GI in brief Flashcards
What are the two most common types of oesophageal carcinoma?
- Adenocarcinoma
2. Squamous carcinoma
The incidence of which oesophageal cancer is increasing? …and which is reducing?
Adenocarcinoma is increasing and squamous is reducing
What is the name of the malignant tumour of skeletal muscle wall of the oesophagus?
Rhabdomyosarcoma
What is the ratio of incidence in oesophageal cancers between men and women?
Adenocarcinoma M:F 5:1
Squamous carcinoma M:F 3:1
What are the risk factors for developing adenocarcinoma? (3)
- Dietary nitrosamines
- GORD
- Barrett’s oesophagus
In which part of the oesophagus does adenocarcinoma typically occur, and how does this differ to squamous cell carcinoma?
Adenocarcinoma tends to develop in the lower half of the oesophagus, whereas squamous cell can develop anyway
What are the risk factors for developing squamous cell carcinoma of the oesophagus?(5)
- Smoking
- Alcohol
- Diet lacking in fresh fruit and veg
- Chronic achalasia
- Chronic caustic strictures
How does oesophageal carcinoma tend to present? (5)
- Dysphagia (particularly if over 45 - should be assumed cancer until proven otherwise)
- Haematemesis (rarely the presenting symptom)
- Incidental screening
- Symptoms of disseminated disease
- Symptoms of local invasion e.g. dysphonia, cough and haemopysis, neck swelling, horner’s syndrome
What investigations may be carried out in suspected oesophageal carcinoma?
Flexible oesophagoscopy and biopsy
a barium swallow is only indicated for failed intubation or suspected post cricoid carcinoma
What are tumours of connective tissue called?
Leiomyosarcomas (belong to part of the disease spectrum of GI stromal tumours)
What are the risk factors for developing a gastric cancer? (4)
- Diet rich in nitrosamines (smoked or fresh fish, pickled fruit)
- Chronic atrophic gastritis
- Blood group A
- Chronic gastric ulceration related to H.pylori
How does gastric cancer tend to present? (6)
- Dyspepsia
- Weight loss, anorexia
- Lethargy, fatigue
- Anaemia
- Occasionally presents as upper GI bleed
- Dysphagia (uncommon unless involving the proximal funds and gastro-oesophageal junction)
What may be the signs on examination of a gastric cancer? (3)
- Weight loss
- Palpable epigastric mass
- Palpable supraclavicular lymph node (Trousers sign) suggests disseminated disease
What investigations are carried out in suspected gastric cancer?
- Gastroscopy
- Barium meal IF gastroscopy is contraindicated
- Staging investigations include US and thoraco-abdominal CT
In the vast majority of gastric cancers, what are the treatment options and why?
The vast majority of gastric cancers involve treatment directed at easing symptoms and palliation, as they are often metastatic or unresectable due to local invasion.
How common is pancreatic carcinoma?
It’s incidence is increasing rapidly, and is the 4th commonest solid organ cancer.
What are the types of pancreatic carcinoma, and which one is by far the most common? (3)
- Ductal adenocarcinoma - 90%
- Mucinous cystic neoplasms - 7%
- Islet cell tumours - 3%
What are the risk factors associated with pancreatic carcinoma? (8)
- Smoking
- Increasing age
- High fat diet
- Diabetes
- Excessive alcohol
- Chronic pancreatitis
- Exposure to naphthalene and benzidine
- Family history - 1/20 have a FH
What % of pancreatic carcinomas affect the head, body and tail of the pancreas respectively?
Head - 65%
Body - 25%
Tail 10%
How does carcinoma of the head of the pancreas present? (7)
- Obstructive jaundice
- Gallbladder is typically palpable
- Pain (upper left quadrant pain or epigastric, can radiate to the back)
- Hepatomegaly due to mets
- Anorexia, nausea and vomiting, fatigue, dyspepsia, pruritus
- Acute pancreatitis
- Thrombophlebitis migrans (Trousseau’s sign)
How does carcinoma of the body and tail present? (6)
- Usually asymptomatic in early stages
- Weight loss and back pain (in approx. 60% of people)
- Epigastric mass
- Jaundice suggests spread to hilar lymph nodes or mets
- Thrombophlebitis migrans
- Diabetes mellitus
What investigations are carried out in suspected pancreatic cancer? (7)
- FBC, LFTs, blood glucose
- Elevated serum CA 19-9 (sensitivity is 90% and specificity is 70%)
- Transabdominal USS
- Doppler US of portal vein
- Helical CT scan of pancreas
- FNA
- ERCP (endoscopic retrograde cholangiopancreatography)
What % of people with pancreatic cancer are not suitable for surgical resection (due to it being detected too late)?
95%
What symptomatic relief treatment can be give to patients with pancreatic cancer? (4)
- ERCP to relieve jaundice
- Morphine
- Chemotherapy
- Resection if applicable - but even if this is possible, 5-year survival is 12%
How common is colorectal carcinoma?
It is the 2nd most common tumour, and the commonest GI malignancy, affecting up to 1 in 18 people.
What is the peak age of incidence for colorectal cancer and which gender does it tend to affect more?
Ages 45-64
M:F 3:1
What are the risk factors for developing colorectal cancer? (11)
- Polyposis syndromes including FAP, HNPCC (lynch syndrome), juvenile polyposis
- Strong FHx
- Previous history of polyps or colorectal cancer
- Chronic UC or Crohn’s disease
- Diet lacking in fruit and veg
- Acromegaly
- Obesity
- Diabetes
- Diet high in red and processed meat
- Smoking
- Alcohol
How does colorectal cancer tend to present if it is located in the rectum? (2)
Rectal location:
- Pr bleeding; deep red on the surface of stools
- Change in bowel habit; difficulty with defecation, sensation of incomplete evacuation and painful defecation (tenesmus)
How would colorectal cancer in the descending-sigmioid location present? (2)
- PR bleeding; typically dark red, mixed with stool, sometimes clotted
- Change in bowel habit; typically increased frequency, variable consistency, mucus PR, bloating and flatuence
How does a right sided colorectal cancer present?
- Iron deficiency anaemia
What are the emergency presentations - 40% of colorectal cancers are discovered this way? (3)
- Large bowel obstruction (colicky pain, bloating, bowels not open)
- Perforation with peritonitis
- Acute OR bleeding
…whatever OR means…
What are the investigations that can be carried out in suspected colorectal cancer? (4)
DRE
Rigid sigmoidoscopy
Flexible sigmoidoscopy
Colonoscopy
What is the treatment for colorectal cancer?
Surgical resection
What is the most common cause of ascites?
Cirrhosis
What is ascites?
Fluid in the peritoneal cavity
What is Meig’s syndrome?
A triad of benign ovarian fibroma, ascites and pleural effusion
What are the causes of transudate ascites? (8)
- Portal hypertension e.g. cirrhosis
- Hepatic outflow obstruction
- Budd-Chiari syndrome
- Hepatic veno-occlusive disease
- Cardiac failure
- Tricuspid regurgitation
- Constrictive pericarditis
- Meig’s syndrome
What are the exudate causes of ascites? (5)
- Peritoneal carcinomatosis
- Peritoneal tuberculosis
- Pancreatitis
- Nephrotic syndrome
- Lymphatic obstruction
How does ascites appear on examination?
Fullness in the flanks, with shifting dullness. Tense ascites is uncomfortable and produces respiratory distress.
A pleural effusion (usually right sided) and peripheral oedema may be present.
What are the investigations recommended in suspected ascites?
Diagnostic aspiration of 20ml of ascetic fluid
What can be given to treat ascites? (2)
- Diuretics - restrict sodium, oral spironolactone, furosemide is added if poor response (aim is to lose 500g of body weight per day)
- Paracentesis - used if ascites is tense or resistant to medical therapy
What causes coeliac disease?
Strong associated with coeliac disease and two HLA class 2 molecules. HLA - DQ2 and DQ8. These are involved in initiating the inflammatory cascade caused by glidan.
How does coeliac disease present? (at least 6)
- Tiredness, malaise
- Indigestion
- Bloating
- Constipation
- Anaemia
- Osteoporosis
- Unexpected weight loss
- Unexplained deficiencies
What is coeliac disease?
An autoimmune condition in which dietary proteins, known as glutens, activate an abnormal mucosal response with chronic inflammation and damage (villous atrophy) to the lining of the small intestine.
What is the estimated incidence of coeliac disease in the UK?
1 in 100 people
What are the complications of coeliac disease? (6)
- Anaemia - due to deficiency of iron, folate and vitamin B12
- Osteoporosis - malabsorption of calcium and/or vitamin D
- Chronic pancreatitis
- Hepatobiliary abnormalities e.g. primary biliary cirrhosis/primary sclerosing cholangitis
- Lactose intolerance
- Malignancy
What test is carried out in suspected coeliac disease - which will not diagnose coeliac, but indicate the need for further testing?
Serology testing - IgA tissue transglutaminase antibody (tTGA) and total IgA first-line.
What are the differentials for coeliac disease? (6)
- Crohn’s disease
- UC
- Malignancy
- Infection e.g. HIV or TB
- IBS
- Cow’s milk protein allergy in children
