oesophagus, small bowel and large bowel Flashcards
What are the signs and symptoms of oesophageal disease?
Heartburn
Dysphasia
-Solids and liquids indicate dysmotility
What does CREST stand for?
This is the features of systemic sclerosis
- Calcinosis
- Raynaud phenomenom
- Eosophageal dysmotility
- Sclerodactyly
- Telangiectasia
What are the clinical findings in hiatus hernia?
Heartburn Noctural epigastric distress from reflux Haematemesis Ulceration and stricture Bowel sounds heard over left lung base
What is the treatment for hiatus hernia?
Non-pharmacological -Avoid foods that reduce lower oesophageal sphincter tone e.g. cofee, chocolate -Sleep with head of bed elevated -Avoid eating large quantities of food Pharmacological -H2 antagonists -PPI Surgery if indicated
What are the signs and symptoms of GORD?
Heartburn Nocturnal cough/asthma Acid damage to enamel Abdominal fullness bloating/belching Barrett oesophagus
What is the treatment for GORD?
See hiatal hernia
Surgery if indicated - fundoplication - gastric wrap around oesophageal junction
What can cause infectious oesophagitis?
Presents with pain swallowing Usually in AIDS can be caused by HSV Cytomegalovirus Oral candida
What is the management for oesophageal varices?
Endoscopy to diagnose/ can treat - ligation, scerotherapy
Insert NG tube to gastric lavage and can assess rate of bleeding
Beta blockers decerase rate of recurrence
TIPS - transjugular intrahepatic portasystemic shunt can be used
What is the difference between mallory-weiss syndrome and boerhaave syndrome?
Mallory weiss is a mucosal tear that is vertical not full perforation
Boerhaave is a complete perforation - can cause pneumomediastinum
What is the pathogenesis and findings of achalasia?
This is when there is loss of the myenteric nerve fibres which causes dilation of the oesophagus with absent peristalsis
Clinical findings:
-nocturnal regurgitation of undigested food
-dysphasia for solids and liquids
-chest pain and heartburn
-frequent hiccups
-nocturnal cough from aspiration
What is the diagnosis and treatment of achalasia?
Abnormal barium swallow - bird beak appearance Non pharmacological -Pneumatic dilation - opens LOS -Oesophagomyotomy Pharacological -Long acting nitrates -Calcium channel blockers -Botulinum toxin injection
What are the common types of oesophageal carcinomas and where do they occur?
Small cell carcinoma - upper and middle thirds of oesophagus
Adenocarcinoma - glandular cells - lower third of oesophagus
What are the clinical findings for oesophageal carcinoma?
Dysphagia for solids initially
rapid weight loss
Painless enlarged supraclvicular lymph nodes
Dry cough and haemoptysis - tracheal invasion
Hoarseness - laryngeal nerve invasion
Hypercalcaemia - parathyroid hormone released by cancer
What are the T 1 to T 4 types of oesophgeal carcinoma?
T1 - confined to submucosa
T2 - Invasion into the muscularis propria
T3 - invasion into the peri-oesophageal adventitia
T4 - invasion into the pleua, pericardium and other organs
What are some signs and symptoms of stomach disease?
haematemesis - ost commonly due to peptic ulcer disease
Melena
What are some causes of acute gastritis?
NSAIDs Alcohol helicobacter pylori CMV Burns
What are the common causes of chronic gastritis?
H. Pylori infection - gram negative
Secretes urease and proteases that cause gastritis
How is H pylori infection diagnosed?
With a urea breath test and stool antigen test
What is the staging of stomach cancers?
T1 - confined to submucosa T2 - Invasion into the muscularis propria T3 - invasion into the subserosa T4a - invasion onto the peritoneum T4b - invasion into other organs
What is the most common stomach cancer?
Gastric adenocarcinoma
What are the signs and symptoms of small bowel disease?
Colicky pain - symptom of bowel obstruction
Diarrhea - may how infaction or malabsorption
Anaemia - due to iron, folic acid, B12 malabsorption
What are the signs and symptoms of large bowel disease?
Diahrrhea - infection, IBD Dysentery - bloody diahorrea with mucus Pain Tenesmus Iron deficiency
What are some common causes of malabsorption?
Pancreatic insufficiency - chronic pancreatitis
Bile salt/acid deficiency
Small bowel disease e.g. coeliac
What is the pathogenesis in coeliac disease?
T cell and IgA response against gluten causes loss of villus, elongation of crypts and increase in the number of intra-epithelial lymphocytes
What is whipples disease?
Accumulation of foamy macrophages in the lamina propria that contains bacteria
What are the characteristics of crohns vs UC?
Crohns is characterised by transmural granulomatous inflammation whereas UC is not transmural and are pseudopolyps. Crohns is skip lesions whereas UC is continous.
What is Meckel’s diverticulum? How do you remember it?
This is a remenant of an embryonic duct causing an outpouching of the gut 2222 2 inches long 2 feet proximal to the iliocoecal valce 2% of population 2% symptomatic
What is the commonest type of tumour in the small bowel?
lymphomas
What is angiodsyplasia?
Vascular malformation that causes - Thin walled blood vessels in the mucosa and submucosa are prone to rupturing
What are the commonest polyps of the colon?
Hyperplastic polyps they show increased cellularity of crypts with heaped up epithelium
What are the commonest tumours of the colon?
Adenocarcinomas
What are the stages of colon cancer?
pT1 Confined to the submucosa
pT2 Invasion into, but not through, the muscularis propria
pT3 Invasion into the subserosa
pT4 Invasion onto the peritoneal surface or adjacent organs
