GI Symposium Flashcards
What history would you take from someone with GI symptoms?
Duration, solids of liquids, pain (better one eating or not)§, weight loss, dysphagia
What categories does dysphagia fall into?
- Oropharyngeal
- Oesophageal
- Gastric
What problem would you expect with oropharyngeal dysphagia?
Salivary gland dysfunction - sjogrens
Tongue - amyloid, hypothyroidism
Palatal/ epiglottal and upper oesophageal - MND, parkinsons
What problem would cause oesophageal dysphagia?
Benign mucosal disease - peptic stricture
Malignant mucosal disease
Motility disorders
What is a pharyngeal pouch?
Defect between constrictor muscles and transverse cricopharyngeus muscles - cause out pouching of mucosa where food can become stuck if becomes large can cause regurgitation
Seen w/ endoscopy or barium swallow
How would you manage dysphagia?
Tx underlying cause
Benign: acid reflux suppression and balloon dilation
Malignancy: surgery +- chemo or radio
What symptoms may you see in upper abdominal discomfort?
Heartburn, abdominal bloating, chest pain
Give 2 examples of causes of upper abdominal discomfort?
- GORD
2. Hiatus hernia
What is GORD - why it happens and symptoms?
- Gastro-oesophageal reflux disease
Excessive relaxation of lower oesophageal sprinter and raised intra-abdominal pressure
Symptoms : heartburn, epigastric pain, acid reflux, nausea, tooth decay, asthma
Management of GORD
- Lifestyle - weight loss, smoking cessation, reduce alcohol
- PPI - irreversibly block H+/K+ ATPase
- H2 antagonist - reduce acid by inhibiting cells produce acid
- Fundoplication
What is a hiatus hernia?
When stomach moves up towards chest due to problems w/ diaphragm
Manage: surgery
What is oesophageal manometry?
Investigation - probe sits at back of gullet and measures pH and pressure (test abnormal amounts of acid)
What hx would you expect of someone with peptic ulceration?
Epigastric pain - can radiate to back and worsened by food (improved by eating duodenal)
Weight loss
Vomiting/ haematemesis
Cause peptic ulceration?
NSAIDs and helicobacter pylori
Appearance would you expect w/ peptic ulcer?
Clean ulcer, visible vessel and adherent clot
Tx peptic ulcer
- Medication to reduce acid - PPI
- Clips
- Injection adrenaline
- Surgery - if perforation
Name some diff types of cancer w/ gastric associations?
- Gastric carcinoma - epigastric pain, weight loss and vomit
- Pancreatic carcinoma - pain that radiated to back, weight loss and poss jaundice
Differentiate visceral and periotoneal pain?
Visceral pain - inflammation inside organ fewer never endings - dull pain
Peritoneal pain - outside organ - lots of nerves - sharp pain
Difference between acute and chronic abdominal pain?
Acute: sweating, guarded, increased HR
Chronic: longer than 6 weeks
Name some causes of emesis?
Systemic illness - viral/ bacterial Drugs/ alcohol Centrally mediated - middle ear disease Psychiatric disorder - bulimia Gastric disease
Management of vomiting?
Identify underlying cause
Antiemetic/ PPI
CBT - if central
Give some examples of small bowel disease?
Lactase deficient, coeliac disease, crohn’s disease
Give some examples of colonic disease?
Ulcerative colitis, Crohn’s disease, carcinoma
Difference between small bowel and colonic disease?
S.B - pale, floating and diff to flush/ throughout day/ pain - variable timing/ pain not relieved by defaecation
Colonic - blood and mucus/ often morning/ pain related to but relieved by defeacation
What is coeliac disease (inc histology and presentation)?
Small bowel disease - gluten sensitivity - immunological response to gliadin
Histology: increased lymphocytes, atrophic villi
Presentation: malabsorption symptoms, dermatitis herpetifromis (immunological response to gluten presented in the skin)
What is Crohn’s disease?
Affect any part GI tract - mouth to rectus
Discontinuous ulceration - cobble stone appearance
Affect all lining of GI tract
Symptoms: pain, fever, diarrhoea, vomiting, weight loss
What is ulcerative colitis?
Affect rectum and colon
Continuous ulceration
Affect just mucosa
Symptoms: diarrhoea, rectal bleeding, pain
What is associated with UC?
Skin - erythema nodosum Mouth - ulceration Joints - arthritis Eyes - uveitis Liver - cirrhosis
Symptoms, investigation and management of colon cancer?
Symptoms: can be none, rectal bleeding, altered bowel habits
Investigation: barium enema, colonoscopy
Manage: evaluate extend of disease - if limited - surgical resection
What associated features would you see with chronic liver disease?
Clubbing, palmar erythema, spider navei
