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Year 3 > MedEd upper GI > Flashcards

MedEd upper GI Flashcards

1
Q

What is achalasia?

A

Failure of the LOS (lower oesophagal sphincter) to relax and aperistalsis

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2
Q

How does achalasia happen?

A

Degeneration of myenteric plexus which produces NO and VIP for relaxation

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3
Q

What are causes of achalasia?

A

Chagas disease

Largely unknown

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4
Q

How will achalasia present? Describe why symptoms arise

A

Dysphagia of both solids and liquids
Regurgitation due to food trapped in oesophagus
Gradual weight loss due to lack of food ingestion

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5
Q

What type of dysphagia will occur in achalasia?

A

Of both solids and liquids

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6
Q

What is the gold standard investigation for achalasia? What other ones might you do? What will they show

A

High res oesophageal manomentry- will show incomlete relaxationa nd epristalsis
Upper GI endoscopy
Barium swallow - will show birds beak

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7
Q

How is achalasia managed?

A

Pharmacologically- CCB or nitrate before meals to reduce chest pain and dysphagia
Surgery- pneumatic dilation, laparoscopic cardiomyotomy

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8
Q

What is GORD?

A

Symptoms and complications resulting from reflux of gastric contents into the oesophagus or beyond

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9
Q

What are RF for GORD?

A 
LOS hypotension
Alcohol
Smoking
Pregnancy
Obesity
Hiatus hernia
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10
Q

How does GORD present?

A

Heartburn/ pain in chest- appears after meals
Acid regurg causes bitter taste in mouth
Waterbrash (increased salivation)
Odynophagia due to oesophagitis or ulceration
Chronic cough
Noctural asthma

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11
Q

What is the gold standard investigation for GORD? What others might you do? What will you see

A

Gold standard= 8 week trail of PPI- reduces symptoms

May do
OGD- will see erosions and ulcerations
Manometry- low pH

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12
Q

How is GORD managed?

A 
non pharmacological: 
weight loss
smoking cessation
small regular meals
avoid acidic fruits and caffiene

pharmacological:
PPI if it worked before
consider adding h2 blocker
antacids for symptom relief

surgical:
nissen fundoplication

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13
Q

What is peptic ulcer disease?

A

Break in lining of stomach with depth to submucosa

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14
Q

What are RF for PUD?

A

H pylori
NSAIDs
Smoking
Increased/decreased gastric emptying

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15
Q

What ulcers are more common out of duodenal and gastric?

A

Duodenal

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16
Q

What is zollinger ellinson syndrome?

A

Tumor causing high gastrin and huge acid production (causes ulcers in stomach and duodenum)

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17
Q

When do cushings ulcers occur?

A

After brain trauma

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18
Q

When do curlings ulcers occur?

A

Due to ischaemia and dehydration eg burns injuries

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19
Q

How does PUD present?

A

Epigastric pain directly after meals
Nausea and vomitting
Mild weight loss

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20
Q

What investigations are done for PUD? What is gold standard? What will they show

A

Gold standard= upper GI endoscopy
H pylori test- urea breath test or stool antigen test
Serum fasting gastrin test

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21
Q

How is PUD managed?

A

lifestyle= reduce smoking and alcohol
medical=
if h pylori- triple therapy w PPI, 2 abx (amox or clarith then metronidazole) 7 day eradication therapy
if not h pylori then usually drug induced so stop the drug and offer 4-8 weeks of PPI therapy

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22
Q

What is gastritis?

A

Mucosal inflammation fo stomach

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23
Q

What is hiatus hernia?

A

Protrusion of abdo contents into thorax

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24
Q

What are types of hiatus hernia? Which is more common

A

Sliding- more common

Rolling

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25
Q

What are RF for hiatus hernia?

A

Obesity

Anything that increases intra abdo pressure

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26
Q

How does hiatus hernia present?

A

Mostly asyptomatic
GORD symptoms- especially on lying down
Palpitations or hiccups due to pericardial nerve irritation

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27
Q

What is gold standard investigation for hiatus hernia? What others might you do?

A

Upper GI endoscopy

CXR- see retrocardiac bubble

28
Q

How is hiatus hernia managed?

A 
Lifestyle= weight loss and PPI
Surgery= only refractory to medical therapy (fundoplication)
29
Q

What are complication of hiatus hernia?

A

Gastric volvulus and barrett’s oesophagys

30
Q

What metaplasia occurs in barrets oesophagus?

A

normal straitified epithelium to columnar epithelium

31
Q

What is barrets oesophagus?

A

Metaplasia of normal straitified epithelium to columnar epithelium

32
Q

What are RF for barret’s oesophagus?

A

GORD

33
Q

What is seen on OGD in barrets oesophagus that shows metaplasia?

A

Light pink to darker pink

34
Q

How does barrets oesophagus present?

A

GORD symptoms

35
Q

What is gold standard investigation for barrets oesophagus?

A

Upper GI endoscopy with biopsy

36
Q

How is barret’s oesophagus managed

A

non dysplastic= maximise PPI therapy and surveillance every 2 years
dysplastic= radiofrequency ablation or endoscopic mucosal resection for nodular growths, once this is done continue with non dysplastic management

37
Q

What are complications of barrets oesophagus?

A

oesophageal cancer

oesophageal stricture

38
Q

What is oesophageal cancer?

A

cancer originating from epithelial lining of oesophagus

39
Q

What are the 2 types of oesophageal cancer? Which is more common

A

Squamous cell- more common

Adenocarcinoma

40
Q

Where in the oesophagus do squamous cell vs adenocarcinoma occur?

A 
Squamous= upper 2/3
Adeno= lower 3rd
41
Q

What are RF for squamous cell oesophagus cancer?

A 
Alcohol
Smoking
Strictures
Achalasia
Nitrosamines
42
Q

What are RF for aednocarcinoma oesophagus cancer?

A

GORD
Barrett’s oesophagus
Obesity
Achalasia

43
Q

How does oesophageal cancer present?

A

Progressive dysphagia- first solids then liquids
Rapid weight loss
Hoarseness of voice

44
Q

How much does oesophageal cancer metastasise and why?

A

A lot and quick

It can invade through serosa v quickly

45
Q

What is GS investigation for oesophageal cacner?

A

Upper GI endoscopy with biopsy

46
Q

What is management for oesophageal cancer?

A

Resect tumor and chemo if there are mets

47
Q

What is gstric cancer?

A

Neoplasm origincating anywhere in the stomach

48
Q

What are the 2 types of gastric adenocarcinomas?

A

Intestinal

Diffuse

49
Q

What is intestinal gastric cancer associated with?

A

H pylori associated

50
Q

What is diffuse gastric cancer associated with?

A

E cadherin mutation

51
Q

What are RF for gastric cancer?

A

H pylori
Pernicious anaemia
Nitrosamines

Also
smoking
high salt intake
low vit c
blood type a
52
Q

How doesgastric cancer present>

A

Vague but unusual epigastric pain
Weight loss
Lymphadenopathy- especially virchow’s node (supraclavicular)

53
Q

Where is the sister mary joseph nodule?

A

Above the belly button

54
Q

What is GS inevstigation for gastric cancer? What will you see? What others might you do

A

Upper GI endoscopy with biopsy will show signet ring cells
CT/MRI for staging
Endoscopic ultraosunf/ FNA

55
Q

How is gastric cancer managed?

A

Resection and chemo if metastasised

56
Q

What is mallory weiss tear?

A

Longitudinal lacertaion in the mucose and submucosa in near GOS

57
Q

What is the cause of mallory weiss tear?

A

Sudden increase in GI pressure without reduction in intrabdo pressure

58
Q

What are RF for mallory weiss tear?

A

Retching
Coughing
Vomitting
Straining and alcoholcs and bulimics

59
Q

What 2 groups of people are more likely to get mallor weiss tear?

A

Bulimics

Alcoholics

60
Q

How does mallory weiss tear present?

A 
Haematemesis
Light headed/dizzy
Postural hypotension
May have dyaphgia/odyphagia
malaena
61
Q

What is GS inevstigatuon for mallory weiss tear? What will you see? What else might you do?

A

Upper GI endoscopy
FBC- shows anaemia
Urea- elevated
CXR- rule out perforation

62
Q

What happens to urea levels in mallory weiss tear?

A

Levels increase

63
Q

What risk assessments are used for upper GI bleeds?

A

Rockall score

Glasgow-Blatchford score

64
Q

How is mallory weiss tear managed?

A

Most of them resolve spontaneously
First line= inject adrenaline or band ligation w endoscopy
Adjuncts= PPI before endoscopy to stop bleeding and antiemetics to stop recurrence
Second line= sengstaken blakemore tube

65
Q

How do you differentiate between PUD and duodenal ulcers?

A

PUD= epigastric pain is directly after eating

Duodenal ulcer= epigastric pain manifests a few hours after eating

66
Q

How is PUD pharmacologically managed when someone is h pylori positive?

A

PPI and 2 abx (usually amoxicillin or clarithromycin plus metronidazole)- 7 day eradication therapy

67
Q

How is PUD pharmacologically managed when someone is h pylori negative?

A

Stop the drug which is causing the ulcer (usually drug)

Offer 4-8 weeks of PPI therapy

Year 3 (104 decks)

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