Other upper GI pathology Flashcards by Jasmine Aikman

GORD basically is due to __ not closing and raised ___

LOS

intrabdominal pressure

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With GORD if wake up coughing then may be due to

food passing UOS => lungs may => reflux bronchitis

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4 grades of GORD ulceration:

1) less than 5mm
2) greater than 5mm
3) less than 70% of circumference
4) greater than 70% of circumference

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Achalasia =

LOS in spasm and oeso body has poor motility

dysphagia for food and liquid

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diagnosis of achalasia is by ___

manometry to measure P of LOS

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treatment of achalasia =

botox to paralyse LOS

surgery - slit open LOS and tie ends

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Nutcracker oesophagus =

Treatment =

oesophageal spasms with excessive amplification/duration of peristalsis that causes dysphagia
CCBs

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Group of symptoms associated with dyspepsia

post-prandial fullness
epigastric pain/burning
early satiety
bloating

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__% of dyspepsia is organic eg.s of causes =

25% - PUD, NSAIDs, gastric ca

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___% of dyspepsia is functional (ie. ____)

75%

no underlying cause/idiopathic

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Peptic ulcer which is better when eating

duodenal

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Peptic ulcer made worse by eating =

gastric

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H. pylori is the cause of ___% of duodenal and ___% of gastric ulcers

90% duodenal

60% gastric

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Causes of PUD = (4)

H. pylori
NSAIDs
gastric dysmotility
outflow obstruction

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H pylori is a gram __ microaeophilic flagellated ____

-ve

bacillus

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H pylori may cause __+__ gastric cancers

may reduce + cancers

(almost all) non-cardia gastric adenocarcinoma
low grade B cell lymphoma
REDUCE: cardia adenocarcinoma, oeso adenocarcinoma

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If H. pylori is predominant in the antrum and does not cause atrophy then ___ ulcers are caused as gastrin secretion ____ and acid secretion ____

duodenal

increased gastrin + acid production

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If H. pylori is predominant in the body and causes atrophy then acid secretion is ____ and ___ ulcers + ____ is caused as gastrin and acid secretion ___

decreased
gastric ulcers and gastric cancer (adenocarcinoma)
are decreased

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Cag ___ H. pylori are oncogenic
They inhibit ____ which causes increased gastrin
This causes duodenal ___ load to increase => duodenal ____ and H. pylori ___ => ulceration
there is no _____

\+ve
somatostatin
acid
metaplasia
colonisation
body gastritis

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to diagnose H. pylori infection must stop ___ (drug)

and tests = (4)

PPIs
biopsy ( urease test, histology and culture)
urease breath test
FAT - faecal antigen test
serology (IgA)

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Urease test is possitive for H. pylori because

H. pylori produce urease to produce ammonium and bicarbonate

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H. pylori eradication therapy =

side effects =

omeprazole + amox. + clarithromycin
OR
omeprazole + metronidazole + clarithromycin
side effects: nausea and diarrhoea

Follow-up for duodenal+/gastric ulcers after treatment?

duodenal = only if symptomatic
gastric = endoscopy at 6-8wks so no malignancy

Gastroenteritis definition

inflammation of the stomach/intestines =>

decreased nutrient absorption and increased fluid and electrolyte loss

___% of gastroenteritis cases are infectious, mostly __ then __ then ___

85% | mostly viral > bac. > parasites

S. aureus pre-formed toxin related gastroenteritis resolves after ___ There is ___ in faeces

6-10hrs | NO pus or blood

Large outbreaks of this occur on cruise ships | mainly efffects older kids and adults

norovirus

norovirus spread is __

faeco-oral, waterbourne, shell-fish

Incubation period for norovirus signs resolution within

24-48hrs abdominal cramps, abrupt nausea, vom and diarr, myalgia 24-48hrs

acute enteritis presents with (4)

fever, diarrhoea, vomiting, abdominal pain

acute colitis presents with (3)

fever, pain, bloody diarrhoea

Diagnosis of paratyphoid/typhoid is by:

BLOOD cultures | and also stool and urine cultures

Treatment for paratyphoid/typhoid =

azithomycin

There is/is not a vaccine for typhoid+/paratyphoid

IS IV/PO vaccine for typhoid = 70% effective | none for paratyphoid

signs and symptoms of enteric fever-like illness eg. typhoid/paratyphoid

fever rigors pain v little diarrhoea (may have constipation)

Campylobacter infection resolves within ___

5-14 days

Campylobacter infection may cause ___

Guillain-Barre Syndrome = tingling of feet => paralysis of legs, arms and rest of body

If camplyobacter is severe then treat with __

azithro/clarithromycin

Causes of bloody diarrhoea eg.s

IBD malignancy ischaemia infection (causing colitis) eg. Shigella, camplyobacter, E. coli, amoeba

Parasites are diagnosed by:

stool microscopy

salmonella enterica, campylobacter and Shigella are diagnosed by:

stool culture

Stool toxin test is used to diagnose

C. diff and E. coli

norovirus is diagnosed by

PCR

anti-spasmodics/motilities are generally only short-term and not given to elderly or IBD because ___

may cause toxic megacolon

Antibiotics are given for GI infections only if ___ | eg.s of infections given in =

IC, severe, chance of spreading to blood/to others | Typhoid, shigellosis (not sonnei), cholera, C. diff, giardiasis, amoebiasis, invasive salmonellosis

C. diff is a ____ gram ___ spore-forming ___

anaerobic +ve bacillus

4Cs that cause C. diff infection

cephalosporins co-amoxiclav clindamycin ciprofloxacin (quinolones)

In C. diff infections must wash hands with ___

soap and water

drug used for first relapse of C. diff

fidoxamicin

most effective treatment for C. diff in future

FMT (faecal microbiota transplant)

Amoebiasis causes _____ may spread to cause __ diagnosis = treatment =

acute bloody diarrhoea commonly liver abscess serology metronidazole - remove from lumen with diloxanide furoate/paromomycin

Giardiasis causes ___ diarrhoea common in ___ (geographical) diagnosis: treatment:

explosive diarrhoea USSR/ eastern europe stool/duodenal aspirate microscopy metronidazole

Most common cause of traveller's diarrhoea =

E. coli enterotoxin