oesophag + anus Flashcards
Severe vomiting –> painful mucosal lacerations @GOJ –> Haematemesis
No systemic disturbance or prior symptoms.
Mallory-Weiss Tear
Often longstanding history of dyspepsia, patients are often OVERWEIGHT. What should NOT be associated with dysphagia or haematemesis.
Hiatus Hernia Uncomplicated hiatus hernias should not be associated with dysphagia or haematemesis.
history of vomiting
severe chest pain
WITHOUT cardiac diagnosis
pneumonia signs without convincing history
Erect CXR shows infiltrate or effusion in 90% of cases
Oesopghageal rupture - Complete disruption of the oesophageal wall in absence of per-existing pathology.
Left postero-lateral oesophageal is commonest site (2-3cm from OG junction).
Progressive dysphagia + WL Usually little or NO history of previous GORD type symptoms.
Squamous cell carcinoma of the oesophagus
Progressive dysphagia, may have previous symptoms of GORD or Barretts oesophagus treated for COPD #smoker macrocytosis and high GGT #alcoholic .
Adenocarcinoma of the oesophagus
Longgggggg history of dysphagia,
Non-progressive.
Usually symptoms of GORD.
Peptic stricture
similar to dysmotility dx…?
dysphagia = episodic
non progressive.
Retrosternal pain may accompany the episodes.
Dysmotility disorder
similar to peptic sticture..??
Triad of:
dysphagia (secondary to oesophageal webs)
glossitis
iron-deficiency anaemia
Treatment includes iron supplementation and dilation of the webs
Plummer-Vinson syndrome
Severe vomiting → painful mucousal lacerations at the gastroesophageal junction resulting in haematemesis. Common in alcoholics
Mallory-Weiss syndrome
Severe vomiting → oesophageal rupture
Boerhaave syndrome
Painful, bright red rectal bleeding post defecation Poss skin tag at 6/12 o clock midline position Assoc with Crohns/UC Below dentate line
Fissure in ano Stool softeners, topical CCB dili/GTN, botulinum toxin, Sphincterotomy
Painless, bright red rectal bleeding ppst defecation and bleeds onto the toilet paper and into the toilet pan Constipation Hx poss!
Haemorroids
May initially present with an abscess and thennnnnnnnn persisting discharge onto the perineum, separate from the anus!!!!
Fistula - SETON MRI
Peri anal swelling and surrounding erythema Ssevere pain in Ano-rectum + fever
Peri anal/ano-rectal abscess Incision and drainage, leave the cavity open to heal by secondary intention
frank haematemesis/altered blood MIXED with vomit.
dyspepsia
nausea and vomiting
anorexia and weight loss
dysphagia
55+ dysphagia OR WL/APain/GORD/Dyspepsia tx fail
55+ Plts+N&V/WAGD // APain/Anemia // N&V+WL/APain/GORD/DyspepsiaTxFail
Gastric cancer
Often NO prodromal features prior to haematemesis and malaena, but this AVM may produce quite considerable haemorrhage and may be difficult to detect endoscopically
Dieulafoy Lesion
Usually haematemesis and epigastric discomfort. Usually there is an underlying cause such as recent NSAID usage. Large volume haemorrhage may occur with considerable haemodynamic compromise
Diffuse erosive gastritis
Small low volume bleeds = more common so would tend to present as iron deficiency anaemia. Erosion into a significant vessel may produce considerable haemorrhage and haematemesis. PAIN @ eating
Gastric ulcer
Difficulty swallowing, dysphagia to both LIQUIDS & SOLIDS!!!!!! and sometimes chest pain Usually caused by failure of distal oesphageal inhibitory neurones
Diagnosis is by pH and manometry studies together with contrast swallow and endoscopy Treatment is with either botulinum toxin, pneumatic dilatation or cardiomyotomy
Achalasia WL Regurg Dysphasia Manometry contrast swallow = dilated tapered oesophagus Balloon Endo dilation – > cardio myotomy + PPI
Diagnosis is by pH and manometry studies together with contrast swallow and endoscopy Treatment is with either botulinum toxin, pneumatic dilatation or cardiomyotomy
Symptoms include dysphagia, retrosternal discomfort and dyspepsia May show ‘nutcracker oesophagus’ on barium swallow
Diffuse oesophageal spasm Spectrum of oesophageal motility disorders Caused by uncoordinated contractions of oesphageal muscles
Tearing interscapular pain Discrepancy in arterial blood pressures taken in both arms May show mediastinal widening on chest x-ray
Dissection of thoracic aorta
Symptoms of obstructed pooing Assoc with childbirth and rectal intususception Either int/ext
Rectal prolapse
Bright red rectal bleed Hx of IBS Assoc w/ chronic straining and constipation. indurated ulcer located anteriorly approximately 4cm from the dentate line Histology = mucosal thickening, lamina propria replaced with collagen and smooth muscle Fibromuscular obliteration @ sigmoidoscopy
Solitary rectal ulcer syndrome
Odynophagia painful swallow unpleasant’ retrosternal sensation Poss dyspepsia Hx
Oesophagitis
