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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
Q

What is a peptic ulcer?

A

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

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26
Q

What factors offer cytoprotection to the cells in the GI tract/promote mucosal defence?

A

((cytoprotection is why we do not feel the effects of the acid))

Prostaglandins
Mucous
Mucosal blood flow
bicarbonate

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27
Q

Ulcers occur as a result of the reduction in cytoprotection. True or false

A

True
not a result of increased acid production

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28
Q

What factors promote mucosal damage and loss of cytoprotection?

A

gastric acid
pepsin
H pylori
NSAIDs - reduce prostaglandin production

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29
Q

What is the presentation of peptic ulcers?

A

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

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30
Q

Haematemesis is often an indication of what kind of bleeding in peptic ulcers ?

A

faster bleeding

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31
Q

Malanea is often an indication of what kind of bleeding in peptic ulcers?

A

slower bleeding

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32
Q

What is the management of an actively bleeding ulcer?

A

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

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33
Q

What is the management of peptic ulcers with no bleeding that are also H. Pylori negative?

A

treat underlying cause of the peptic ulcer
avoid using NSAIDs
PPI
H2 antagonist (prevents stimulation of acid production)

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34
Q

What is the management of peptic ulcers with no bleeding but H.pylori positive?

A

treat underlying cause of peptic ulcer
avoid NSAIDs
H. Pylori eradication therapy

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35
Q

How does H. pylori damage encourage development of peptic ulcers?

A

they damage mucous protection (against acid)

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36
Q

What type of bacterium is helicobacter pylori?

A

a gram negative microaerophilic bacterium

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37
Q

___% of individuals affected with H. pylori are asymptomatic

A

80

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38
Q

What is the MOA of H. pylori in damaging mucosa?

A

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

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39
Q

There is an increased prevalence of oesophageal cancer in what regions of the world?

A

afro-carribean and far eastern populations

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40
Q

Adenocarcinoma is a disease of _________ countries

A

developed

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41
Q

There is a _________ dominance for oesophageal cancer (gender)

A

male

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42
Q

Squamous cell carcinoma is a disease of __________ countries

A

developing

risk increases with smoking and alcohol

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43
Q

What are the main types of oesophageal cancer?

A

squamous cell carcinoma
adenocarcinoma

44
Q

What are the risk factors for oesophageal cancers?

A

alcohol
GORD
smoking
barrets oesophagus - associated with adenocarcinoma oesophageal cancers

45
Q

Where are squamous cell oesophageal cancers usually located?

A

usually halfway down the oesophagus

46
Q

Where are adenocarcinoma oesophageal cancers usually located?

A

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
Q

What is the presentation of oesophageal cancers?

A

weight loss- due to pain on swallowing
cachexia- weakness/wasting
progressive dysphagia (solids >fluids)
odynophagia (painful sensation in relation to swallowing)
hoarse voice

48
Q

What is the survival rate for oesophageal cancers according to cancer research UK?

A

5 year survival rate in 15% of cases

49
Q

What investigations can be carried out to diagnose oesophageal cancers?

A

OGD (oesophagogastroduodenoscopy)
CT thorax, abdominal
MRI thorax abdominal
Ultrasound (can include ultrasound of liver for metastatic stread)

50
Q

What is the metastatic spread of oesophageal cancer (common sites of metastasis)?

A

lymph nodes
liver
lungs
bone

51
Q

What is the management of low grade oesophageal cancer?

A

endoscopic resection +/- ablation (removal)
MI (minimally invasive) oesophagectomy

52
Q

What is the management of middle grade oesophageal cancer?

A

surgical resection (if surgical candidate)
Chemo or radio monotherapy (one or the other)

53
Q

What is the management of advanced oesophageal cancer?

A

chemo AND radiotherapy
palliative stent to ease swallowing

54
Q

What is the most common type of stomach cancer?

A

adenocarcinomas

55
Q

What are the other types of stomach cancer?

A

Lymphoma (lympoid tissue, MALT?)
Leiomyosarcoma
NETs (neuroendocrine tumours)
squamous cell carcinoma

56
Q

There is a higher incidence of stomach cancer in what part of the world?

A

East Asia
Eastern Europe
South America

57
Q

What is the usual age of onset for stomach cancer?

A

50-70 years

58
Q

What are the risk factors of stomach cancer?

A

Pernicious anaemia
H. Pylori
Cured meats (N- nitrosos compounds)-nitrosamines are keratogenic
Smoking (evidence is not strong)

59
Q

What is pernicious anaemia?

A

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
Q

What are some causes of pernicious anaemia?

A

genetic susceptibility
H. pylori

61
Q

What are the symptoms of pernicious anaemia ?

A

peripheral sensory neuropathy
yellow-blue blindness
depression
paranoi
dementioa
hearth failure
multiple infections

62
Q

Pernicious anaemia is often described as a disease of the _________.

A

elderly

63
Q

What are the presentations of stomach cancer?

A

abdominal pain
weight loss
lymphadenopathy
GI bleed (uncommon)
Virchows node- lymphatic drainage from abdominal cavity
Sister Mary Joseph nodule- transperitoneal spread (metastatic spread)

64
Q

What is the prognosis of stomach cancer in the UK according to Cancer Research UK

A

5 year survival in 19 % of cases

65
Q

What is the management of low grade stomach cancer?

A

surgical resection
peri-or post operative chemo

66
Q

What is the management of middle grade stomach cancer?

A

chemoradiation

67
Q

What is the management of advanced stomach cancer?

A

chemoradiation
palliative gastrectomy

68
Q

What is the metastatic spread of stomach cancer?

A

lymph nodes
liver
lungs
bone
peritoneum

69
Q

Majority of colorectal cancers are ___________. (type of cancer)

A

adenocarcinomas

70
Q

What percentage of colorectal cancers occur in the colon?

A

71%

71
Q

What percentage of colorectal cancers occurs in the rectum?

A

29%

72
Q

What is the greatest risk factor for colorectal cancers?

A

age

73
Q

99% of colorectal cancer cases occur in what age group ?

A

> 40 years

74
Q

What are the genetic components of colorectal cancers?

A

familial adenopolyposis
hereditary non-polpyosis colorectal cancer (polyps not present)

75
Q

What are the environmental risk factors for colorectal cancers?

A

age
obesity
red meat consumption
low fibre diet

76
Q

What is the pattern of inheritance for familial adenopolyposis (FAP)?

A

autosomal dominant
only one copy of the gene required for phenotype/disease to be expressed

77
Q

What is the gene affected in FAP?

A

APC

78
Q

What is the characteristic presentation of FAP?

A

multiple benign polyps of the large intestine

79
Q

What is the pattern of inheritance for Hereditary Non-polyposis colorectal cancer (HNPCC)?

A

Autosomal dominant

80
Q

What gene is affected in HNPCC?

A

MSH gene

81
Q

HNPCC can affect what areas?

A

endometrial
ovary
stomach

82
Q

What does the 2 hit hypothesis refer to (colorectal cancer) ?

A

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
Q

What is the pathophysiology of colorectal cancer?

A

normal epithelium
early adenoma
intermediate adenoma
late adenoma
carcinoma

84
Q

What is the presentation of colorectal cancer?

A

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
Q

What is the metastatic spread of colorectal cancer?

A

lymph nodes
liver
lungs
bone
brain

86
Q

How is colorectal cancer screened for?

A

Faecal occult blood test
Every 2 years
for 60-74 years
>75 screening test is available on request

87
Q

What is the next step after a faecal occult blood test with an abnormal result?

A

colonoscopy

88
Q

There ware many variations of bowel cancer management. What are these variations dependent on ?

A

stage
patient suitability

89
Q

Give some examples of bowel cancer management strategies

A

surgical resection
stending
chemotherapy
radiotherapy (adjuvant and neoadjuvant)

90
Q

What are the oral complications of cancer treatment ?

A

oral mucositis
infection
xerostomia/salivary gland dysfunction
functional disabilities
taste alterations
nutritional compromise
abnormal dental development

91
Q

What are oral complications of chemotherapy specifically?

A

neurotoxicity- can mimic tooth ache
bleeding

92
Q

What are oral complications of radiotherapy specifically?

A

osteonecrosis
trismus (lockjaw, spasms of muscles of mastication) / tissue fibrosis
radiation caries- tooth decay as as a result of radiation induced dry mouth

93
Q

What is metastasis ?

A

development of secondary malignant growth distant from primary site of cancer

94
Q

What are the routes of cancer metastasis?

A

direct
haematogenous (via blood)
lymphatic (via lymph)
transcolemic e.g. via peritoneal cavity

95
Q

What are the common metastatic sites of breast cancer?

A

bone
lung
lymph node
liver
brain

96
Q

What are the common metastatic sites of prostate cancer?

A

bone
lymph node
lung
brain
liver

97
Q

What are the common metastatic sites of colorectal cancer?

A

liver
lung
bone
brain

98
Q

What are the common metastatic sites of lung cancer?

A

lung
adrenal gland
bone
brain
liver

99
Q

TNM staging; T refers to …

A

size of tumour
graded 1-4

100
Q

TNM staging; N refer to …

A

node (lymph node presence)
0-3

101
Q

TNM staging; M refer to …

A

Metastasis
0-1

102
Q

What does the number staging for cancer refer to?

A

stage 0- carcinoma in situ, early
stage I- localised
stage II- early locally advanced
stage III- late locally advanced
Stage IV- metastasised

103
Q

What are the types of cancer staging ?

A

TNM staging
Number staging (1-5)
Specific staging

104
Q

Give examples of specific staging

A

Duke’s staging in colorectal cancer
Breslow staging in melanoma

105
Q

What cancer staging method is most commonly used to stage cancers?

A

TNM system

HHD 2 (37 decks)

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