Medical Problems Involving Upper GI Tract Flashcards
1
Q
What does the GI tract consist of
A
- oesophagus
- stomach
- duodenum
2
Q
What is dysphagia
A
Difficulty in swallowing
3
Q
Does dysphagia need to be investigated in all cases
A
Always needs urgent investigation to exclude malignancy unless of short duration or associated with a sore throat
4
Q
What does painful swallowing indicate
A
Suggests oesophageal cancer, ulcer, spasm, candidiasis
5
Q
What does difficulty making the swallowing movement suggest
A
Suspect ‘bulbar’ palsy (especially if swallowing
causes coughing)
6
Q
What does difficulty to swallow solids and liquids from the outset indicate
A
Motility disorder or pharyngeal cause
7
Q
What does intermittent dysphagia suggest
A
Oesophageal spasms
8
Q
What does constant and declining dysphagia indicate
A
malignant stricture
9
Q
What does the neck bulging or gurgling on swallowing indicate
A
Pharyngeal pouch
10
Q
What malignant strictures can cause dysphagia
A
Pharyngeal stricture
Oesophageal stricture
Gastric cancer
11
Q
What benign strictures can cause dysphagia
A
Oesophageal web or ring
12
Q
What extrinsic pressure can cause dysphagia
A
Lung cancer
Retrosternal goitre
Aortic aneurysm
Left atrial enlargement
13
Q
What motility disorders can cause dysphagia
A
- Achalasia
- Diffuse oesophageal spasm
- Systemic sclerosis
- Myasthenia gravis
- Bulbar / pseudobulbar palsy
14
Q
What can cause dysphagia that isn’t a mechanical block or motility disorder
A
- Oesophagitis
* Globus hystericus
15
Q
What is affected in myasthenia gravis
A
Autoimmune condition involving antibodies to ACh receptors, affects neuromuscular transmission
16
Q
What are the signs of myasthenia gravis
A
Increasing muscular fatigue - Extraocular > Bulbar > face > neck > limbs
Ptosis - early sign
17
Q
What are the clinical features of bulbar palsy
A
- Presentation of diseases involving cranial nuclei of IX-XII
- LMN lesion of tongue and muscles of talking and swallowing
- Flacid, fasciculation tongue
- Speech quiet, hoarse or nasal
- Normal or absent jaw jerk
18
Q
What are some of the causes of bulbar palsy
A
- Motor Neuron Disease
- Synringobulbia
- Myasthenia gravis
19
Q
Who does paterson-jelly syndrome happen most commonly in
A
Females
20
Q
What are the clinical features of Paterson-Kelly syndrome
A
- Post cricoid membrane webs making swallowing hard
- Iron-deficiency anaemia
- Glossitis
- Increased incidence of both pharyngeal and oral carcinoma
21
Q
What is Achalasia a problem with
A
- The lower oesophageal sphincter as it fails to relax
22
Q
What degenerates in Achalasia
A
Degeneration of the Myenteric Plexus
23
Q
What are the symptoms of Achalasia
A
Dysphagia
Regurgitation
Substernal cramps
Weight loss
24
Q
What can be done to show the oesophageal dilatation
A
Barium swallowing
25
What is Achalasia a risk factor for
Oesophageal cancer
26
What is GORD
Gastro-Oesophageal reflux disease
27
What's wrong with you in GORD
You reflux the stomach contents causing troublesome symptoms with at least two heartburn episodes each week
Associated with dysfunction of lower oesophageal sphincter
28
What are the potential sequelae for GORD if its prolonged/excessive
- Oesophagitis
- Benign oesophageal strictures
- Barrett's oesophagus
29
What are some predisposing factors for GORD
- Hiatus Hernia
- Lower oesophageal sphincter hypotension
- Loss of oesophageal peristaltic function
- Gastric acid hypersecretion
- Delayed gastric emptying
- Overeating
- Smoking
- Alcohol
- Pregnancy
Theres more
30
What are the oesophageal GORD symptoms
- Heartburn
- Belching
- Acid brash (acid or bile reflux)
- Water brash (excessive salivation)
- Odynophagia (painful swallowing)
31
What are the extra-oesophageal GORD symptoms
- Nocturnal asthma
- Chronic cough
- Laryngitis (hoarseness, throat clearing)
- Sinusitis
32
What are some of the potential complications of GORD
- Oesophagitis
- Ulcers
- Benign stricture
- Barrett's oesophagus
- Oesophageal adenocarcinoma
- Iron Deficiency anaemia
33
What lifestyle treatments can be used to treat GORD
- Weight loss
- Smoking cessation
- Raise bedhead
- Small regular meals
- Avoid hot or caffeinated drinks, alcohol, acidic fruits, spicy food and eating < 3 hours before bed
- Avoid drugs affecting oesophageal motility (nitrates, anticholinergics, tricyclic antidepressants) or damage mucosa (NSAIDs, bisphosphonates)
34
What medication can be used to treat GORD
- Antacids e.g. alginates like Gaviscon
| - Proton pump inhibitors e.g. omeprazole, lansoperazole, better than H2 antagonists like ranitidine
35
What surgery can be done to treat GORD
* Only if symptoms are severe and refractory to medical measures and there is severe reflux
* Eg Nissen fundoplication
36
What are the dental features of GORD
* Unpleasant taste
* Enamel erosion
* Maybe exacerbated by treatment with NSAIDs
37
What causes hiatus hernia
Proximal stomach herniates into thorax
38
What types of hiatus hernia are there
Sliding
| Rolling
39
AY BAWS CAN I HABE DE NOTE PLZ
50% of hiatus hernia patients have symptomatic gastro-oesophageal reflux
40
What form of hiatus hernia is the most common
Sliding - 80%
| Rolling - 20%
41
What are the clinical features of sliding hiatus hernia
• Gastro-oesophageal
junction slides into chest
• Often associated with acid reflux
• Lower oesophageal sphincter less competent
42
What are the clinical features of rolling hiatus hernia
* Gastro-oesophageal junction remains in abdomen
* Bulge of stomach herniates into chest alongside oesophagus
* ‘para-oesophageal hernia’
* Acid reflux uncommon
* May strangulate
43
What investigations can be done for hiatus herniae
- Barium swallow
| - Upper GI endoscopy
44
What treatments are there fore hiatus hernia
- Lose weight
- Treat reflux symptoms
- Surgery
45
When is surgical repair used in patients with hiatus hernia
- Intractable symptoms despite maximum medical therapy
- Complications
- Rolling hiatus hernia even if asymptomatic
46
What is Barrett's Oesophagus caused by
Chronic reflux oesophagitis
47
What happens to the epithelium of a patient with barrett's oesophagus
Normal oesophageal squamous epithelial is replaced by columnar gastric epithelium that may be continuous or patchy
48
What does Barrett's oesophagus cause a much higher risk of
Adenocarcinoma of the oesophagus
49
AY BAWS CAN I HABE DE NOTE PLZ
Unlike gastro-oesophageal reflux disease (GORD) there is no link in barrett's oesophagus to Helicobacter pylori
50
Who is mainly affected by oesophageal carcinoma
Typically in men over the age of 50
51
What are some of the oesophageal carcinoma risk factors
- XS alcohol
- Smoking
- Achalasia
- Obesity
- Low vitamin A and C
- GORD
- Nitrosamine exposure
- Barrett's
- Tylosis
52
What are the classic clinical features of oesophageal carcinoma
- Hoarseness, cough
- Dysphagia
- Loss of weight
- Retrosternal chest pain
- Lymphadenopathy occ
53
What sections of the oesophagus can be affected by which types of carcinoma
Upper third - Squamous cell carcinoma
Middle third - Squamous cell carcinoma
Lower third - Adenocarcinoma
54
Which sections of the oesophagus are most commonly affected by carcinomas
Upper third - 20%
Middle third - 50%
Lower third - 30%
55
What is Tylosis characterised by (clinical features pretty much)
- Genetic disorder
- Thickening (hyperkeratosis) of palms and soles
- White patches in the mouth (oral leukoplakia)
- Very high risk of oesophageal cancer
56
What kind of inheritance does tylosis show
Autosomal dominant
57
What are the dental aspects to consider in patients with Tylosis
- Increased chance of developing second cancer in the head and neck
- May occur secondary to patterson-kelly syndrome
- Rarely patients may have tylosis and oral leukoplakia
58
What are some things that can indicated pharyngeal pouches
- Examinations finding are few
- Includes emaciation
- Rarely a swelling might be felt in the neck that may gurgle on palpation (Boyce's)
- Diagnosis on barium swallow
59
What is Killian's Dehiscence and how does it relate to pharyngeal pouches
This is an area of weakness between the thyropharyngeus and then cricopharyngeus, this is where the swelling will appear in the pharyngeal pouch
60
What are the typical signs and symptoms of pharyngeal pouches
- Age over 70
- Dysphagia
- Regurgitation
- Aspiration
- Cough
- borborygmi
- Halitosis
- Hoarseness
61
What is dyspepsia
Non-specific group of symptoms related to upper GI tract
62
What are some non-specific symptoms of dyspepsia
- Epigastric pain maybe related to eating some foods, hunger and time of day
- Heartburn
- maybe associated with bloating and fullness after meals
63
What are the ALARMS/warning signs of non specific symptoms that need to be investigated
- Anaemia
- Loss of weight
- Anorexia
- Recent onset with progressive symptoms
- Melaena or haematemesis
- Swallowing difficulty
64
What is an ulcer
A break in the continuity of an epithelial surface
65
What are some of the risk factors of peptic ulceration
Helicobacter pylori infection
Drugs - aspirin, NSAIDs, corticosteroids
Smoking
Stress
66
Why do drugs like aspirin and dat help to cause peptic ulcers
They reduce prostaglandin production that protects the mucosal surface of the stomach
67
What are the 2 types of peptic ulceration
Gastric
| Duodenal
68
What are the typical clinical features of gastric ulceration
- Mainly elderly
- Affects lesser curve of stomach
- Asymptomatic
- Epigastric pain related to meals and relieved by antacids
- Weight loss
69
What are the typical clinical features of duodenal ulceration
- 4x more common than gastric ulceration
- May be asymptomatic
- Epigastric pain typically before eating or at night
- Relieved by eating or drinking milk
70
What risk factors are there for gastric cancer
- Helicobacter pylori infection
- Cigarette smoking
- Alcohol
- Dietary salt and food preservation
- Dietary fruit and vegetable
- Pernicious anaemia
71
What are some of the clinical presentations of gastric cancer
- Often non-specific and vague
- Typically male smokers aged 60-84 with upper abdominal pain and weight loss
- Nausea
- Dysphagia
- Melaena
- Anaemia
- Virchow's node
- Sister Mary Joseph's nodule
72
What are some alarm features that are suggestive of gastric cancer that need to be investigated immediately
- New onset dyspepsia in patients > 55 years
- Family history of upper GIT cancer
- Unintended weight loss
- Upper or lower GI bleeding
- Progressive dysphagia
- Odynophagia
- Unexplained iron deficiency anaemia
- Persistent vomiting
- Palpable mass or lymphadenopathy
- Jaundice
73
What investigations can be done for gastric cancers
- Endoscopy and biopsy or primary tumour
- At least six biopsy samples from mass and adjacent tissue
- Staging may involve endoscopic ultrasonography (EUS)
- CT abdomen for liver metastases
- PET scan
74
What is haematemesis
Vomiting of blood - may be fresh red or coffee grounds
75
What is Melaena
Black motions with a tarry appearance and smell
76
What are some common causes of haemorrhage/GI bleeding
- Gastritis or gastric erosions
- Duodenitis
- Oesophagitis
- Peptic ulcers
- Drugs - NSAIDs, aspirin, corticosteroids, warfarin, thrombolytics
- Mallory-Weiss tear
- Malignancy
77
What are varices
- Dilated collateral veins at sites of portosystemic anastomosis
78
What are varices in the GIT caused by
Portal hypertension
79
Where are varices most commonly found
Lower oesophagus but also the stomach
80
What is Mallory-Weiss tear/syndrome caused by
Forceful or long-term vomiting or coughing resulting in bleeding via an oesophageal tear
81
What layers of the GIT does a Mallory-Weiss tear affect
The mucosa and submucosa but not the underlying muscular layer
82
What are Mallory-Weiss tears/syndrome associated with
- Alcoholism
- Eating disorders
- Hyperemesis
- Gravidarum
- Epileptic convulsions
- NSAID abuse
83
How are Mallory-Weiss tears treated
- They usually heal themselves without active treatment support with/out PPI or H2 antagonist
- Bleeding usually stops after 24-48 hours
- Endoscopic cauterisation or injection of adrenaline or surgical management or embolisation occasionally required
84
What are the initial management processes of an upper GI bleed
- Protect the airway and give a high flow of O2
- Resuscitate ABC
- 2 large bore cannulae
- FBC, U&E, LFT, crossmatch, clotting
- IV fluids and omeprazole
- Urinary catheter
- Transfuse
- Urgent endoscopy
