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Goljan Gastro > oesophagus, small bowel and large bowel > Flashcards

oesophagus, small bowel and large bowel Flashcards

1
Q

What are the signs and symptoms of oesophageal disease?

A

Heartburn
Dysphasia
-Solids and liquids indicate dysmotility

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2
Q

What does CREST stand for?

A

This is the features of systemic sclerosis

  • Calcinosis
  • Raynaud phenomenom
  • Eosophageal dysmotility
  • Sclerodactyly
  • Telangiectasia
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3
Q

What are the clinical findings in hiatus hernia?

A 
Heartburn
Noctural epigastric distress from reflux
Haematemesis
Ulceration and stricture
Bowel sounds heard over left lung base
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4
Q

What is the treatment for hiatus hernia?

A 
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
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5
Q

What are the signs and symptoms of GORD?

A 
Heartburn
Nocturnal cough/asthma
Acid damage to enamel
Abdominal fullness
bloating/belching
Barrett oesophagus
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6
Q

What is the treatment for GORD?

A

See hiatal hernia

Surgery if indicated - fundoplication - gastric wrap around oesophageal junction

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7
Q

What can cause infectious oesophagitis?

A 
Presents with pain swallowing
Usually in AIDS
can be caused by HSV
Cytomegalovirus 
Oral candida
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8
Q

What is the management for oesophageal varices?

A

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

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9
Q

What is the difference between mallory-weiss syndrome and boerhaave syndrome?

A

Mallory weiss is a mucosal tear that is vertical not full perforation
Boerhaave is a complete perforation - can cause pneumomediastinum

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10
Q

What is the pathogenesis and findings of achalasia?

A

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

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11
Q

What is the diagnosis and treatment of achalasia?

A 
Abnormal barium swallow - bird beak appearance
Non pharmacological
-Pneumatic dilation - opens LOS
-Oesophagomyotomy
Pharacological
-Long acting nitrates
-Calcium channel blockers
-Botulinum toxin injection
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12
Q

What are the common types of oesophageal carcinomas and where do they occur?

A

Small cell carcinoma - upper and middle thirds of oesophagus

Adenocarcinoma - glandular cells - lower third of oesophagus

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13
Q

What are the clinical findings for oesophageal carcinoma?

A

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

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14
Q

What are the T 1 to T 4 types of oesophgeal carcinoma?

A

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

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15
Q

What are some signs and symptoms of stomach disease?

A

haematemesis - ost commonly due to peptic ulcer disease

Melena

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16
Q

What are some causes of acute gastritis?

A 
NSAIDs
Alcohol
helicobacter pylori
CMV
Burns
17
Q

What are the common causes of chronic gastritis?

A

H. Pylori infection - gram negative

Secretes urease and proteases that cause gastritis

18
Q

How is H pylori infection diagnosed?

A

With a urea breath test and stool antigen test

19
Q

What is the staging of stomach cancers?

A 
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
20
Q

What is the most common stomach cancer?

A

Gastric adenocarcinoma

21
Q

What are the signs and symptoms of small bowel disease?

A

Colicky pain - symptom of bowel obstruction
Diarrhea - may how infaction or malabsorption
Anaemia - due to iron, folic acid, B12 malabsorption

22
Q

What are the signs and symptoms of large bowel disease?

A 
Diahrrhea - infection, IBD
Dysentery - bloody diahorrea with mucus
Pain
Tenesmus
Iron deficiency
23
Q

What are some common causes of malabsorption?

A

Pancreatic insufficiency - chronic pancreatitis
Bile salt/acid deficiency
Small bowel disease e.g. coeliac

24
Q

What is the pathogenesis in coeliac disease?

A

T cell and IgA response against gluten causes loss of villus, elongation of crypts and increase in the number of intra-epithelial lymphocytes

25
Q

What is whipples disease?

A

Accumulation of foamy macrophages in the lamina propria that contains bacteria

26
Q

What are the characteristics of crohns vs UC?

A

Crohns is characterised by transmural granulomatous inflammation whereas UC is not transmural and are pseudopolyps. Crohns is skip lesions whereas UC is continous.

27
Q

What is Meckel’s diverticulum? How do you remember it?

A 
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
28
Q

What is the commonest type of tumour in the small bowel?

A

lymphomas

29
Q

What is angiodsyplasia?

A

Vascular malformation that causes - Thin walled blood vessels in the mucosa and submucosa are prone to rupturing

30
Q

What are the commonest polyps of the colon?

A

Hyperplastic polyps they show increased cellularity of crypts with heaped up epithelium

31
Q

What are the commonest tumours of the colon?

A

Adenocarcinomas

32
Q

What are the stages of colon cancer?

A

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

Goljan Gastro (2 decks)

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