bleeding?

A
  • Oesophagus : caused by reflux
  • Stomach : decreased resistance to acid
  • Duodenum : increased acid production leads to bleeding and ulcers
30
Q

What are the sites of upper GI bleeding?

A
  • Oesophagus : caused by reflux
  • Stomach : decreased resistance to acid
  • Duodenum : increased acid production leads to bleeding and ulcers
31
Q

What are the signs and symptoms of upper GI bleeding?

A
  • Pain
  • Vomiting
  • Haematemesis (vomiting up blood)
  • Ulcer with scarring
32
Q

What are the two outcomes of an ulcer?

A
  • Healing of an ulcer leads to local scarring by secondary intention
  • Progressing through the gut wall and perforation
33
Q

How do we manage upper GI bleeding?

A
  • Control of predisposing factors
  • Antacids (medications to neutralise acid in the stomach)
  • H2 blockers, proton pump inhibitors
  • Treat H pylori
  • Surgery can be performed to prevent bleeding vessels by blood vessel repair
34
Q

What causes gastritis of the stomach lining?

What does gastritis do to the stomach lining?

A
  • Excessive alcohol, chronic vomiting, stress, aspirin and NSAIDS

Chronic inflammation erodes the mucus layer, ulceration, bleeding and malignant conversion.
Inflammation reduces function of stomach and stomach lining by damaging parietal cells.

35
Q

Why does gastritis lead to either microcytic or macrocytic anaemia?

A

Microcytic : Less acid production by parietal cells leads to iron deficiencies as Fe3+ iron is not converted to Fe2+ iron

Macrocytic : less intrinsic factor produced by parietal cells leads to no B12 absorbed in the terminal ileum

36
Q

What is the change in Barretts oesophagus to the mucosa?

A

Non keratinised stratified squamous epithelium to columnar epithelium (same as stomach)

37
Q

What are the symptoms of Barretts oesophagus?

A
  • Heartburn
  • Dysphagia
  • Sensation of food stuck in the oesophagus
  • Vomiting
  • Unintentional weight loss
38
Q

What are the majority of oesophageal carcinomas?

A

Squamous cell carcinoma

39
Q

What are the risk factors of oesophageal cancer?

A
  • Smoking
  • Heavy alcohol intake
  • Food toxins
  • Peptic disease
  • Achalasia of cardia
  • Pharyngeal pouch
  • Oesophageal web
  • Coeliac disease
40
Q

Where does oesophageal cancer usually spread to?

A
  • Trachea (leading to coughing and choking)

- Recurrent laryngeal nerve invasion (leading to a horse voice)

41
Q

How do we diagnose oesophageal cancer?

A
  • Barium swallow
  • CT scan
  • MRI scan
  • Endoscopy
  • Biopsy
42
Q

How do we know whether to cure or give palliative care when someone has oesophageal cancer?

A

Cure : need to have 5cm of normal tissue around the cancer

Palliative : surgery or radiotherapy

43
Q

What is pyloric stenosis?

What is the treatment of this?

A

When the pyloric sphincter goes into spasm and maintains a closed outflow track so no food can exit the stomach.

Treatment : cut the pyloric sphincter muscle and sew it in the other direction to cut along the GI tract. This weakens the stenosis.

YR3 HUD (23 decks)

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