MedEd upper GI Flashcards
What is achalasia?
Failure of the LOS (lower oesophagal sphincter) to relax and aperistalsis
How does achalasia happen?
Degeneration of myenteric plexus which produces NO and VIP for relaxation
What are causes of achalasia?
Chagas disease
Largely unknown
How will achalasia present? Describe why symptoms arise
Dysphagia of both solids and liquids
Regurgitation due to food trapped in oesophagus
Gradual weight loss due to lack of food ingestion
What type of dysphagia will occur in achalasia?
Of both solids and liquids
What is the gold standard investigation for achalasia? What other ones might you do? What will they show
High res oesophageal manomentry- will show incomlete relaxationa nd epristalsis
Upper GI endoscopy
Barium swallow - will show birds beak
How is achalasia managed?
Pharmacologically- CCB or nitrate before meals to reduce chest pain and dysphagia
Surgery- pneumatic dilation, laparoscopic cardiomyotomy
What is GORD?
Symptoms and complications resulting from reflux of gastric contents into the oesophagus or beyond
What are RF for GORD?
LOS hypotension Alcohol Smoking Pregnancy Obesity Hiatus hernia
How does GORD present?
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
What is the gold standard investigation for GORD? What others might you do? What will you see
Gold standard= 8 week trail of PPI- reduces symptoms
May do
OGD- will see erosions and ulcerations
Manometry- low pH
How is GORD managed?
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
What is peptic ulcer disease?
Break in lining of stomach with depth to submucosa
What are RF for PUD?
H pylori
NSAIDs
Smoking
Increased/decreased gastric emptying
What ulcers are more common out of duodenal and gastric?
Duodenal
What is zollinger ellinson syndrome?
Tumor causing high gastrin and huge acid production (causes ulcers in stomach and duodenum)
When do cushings ulcers occur?
After brain trauma
When do curlings ulcers occur?
Due to ischaemia and dehydration eg burns injuries
How does PUD present?
Epigastric pain directly after meals
Nausea and vomitting
Mild weight loss
What investigations are done for PUD? What is gold standard? What will they show
Gold standard= upper GI endoscopy
H pylori test- urea breath test or stool antigen test
Serum fasting gastrin test
How is PUD managed?
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
What is gastritis?
Mucosal inflammation fo stomach
What is hiatus hernia?
Protrusion of abdo contents into thorax
What are types of hiatus hernia? Which is more common
Sliding- more common
Rolling
What are RF for hiatus hernia?
Obesity
Anything that increases intra abdo pressure
How does hiatus hernia present?
Mostly asyptomatic
GORD symptoms- especially on lying down
Palpitations or hiccups due to pericardial nerve irritation
What is gold standard investigation for hiatus hernia? What others might you do?
Upper GI endoscopy
CXR- see retrocardiac bubble
How is hiatus hernia managed?
Lifestyle= weight loss and PPI Surgery= only refractory to medical therapy (fundoplication)
What are complication of hiatus hernia?
Gastric volvulus and barrett’s oesophagys
What metaplasia occurs in barrets oesophagus?
normal straitified epithelium to columnar epithelium
What is barrets oesophagus?
Metaplasia of normal straitified epithelium to columnar epithelium
What are RF for barret’s oesophagus?
GORD
What is seen on OGD in barrets oesophagus that shows metaplasia?
Light pink to darker pink
How does barrets oesophagus present?
GORD symptoms
What is gold standard investigation for barrets oesophagus?
Upper GI endoscopy with biopsy
How is barret’s oesophagus managed
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
What are complications of barrets oesophagus?
oesophageal cancer
oesophageal stricture
What is oesophageal cancer?
cancer originating from epithelial lining of oesophagus
What are the 2 types of oesophageal cancer? Which is more common
Squamous cell- more common
Adenocarcinoma
Where in the oesophagus do squamous cell vs adenocarcinoma occur?
Squamous= upper 2/3 Adeno= lower 3rd
What are RF for squamous cell oesophagus cancer?
Alcohol Smoking Strictures Achalasia Nitrosamines
What are RF for aednocarcinoma oesophagus cancer?
GORD
Barrett’s oesophagus
Obesity
Achalasia
How does oesophageal cancer present?
Progressive dysphagia- first solids then liquids
Rapid weight loss
Hoarseness of voice
How much does oesophageal cancer metastasise and why?
A lot and quick
It can invade through serosa v quickly
What is GS investigation for oesophageal cacner?
Upper GI endoscopy with biopsy
What is management for oesophageal cancer?
Resect tumor and chemo if there are mets
What is gstric cancer?
Neoplasm origincating anywhere in the stomach
What are the 2 types of gastric adenocarcinomas?
Intestinal
Diffuse
What is intestinal gastric cancer associated with?
H pylori associated
What is diffuse gastric cancer associated with?
E cadherin mutation
What are RF for gastric cancer?
H pylori
Pernicious anaemia
Nitrosamines
Also smoking high salt intake low vit c blood type a
How doesgastric cancer present>
Vague but unusual epigastric pain
Weight loss
Lymphadenopathy- especially virchow’s node (supraclavicular)
Where is the sister mary joseph nodule?
Above the belly button
What is GS inevstigation for gastric cancer? What will you see? What others might you do
Upper GI endoscopy with biopsy will show signet ring cells
CT/MRI for staging
Endoscopic ultraosunf/ FNA
How is gastric cancer managed?
Resection and chemo if metastasised
What is mallory weiss tear?
Longitudinal lacertaion in the mucose and submucosa in near GOS
What is the cause of mallory weiss tear?
Sudden increase in GI pressure without reduction in intrabdo pressure
What are RF for mallory weiss tear?
Retching
Coughing
Vomitting
Straining and alcoholcs and bulimics
What 2 groups of people are more likely to get mallor weiss tear?
Bulimics
Alcoholics
How does mallory weiss tear present?
Haematemesis Light headed/dizzy Postural hypotension May have dyaphgia/odyphagia malaena
What is GS inevstigatuon for mallory weiss tear? What will you see? What else might you do?
Upper GI endoscopy
FBC- shows anaemia
Urea- elevated
CXR- rule out perforation
What happens to urea levels in mallory weiss tear?
Levels increase
What risk assessments are used for upper GI bleeds?
Rockall score
Glasgow-Blatchford score
How is mallory weiss tear managed?
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
How do you differentiate between PUD and duodenal ulcers?
PUD= epigastric pain is directly after eating
Duodenal ulcer= epigastric pain manifests a few hours after eating
How is PUD pharmacologically managed when someone is h pylori positive?
PPI and 2 abx (usually amoxicillin or clarithromycin plus metronidazole)- 7 day eradication therapy
How is PUD pharmacologically managed when someone is h pylori negative?
Stop the drug which is causing the ulcer (usually drug)
Offer 4-8 weeks of PPI therapy
