GI Symptoms Flashcards
What is Achalasia
Achalasia is an oesophageal motility disorder characterised by an inability for the lower oesophageal sphincter (LES) to relax in response to swallowing. in the abscence of another disorder
Cause is unknown but associated with loss of inhibitory neurons secreting VIP and nitrous oxide within the Auerbach (myenteric) plexus, resulting in unopposed excitatory activity and the inability for LES relaxation
= LOS contraction and distal oesophageal dilation = lack of peristaltic
Clinical features of achalasia
Difficulty swallowing (dysphagia) of both solids and liquids
Retrosternal chest pain: heartburn
Weight loss due to reduced oral intake
DX Achalasia
1st line - OGD (not sensitive or speficic but rules out malignancy)
Barium Swallow:
oesophageal expansion above sphincter
‘BIRD BEAK’ Appearance - tapering of oesophagus into LOS
GS Oesophageal manometry: the gold standard for establishing the diagnosis.
Two criteria for diagnosis are incomplete relaxation of the LES with wet swallows, and oesophageal peristalsis
tx Achalasia
Meds - CCB verapamil / Nitrates isosorbide dinitrate
surgical - Laparoscopic Heller Procedure (Cardiomyotomy)
Endoscopy - balloon expansion/botinum toxin injection
What is dyspepsia?
presenting sx of indigestion - discomfort: N/V, bloating, early satiety or pain in upper abdomen often after/before eating
DX - Endoscopy
What is the clinical classification of diarrhea
3+ water stools daily
acute < 14 days
sub acute 14-28 days
chronic > 28 days
what are the causes non-infective causes of diarrhea
IBD, Coeliac, hyperthyroidism, malignancy
these usally present as chronic diarrhea
what are the bacterial causes of diarrhea
Campylobacter jejuni
E. Coli
Salmonella
Shigella
C.diff
cholera
What are the viral causes of diarrhea
These are the mc causes
rota virus in kinds, norovirus in adults
Types of diarrhoea
Clinical tool to classify faeces
Bristol stool chart (Type 1 - Hard/Nutty to Type 7 - Watery entirely liquid)
