GI Flashcards
What is Oesophagitis?
inflammation of the inner lining of oesophagus
What is the most common cause of Oesophagitis?
GORD
What are the symptoms of Oesophagitis?
- Heartburn
- N + V
- Dysphagia
- Painful swallowing (w/o red flags)
- symptoms resolve spontaneously
How to investigate Oesophagitis?
OGD - investigate severity
Barium swallow - r/o malignancy
What is Mallory Weiss Tear?
- Tear along the right border or near the gastro-oesophageal junction
What commonly causes Mallory Weiss Tear?
- Forceful bout of retching , vomitting, coughing,straining or even hicupping
What are the symptoms of Mallory Weiss Tear?
- Haematemesis
- Dizziness
- abdo pain
- dysphagia
- Melaena (RARE)
(no systemic symptoms)
How to investigate Mallory Weiss Tear?
- OGD: visualise tear
What are the most common types of Oesophageal Cancer?
Identify their location.
- Squamous Cell Cancer
- Upper 2/3 of oesophagus - Adenocarcinoma
- Lower 1/3 near gastro-oesophageal junction
What are some of the risk factors for adenocarcinoma (Oesophageal Cancer)?
- GORD
- Barrett’s oesophagus
- Obesity
If alcohol caused Oesophageal Cancer, what would the blood findings be?
- Increased GGT
- Macrocytosis
What are the symptoms of Oesophageal Cancer?
- Dysphagia
- anorexia + weight loss
- Vomiting
Other:
- Pain on swallowing
- Hoarseness
- acid reflux
- Melaena
What investigation is use for diagnosis of Oesophageal Cancer?
Upper GI endoscopy with biopsy
How is Oesophageal Cancer staged?
- CT scan : if metastatic
2. Endoscopic USS: no metastases, local staging
When does a patient warrant an urgent endoscopy (2WW) for Oesophageal Cancer?
- Dysphagia
2. 55 year + upper abdo pain, reflux, dyspepsia
What is Oesophageal Stricture?
Narrowing of the food pipe
What causes Oesophageal Stricture?
- Scarring from acid reflux in persisitent GORD/
- carcinoma of oesophagus
Whata are the symptoms of Oesophageal Stricture?
- Dysphagia
- Heartburn
- Weight loss
- Chest pain
What signs can present with malignant Oesophageal Stricture?
- Lympadenopathy
What investigations can be carried out for Oesophageal Stricture?
- CXR
- Endoscopy
- Barium swallow
- CT or endoscopic USS
What is Oesophageal Varices?
- Dilated collateral blood vessels that develop as a complication of portal hypertension
What causes Oesophageal Varices?
- Anything condition that causes portal hypertension
- Can be split into 2 categories:
- Pre-hepatic:
- Portal vein thrombosis
- Portal vein obstruction - Intra-hepatic:
- Cirrhosis
- Acute hepatitis
- Idiopathic portal hypertension - Post- hepatic:
- compression (tumour)
What are the symptoms of Oesophageal Varices?
- Haematemesis
- Melaena
- Abdo pain
- Dyshpagia /pain on swallowing
- Ascites
- Jaundice
What are signs of Oesophageal Varices?
- Spider naevi
- Caput medusa
- signs of chronic liver disease
- Hypotension
- Pallor
- Tachycardia
- Reduced GCS
How to investigate Oesophageal Varices?
- Diagnostic: endoscopy
- Bloods: Hb (low), platelets (low)
What is Achalasia?
- Failure of oesophageal peristalsis and of relaxation of the LOS
What are the symptoms of Achalasia?
- Dysphagia (BOTH liquid + solid)
- gradual weight loss
- heart burn
- regurgitation of food
- -> may lead to cough, aspiration pneumonia
What is the diagnostic investigation for Achalasia?
Oesophageal manometry
- assess motor function
What are other investigation carried out for Achalasia?
- Barium swallow :
- ‘bird’s beak’ appearance - CXR:
- wide mediastinum
What is GORD?
Reflux of gastric contents back into the oesophagus
What are the symptoms of GORD?
- Heartburn worse after meal or supine
What is the investigations for GORD?
- Hx is enough for diagnosis
What is gastritis?
histological presence of gastric mucosal inflammation
Most common cause of gastritis
Helicobacter pylori
Other:
- NSAIDs
What are the symptoms of gastritis?
- epigastric pain
- N + V
- Dyspepsia
- Fever
- loss of appetite
Signs of gastritis
- Epigastric tenderness
- glossitis
- halitosis
Investigations for gastritis
H.Pylori:
- Urea breath test
- faecal antigen histology
- rapid urease test
- Gastric muscosal histology
What is peptic ulcer disease?
A breach in the epithelium of the gastric or duodenal mucosa that penetrates the muscularis mucosa
What are the main causes of peptic ulcer disease?
- H.pylori
2. Long-term NSAID use
What are the types of peptic ulcer disease and their symptoms?
Gastric ulcer:
- pain increases while eating
- weight loss
Duodenal ulcer:
- pain is eased by eating
- weight gain
General:
- epigastric pain
- nausea
- chest discomfort
If a patient has acute upper abdo pain, what investigation must be carried out?
Erect x-ray
What would you see in an x-ray when some one has perforated ulcer?
CXR: free air under diaphragm
What investigation should be carried out for peptic ulcer disease?
- H.pylori test
- Upper endoscopy
What are the symptoms of gastric cancer?
- dysphagia
- pain
- acid reflux
- loss of appetite + weight loss
- anaemia
How to investigate gastric cancer?
- Diagnosis: Endoscopy + biopsy
- Staging : CT
- Bloods: anaemia
What are the red flag signs for stomach cancer?
- Abdo mass
- rebound tenderness with rigid abdomen
- absent bowel sounds
- acute pain + vomiting
- ecchymosis of flanks + abdo
What is the referral requirement for 2WW stomach cancer?
- upper abdo mass
What is the referral requirement for 2WW UGI endoscopy?
- dysphagia
2. > 55 + upper abdo pain, reflux, dyspepsia
What is pyloric stenosis?
- Pylorus of the stomach is stenosed
- does not allow the passage of food
What are the symptoms of pyloric stenosis?
- projectile vomiting* - typically 30 mins after feed
- constipation
- dehydration
- palpable mass (upper abdo)
What are the signs of pyloric stenosis?
- poor weight gain
- hypokalaemic alkalosis
What investigation is diagnostic pyloric stenosis?
USS
What is Cholelithiasis?
A gallstone
- solid deposit that forms within the bladder
What are the risk factors for gallstones?
5 F’s
- Female
- Fat
- Fair
- Fertile
- Forty
What are the classic symptoms for Cholelithiasis?
- Colicky RUQ pain - post prandially
- –> worse after fatty meal
- N + V
What is the diagnostic work up in suspected Cholelithiasis??
USS + LFT
What is acute cholecystitis?
- inflammation of the gallbladder
What are the signs for acute cholecystitis?
- RUQ pain:
- radiate to right shoulder
- sudden onset - Fevers (systemic)
- Possible jaundice
What are the signs for acute cholecystitis?
- Murphy’s sign : inspiratory arrest upon palpation of RUQ
What blood test findings may you have with acute cholecystitis?
- LFTs typically normal
What is the first investigation for acute cholecystitis?
Abdo USS
What is chronic cholecystitis?
- repeated attacks of biliary colic + permanent damage to the gallbladder
- gallbladder healing by fibrosis + shrinks in size
What are symptoms of chronic cholecystitis?
- RUQ pain after meals
- fat intolerance
What investigative findings will you have for chronic cholecystitis?
AXR : porcelain gallbladder
Which finding on biopsy would be most consistent with a diagnosis of gastric adenocarcinoma?
signet ring cells
What are the causes of acute pancreatitis?
* GET SMASHED * Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion venom Hypercholesterolaemia ERCP Drugs
What are the symptoms of acute pancreatitis?
- Severe epigastric pain (radiate to back)
- vomiting
- low-grade fever
- sudden onset + short duration
What are the signs of acute pancreatitis?
- Epigastric tenderness
- low-grade fever
- Peri-umbilical discoloration (cullen’s sign)
- Flank discolouration (grey-turner’s sign)
How can you make diagnosis of acute pancreatitis be made without imaging?
If characteristic pain + amylase /lipase > 3 time upper limit of normal
What imaging is used in acute pancreatitis?
USS
Other : contrast - CT
What scoring systems may be used to identify severe pancreatitis?
- Ranson score
- Glasgow score
- APACHE II