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CHHD > Medical Problems Involving Upper GI Tract > Flashcards

Medical Problems Involving Upper GI Tract Flashcards

1
Q

What does the GI tract consist of

A
  • oesophagus
  • stomach
  • duodenum
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2
Q

What is dysphagia

A

Difficulty in swallowing

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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

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4
Q

What does painful swallowing indicate

A

Suggests oesophageal cancer, ulcer, spasm, candidiasis

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5
Q

What does difficulty making the swallowing movement suggest

A

Suspect ‘bulbar’ palsy (especially if swallowing

causes coughing)

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6
Q

What does difficulty to swallow solids and liquids from the outset indicate

A

Motility disorder or pharyngeal cause

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7
Q

What does intermittent dysphagia suggest

A

Oesophageal spasms

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8
Q

What does constant and declining dysphagia indicate

A

malignant stricture

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9
Q

What does the neck bulging or gurgling on swallowing indicate

A

Pharyngeal pouch

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10
Q

What malignant strictures can cause dysphagia

A

Pharyngeal stricture
Oesophageal stricture
Gastric cancer

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11
Q

What benign strictures can cause dysphagia

A

Oesophageal web or ring

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12
Q

What extrinsic pressure can cause dysphagia

A

Lung cancer
Retrosternal goitre
Aortic aneurysm
Left atrial enlargement

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13
Q

What motility disorders can cause dysphagia

A
  • Achalasia
  • Diffuse oesophageal spasm
  • Systemic sclerosis
  • Myasthenia gravis
  • Bulbar / pseudobulbar palsy
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14
Q

What can cause dysphagia that isn’t a mechanical block or motility disorder

A
  • Oesophagitis

* Globus hystericus

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15
Q

What is affected in myasthenia gravis

A

Autoimmune condition involving antibodies to ACh receptors, affects neuromuscular transmission

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16
Q

What are the signs of myasthenia gravis

A

Increasing muscular fatigue - Extraocular > Bulbar > face > neck > limbs

Ptosis - early sign

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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
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18
Q

What are some of the causes of bulbar palsy

A
  • Motor Neuron Disease
  • Synringobulbia
  • Myasthenia gravis
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19
Q

Who does paterson-jelly syndrome happen most commonly in

A

Females

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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
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21
Q

What is Achalasia a problem with

A
  • The lower oesophageal sphincter as it fails to relax
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22
Q

What degenerates in Achalasia

A

Degeneration of the Myenteric Plexus

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23
Q

What are the symptoms of Achalasia

A

Dysphagia
Regurgitation
Substernal cramps
Weight loss

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24
Q

What can be done to show the oesophageal dilatation

A

Barium swallowing

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25
Q

What is Achalasia a risk factor for

A

Oesophageal cancer

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26
Q

What is GORD

A

Gastro-Oesophageal reflux disease

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27
Q

What’s wrong with you in GORD

A

You reflux the stomach contents causing troublesome symptoms with at least two heartburn episodes each week

Associated with dysfunction of lower oesophageal sphincter

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28
Q

What are the potential sequelae for GORD if its prolonged/excessive

A
  • Oesophagitis
  • Benign oesophageal strictures
  • Barrett’s oesophagus
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29
Q

What are some predisposing factors for GORD

A
  • Hiatus Hernia
  • Lower oesophageal sphincter hypotension
  • Loss of oesophageal peristaltic function
  • Gastric acid hypersecretion
  • Delayed gastric emptying
  • Overeating
  • Smoking
  • Alcohol
  • Pregnancy
    Theres more
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30
Q

What are the oesophageal GORD symptoms

A
  • Heartburn
  • Belching
  • Acid brash (acid or bile reflux)
  • Water brash (excessive salivation)
  • Odynophagia (painful swallowing)
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31
Q

What are the extra-oesophageal GORD symptoms

A
  • Nocturnal asthma
  • Chronic cough
  • Laryngitis (hoarseness, throat clearing)
  • Sinusitis
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32
Q

What are some of the potential complications of GORD

A
  • Oesophagitis
  • Ulcers
  • Benign stricture
  • Barrett’s oesophagus
  • Oesophageal adenocarcinoma
  • Iron Deficiency anaemia
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33
Q

What lifestyle treatments can be used to treat GORD

A
  • 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)
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34
Q

What medication can be used to treat GORD

A
  • Antacids e.g. alginates like Gaviscon

- Proton pump inhibitors e.g. omeprazole, lansoperazole, better than H2 antagonists like ranitidine

35
Q

What surgery can be done to treat GORD

A
  • Only if symptoms are severe and refractory to medical measures and there is severe reflux
  • Eg Nissen fundoplication
36
Q

What are the dental features of GORD

A
  • Unpleasant taste
  • Enamel erosion
  • Maybe exacerbated by treatment with NSAIDs
37
Q

What causes hiatus hernia

A

Proximal stomach herniates into thorax

38
Q

What types of hiatus hernia are there

A

Sliding

Rolling

39
Q

AY BAWS CAN I HABE DE NOTE PLZ

A

50% of hiatus hernia patients have symptomatic gastro-oesophageal reflux

40
Q

What form of hiatus hernia is the most common

A

Sliding - 80%

Rolling - 20%

41
Q

What are the clinical features of sliding hiatus hernia

A

• Gastro-oesophageal
junction slides into chest
• Often associated with acid reflux
• Lower oesophageal sphincter less competent

42
Q

What are the clinical features of rolling hiatus hernia

A
  • Gastro-oesophageal junction remains in abdomen
  • Bulge of stomach herniates into chest alongside oesophagus
  • ‘para-oesophageal hernia’
  • Acid reflux uncommon
  • May strangulate
43
Q

What investigations can be done for hiatus herniae

A
  • Barium swallow

- Upper GI endoscopy

44
Q

What treatments are there fore hiatus hernia

A
  • Lose weight
  • Treat reflux symptoms
  • Surgery
45
Q

When is surgical repair used in patients with hiatus hernia

A
  • Intractable symptoms despite maximum medical therapy
  • Complications
  • Rolling hiatus hernia even if asymptomatic
46
Q

What is Barrett’s Oesophagus caused by

A

Chronic reflux oesophagitis

47
Q

What happens to the epithelium of a patient with barrett’s oesophagus

A

Normal oesophageal squamous epithelial is replaced by columnar gastric epithelium that may be continuous or patchy

48
Q

What does Barrett’s oesophagus cause a much higher risk of

A

Adenocarcinoma of the oesophagus

49
Q

AY BAWS CAN I HABE DE NOTE PLZ

A

Unlike gastro-oesophageal reflux disease (GORD) there is no link in barrett’s oesophagus to Helicobacter pylori

50
Q

Who is mainly affected by oesophageal carcinoma

A

Typically in men over the age of 50

51
Q

What are some of the oesophageal carcinoma risk factors

A
  • XS alcohol
  • Smoking
  • Achalasia
  • Obesity
  • Low vitamin A and C
  • GORD
  • Nitrosamine exposure
  • Barrett’s
  • Tylosis
52
Q

What are the classic clinical features of oesophageal carcinoma

A
  • Hoarseness, cough
  • Dysphagia
  • Loss of weight
  • Retrosternal chest pain
  • Lymphadenopathy occ
53
Q

What sections of the oesophagus can be affected by which types of carcinoma

A

Upper third - Squamous cell carcinoma
Middle third - Squamous cell carcinoma
Lower third - Adenocarcinoma

54
Q

Which sections of the oesophagus are most commonly affected by carcinomas

A

Upper third - 20%
Middle third - 50%
Lower third - 30%

55
Q

What is Tylosis characterised by (clinical features pretty much)

A
  • Genetic disorder
  • Thickening (hyperkeratosis) of palms and soles
  • White patches in the mouth (oral leukoplakia)
  • Very high risk of oesophageal cancer
56
Q

What kind of inheritance does tylosis show

A

Autosomal dominant

57
Q

What are the dental aspects to consider in patients with Tylosis

A
  • 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
Q

What are some things that can indicated pharyngeal pouches

A
  • 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
Q

What is Killian’s Dehiscence and how does it relate to pharyngeal pouches

A

This is an area of weakness between the thyropharyngeus and then cricopharyngeus, this is where the swelling will appear in the pharyngeal pouch

60
Q

What are the typical signs and symptoms of pharyngeal pouches

A
  • Age over 70
  • Dysphagia
  • Regurgitation
  • Aspiration
  • Cough
  • borborygmi
  • Halitosis
  • Hoarseness
61
Q

What is dyspepsia

A

Non-specific group of symptoms related to upper GI tract

62
Q

What are some non-specific symptoms of dyspepsia

A
  • Epigastric pain maybe related to eating some foods, hunger and time of day
  • Heartburn
  • maybe associated with bloating and fullness after meals
63
Q

What are the ALARMS/warning signs of non specific symptoms that need to be investigated

A
  • Anaemia
  • Loss of weight
  • Anorexia
  • Recent onset with progressive symptoms
  • Melaena or haematemesis
  • Swallowing difficulty
64
Q

What is an ulcer

A

A break in the continuity of an epithelial surface

65
Q

What are some of the risk factors of peptic ulceration

A

Helicobacter pylori infection
Drugs - aspirin, NSAIDs, corticosteroids
Smoking
Stress

66
Q

Why do drugs like aspirin and dat help to cause peptic ulcers

A

They reduce prostaglandin production that protects the mucosal surface of the stomach

67
Q

What are the 2 types of peptic ulceration

A

Gastric

Duodenal

68
Q

What are the typical clinical features of gastric ulceration

A
  • Mainly elderly
  • Affects lesser curve of stomach
  • Asymptomatic
  • Epigastric pain related to meals and relieved by antacids
  • Weight loss
69
Q

What are the typical clinical features of duodenal ulceration

A
  • 4x more common than gastric ulceration
  • May be asymptomatic
  • Epigastric pain typically before eating or at night
  • Relieved by eating or drinking milk
70
Q

What risk factors are there for gastric cancer

A
  • Helicobacter pylori infection
  • Cigarette smoking
  • Alcohol
  • Dietary salt and food preservation
  • Dietary fruit and vegetable
  • Pernicious anaemia
71
Q

What are some of the clinical presentations of gastric cancer

A
  • 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
Q

What are some alarm features that are suggestive of gastric cancer that need to be investigated immediately

A
  • 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
Q

What investigations can be done for gastric cancers

A
  • 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
Q

What is haematemesis

A

Vomiting of blood - may be fresh red or coffee grounds

75
Q

What is Melaena

A

Black motions with a tarry appearance and smell

76
Q

What are some common causes of haemorrhage/GI bleeding

A
  • Gastritis or gastric erosions
  • Duodenitis
  • Oesophagitis
  • Peptic ulcers
  • Drugs - NSAIDs, aspirin, corticosteroids, warfarin, thrombolytics
  • Mallory-Weiss tear
  • Malignancy
77
Q

What are varices

A
  • Dilated collateral veins at sites of portosystemic anastomosis
78
Q

What are varices in the GIT caused by

A

Portal hypertension

79
Q

Where are varices most commonly found

A

Lower oesophagus but also the stomach

80
Q

What is Mallory-Weiss tear/syndrome caused by

A

Forceful or long-term vomiting or coughing resulting in bleeding via an oesophageal tear

81
Q

What layers of the GIT does a Mallory-Weiss tear affect

A

The mucosa and submucosa but not the underlying muscular layer

82
Q

What are Mallory-Weiss tears/syndrome associated with

A
  • Alcoholism
  • Eating disorders
  • Hyperemesis
  • Gravidarum
  • Epileptic convulsions
  • NSAID abuse
83
Q

How are Mallory-Weiss tears treated

A
  • 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
Q

What are the initial management processes of an upper GI bleed

A
  • 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

CHHD (27 decks)

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