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HHD 2 > Peptic Disease and GI Cancer > Flashcards

Peptic Disease and GI Cancer Flashcards

1
Q

What is GORD (gastro-oesophageal reflex disorder)?

A

these are symptoms or complications resulting from the reflux of gastric contents into the oesophagus or beyond, into the oral cavity (including the larynx) or lung.

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2
Q

_____% of all westerners are affected by GORD

A

10-20

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3
Q

What is the pathological cause of GORD?

A

relaxation of the lower oesophageal sphincter which causes the reflux of gastric contents into the oesophagus

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4
Q

What are the presentations of GORD?

A

dyspepsia (heartburn)
acid regurgitation
laryngitis
globus
enamel erosion
halitosis

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5
Q

What can exacerbate symptoms of dyspepsia?

A

worse on lying or bending over
worse after meals
worse at night

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6
Q

What does globus refer to ?

A

the feeling that something is blocking your throat (oesophagus)
it is the perceived ability to swallow

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7
Q

What are the risk factors for GORD?

A

Obesity
Hiatus hernia
genetic component
alcohol
smoking
stress
pregnancy- due to increased pressure on abdominal contents
coffee
fatty foods
Calcium channel blockers

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8
Q

What is a hiatus hernia?

A

this is when the actual top of the stomach herniates up into the chest cavity

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9
Q

What is the first line management of GORD?

A

trial of proton pump inhibitors- completely blocks all acid production
lifestyle changes

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10
Q

What is the MOA of proton pump inhibitors?

A

they essentially function to block/stop the secretion of gastric acid (HCl) by the parietal cells

they do this by binding and blocking the action of the H+/K+ ATPase on the luminal surface of the parietal cells
Thus inhibiting secretion of gastric acid.

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11
Q

What investigations can you carry our for a GORD diagnosis?

A

Oseophagogastrodueodenoscopy (OGD)- using a telescope

Amulatory pH monitoring

Barium swallow to see any narrowing, scarring or blockage

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12
Q

What management can be considered for ongoing symptoms of GORD?

A

Surgery (fundoplication)
H2 antagonist

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13
Q

What is a Nissen Fundoplication and how is it useful in managing GORD?

A

a fundoplication is the narrowing of the oesophagus, the top end of the stomach (fundus) is wrapped around the bottom end of the oesophagus to create a narrowing and replace the (failed) oesophageal sphincter

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14
Q

What is an adjunct of the Nissen Fundoplication?

A

H2 antagonist

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15
Q

What is the MOA of H2 antagonists?

A

the bind to and block histamine H2 receptors located on gastric parietal cells.

Histamine is one of the mechanisms through which gastric acid is secreted from parietal cells. Binding of histamine can stimulate the action of H+/K+ ATPase (this increasing acid production)

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16
Q

What are the complications of GORD?

A

oesophageal cancer
haemorrhage
perforation
oesophageal stricture
Barretts oesophagus
adenocarcinoma of oesophagus

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17
Q

What is an adenocarcinoma?

A

malignancy associated with glandular cells

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18
Q

What is metaplasia?

A

changes of a normal oral flora into pre-malignant tissues

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19
Q

What is dysplasia?

A

a bad growth

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20
Q

What is barretts oesophagus?

A

this is a change in the squamous epithelium of the oesophagus to columnar epithelium (metaplasia)

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21
Q

What is barretts oesophagus associated with?

A

GORD

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22
Q

How is barretts oesophagus diagnosed?

A

diagnosis is histological
histology would demonstrate intestinal columnar lined epithelium with or without goblet cells

((columnar cells with goblet cells are endogenous to intestine))

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23
Q

There is an increased risk of adenocarcinoma with barretts oesophagus. True or false

A

true

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24
Q

Briefly state the stages of development of an adenocarcinoma of the oesophagus

A

((remember adenocarcinoma of the oesophagus would indicate that there has been a change to glandular as opposed to previous squamous epithelial tissue)

Squamous epithelium
Inflammation
Ulceration
Healing
Barretts columnar epitheliym
low dysplasia
high dysplasia
cancer

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25
What is a peptic ulcer?
this is a break in the epithelial mucosal lining of the stomach or duodenum (25cm) of more than 5mm in diameter with depth of the submucosa. Does not extend into muscularis
26
What factors offer cytoprotection to the cells in the GI tract/promote mucosal defence?
((cytoprotection is why we do not feel the effects of the acid)) Prostaglandins Mucous Mucosal blood flow bicarbonate
27
Ulcers occur as a result of the reduction in cytoprotection. True or false
True not a result of increased acid production
28
What factors promote mucosal damage and loss of cytoprotection?
gastric acid pepsin H pylori NSAIDs - reduce prostaglandin production
29
What is the presentation of peptic ulcers?
abdominal pain "pointing sign"- showing site of pain with one finger epigastric tenderness nausea and vomiting weight loss haematemesis (blood in vomit) malaena (bleeding in faeces) perforation
30
Haematemesis is often an indication of what kind of bleeding in peptic ulcers ?
faster bleeding
31
Malanea is often an indication of what kind of bleeding in peptic ulcers?
slower bleeding
32
What is the management of an actively bleeding ulcer?
ABCD resuscitation 2x wide bore cannulas (fluid delivery) Blood resuscitation Endoscopy proton pump inhibitors (IV)- helps stop the bleeding- stops acid production, protects cells, stops bleeding
33
What is the management of peptic ulcers with no bleeding that are also H. Pylori negative?
treat underlying cause of the peptic ulcer avoid using NSAIDs PPI H2 antagonist (prevents stimulation of acid production)
34
What is the management of peptic ulcers with no bleeding but H.pylori positive?
treat underlying cause of peptic ulcer avoid NSAIDs H. Pylori eradication therapy
35
How does H. pylori damage encourage development of peptic ulcers?
they damage mucous protection (against acid)
36
What type of bacterium is helicobacter pylori?
a gram negative microaerophilic bacterium
37
___% of individuals affected with H. pylori are asymptomatic
80
38
What is the MOA of H. pylori in damaging mucosa?
it penetrates the mucoid lining of the stomach to find less acidic region urease of bacteria breaks down urea into CO2 and ammonia which is toxic to cells. immune response is triggered to the presence of the bacteria which in response increased acid production. More acid is present in the duodenum
39
There is an increased prevalence of oesophageal cancer in what regions of the world?
afro-carribean and far eastern populations
40
Adenocarcinoma is a disease of _________ countries
developed
41
There is a _________ dominance for oesophageal cancer (gender)
male
42
Squamous cell carcinoma is a disease of __________ countries
developing risk increases with smoking and alcohol
43
What are the main types of oesophageal cancer?
squamous cell carcinoma adenocarcinoma
44
What are the risk factors for oesophageal cancers?
alcohol GORD smoking barrets oesophagus - associated with adenocarcinoma oesophageal cancers
45
Where are squamous cell oesophageal cancers usually located?
usually halfway down the oesophagus
46
Where are adenocarcinoma oesophageal cancers usually located?
tend to be at the bottom end of the oesophagus where acid is refluxing Ulcers then lead to barretts oesophagus which is associated with adenocarcinomas of the oesophagus
47
What is the presentation of oesophageal cancers?
weight loss- due to pain on swallowing cachexia- weakness/wasting progressive dysphagia (solids >fluids) odynophagia (painful sensation in relation to swallowing) hoarse voice
48
What is the survival rate for oesophageal cancers according to cancer research UK?
5 year survival rate in 15% of cases
49
What investigations can be carried out to diagnose oesophageal cancers?
OGD (oesophagogastroduodenoscopy) CT thorax, abdominal MRI thorax abdominal Ultrasound (can include ultrasound of liver for metastatic stread)
50
What is the metastatic spread of oesophageal cancer (common sites of metastasis)?
lymph nodes liver lungs bone
51
What is the management of low grade oesophageal cancer?
endoscopic resection +/- ablation (removal) MI (minimally invasive) oesophagectomy
52
What is the management of middle grade oesophageal cancer?
surgical resection (if surgical candidate) Chemo or radio monotherapy (one or the other)
53
What is the management of advanced oesophageal cancer?
chemo AND radiotherapy palliative stent to ease swallowing
54
What is the most common type of stomach cancer?
adenocarcinomas
55
What are the other types of stomach cancer?
Lymphoma (lympoid tissue, MALT?) Leiomyosarcoma NETs (neuroendocrine tumours) squamous cell carcinoma
56
There is a higher incidence of stomach cancer in what part of the world?
East Asia Eastern Europe South America
57
What is the usual age of onset for stomach cancer?
50-70 years
58
What are the risk factors of stomach cancer?
Pernicious anaemia H. Pylori Cured meats (N- nitrosos compounds)-nitrosamines are keratogenic Smoking (evidence is not strong)
59
What is pernicious anaemia?
autoimmune condition that affects the stomach. Involves gastritis, atrophy of body and fundus of the stomach which leads to loss of normal gastric glands, mucosal architecture, and parietal and chief cells (pepsinogen). disease in red blood cells that occurs when intestines are unable to absorb B12 usually due to lack of intrinsic factor (IF) leads to macrocytic anaemia
60
What are some causes of pernicious anaemia?
genetic susceptibility H. pylori
61
What are the symptoms of pernicious anaemia ?
peripheral sensory neuropathy yellow-blue blindness depression paranoi dementioa hearth failure multiple infections
62
Pernicious anaemia is often described as a disease of the _________.
elderly
63
What are the presentations of stomach cancer?
abdominal pain weight loss lymphadenopathy GI bleed (uncommon) Virchows node- lymphatic drainage from abdominal cavity Sister Mary Joseph nodule- transperitoneal spread (metastatic spread)
64
What is the prognosis of stomach cancer in the UK according to Cancer Research UK
5 year survival in 19 % of cases
65
What is the management of low grade stomach cancer?
surgical resection peri-or post operative chemo
66
What is the management of middle grade stomach cancer?
chemoradiation
67
What is the management of advanced stomach cancer?
chemoradiation palliative gastrectomy
68
What is the metastatic spread of stomach cancer?
lymph nodes liver lungs bone peritoneum
69
Majority of colorectal cancers are ___________. (type of cancer)
adenocarcinomas
70
What percentage of colorectal cancers occur in the colon?
71%
71
What percentage of colorectal cancers occurs in the rectum?
29%
72
What is the greatest risk factor for colorectal cancers?
age
73
99% of colorectal cancer cases occur in what age group ?
>40 years
74
What are the genetic components of colorectal cancers?
familial adenopolyposis hereditary non-polpyosis colorectal cancer (polyps not present)
75
What are the environmental risk factors for colorectal cancers?
age obesity red meat consumption low fibre diet
76
What is the pattern of inheritance for familial adenopolyposis (FAP)?
autosomal dominant only one copy of the gene required for phenotype/disease to be expressed
77
What is the gene affected in FAP?
APC
78
What is the characteristic presentation of FAP?
multiple benign polyps of the large intestine
79
What is the pattern of inheritance for Hereditary Non-polyposis colorectal cancer (HNPCC)?
Autosomal dominant
80
What gene is affected in HNPCC?
MSH gene
81
HNPCC can affect what areas?
endometrial ovary stomach
82
What does the 2 hit hypothesis refer to (colorectal cancer) ?
meets epigenetics There is usually a familial genetic disposition (mutation in tumour suppressor genes) as well as a sporadic mutation in the other allele
83
What is the pathophysiology of colorectal cancer?
normal epithelium early adenoma intermediate adenoma late adenoma carcinoma
84
What is the presentation of colorectal cancer?
rectal bleeding change in bowel habit tenesmus (feeling that you need to pass stool even though your bowels are empty) abdominal mass anaemia weight loss
85
What is the metastatic spread of colorectal cancer?
lymph nodes liver lungs bone brain
86
How is colorectal cancer screened for?
Faecal occult blood test Every 2 years for 60-74 years >75 screening test is available on request
87
What is the next step after a faecal occult blood test with an abnormal result?
colonoscopy
88
There ware many variations of bowel cancer management. What are these variations dependent on ?
stage patient suitability
89
Give some examples of bowel cancer management strategies
surgical resection stending chemotherapy radiotherapy (adjuvant and neoadjuvant)
90
What are the oral complications of cancer treatment ?
oral mucositis infection xerostomia/salivary gland dysfunction functional disabilities taste alterations nutritional compromise abnormal dental development
91
What are oral complications of chemotherapy specifically?
neurotoxicity- can mimic tooth ache bleeding
92
What are oral complications of radiotherapy specifically?
osteonecrosis trismus (lockjaw, spasms of muscles of mastication) / tissue fibrosis radiation caries- tooth decay as as a result of radiation induced dry mouth
93
What is metastasis ?
development of secondary malignant growth distant from primary site of cancer
94
What are the routes of cancer metastasis?
direct haematogenous (via blood) lymphatic (via lymph) transcolemic e.g. via peritoneal cavity
95
What are the common metastatic sites of breast cancer?
bone lung lymph node liver brain
96
What are the common metastatic sites of prostate cancer?
bone lymph node lung brain liver
97
What are the common metastatic sites of colorectal cancer?
liver lung bone brain
98
What are the common metastatic sites of lung cancer?
lung adrenal gland bone brain liver
99
TNM staging; T refers to ...
size of tumour graded 1-4
100
TNM staging; N refer to ...
node (lymph node presence) 0-3
101
TNM staging; M refer to ...
Metastasis 0-1
102
What does the number staging for cancer refer to?
stage 0- carcinoma in situ, early stage I- localised stage II- early locally advanced stage III- late locally advanced Stage IV- metastasised
103
What are the types of cancer staging ?
TNM staging Number staging (1-5) Specific staging
104
Give examples of specific staging
Duke's staging in colorectal cancer Breslow staging in melanoma
105
What cancer staging method is most commonly used to stage cancers?
TNM system

HHD 2 (37 decks)

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