Session 8- Upper and Lower GI malignancies Flashcards
what are some benign causes of dysphagia
strictures
foreign bodies
nerve palsies
what are some malignant causes of dysphagis
squamous cell carcinoma
adenocarcinoma
what carcinoma arises from stratified squamous epithelium
squamous cell carcinoma
what type of epithelia does a adenocarcinoma arise from
simple columnar epithelium
how can we diagnose barretts oesophagus
endoscopy - can take biospy
barium swallow - cant take biopsy
what is the prognosis of barretts
5 years
red flags of upper GI malignancy
ALARM
a- anaemia l- loss of weight a- anorexia r- recent onset of progressive symtoms m-masses- maleana
what three ways can a oesophagel malignancy be
intra-luminal
extra-luminal
luminal
red flags of epigastric pain
maleana
haemtemesis
what causes haematemesis
varices
ulcers
mallory-weiss- tears in oesophagus
benign causes of epigastric pain
gastritis
peptic ulcers
pancreatitis
where can an adenocarcinoma present in stomach
antrum
cardia
risk factors for gastric cancer
high salt diet smoking FHx H. pylori old age ]men
how can you get malignancy in the liver
hepatocellular carcinoma- cirrhosis
metastises - portal circulation
what are common metasis to the liver
breast colon lung skin ovaries
how can metastise to the liver
haemtogenous
transcoelemic
lymph
what are the majorty of pancreatic cancers
exocrine- 90%
what is an exocrine pancreatic cancer
ductal adenocarcinoma
how does a ductal adenocarcinoma affect the pancreas
head- jaundice as it interfers with billary flow into duodenum
tail/body- malabsorption
risk factors for pancreatic cancer
FHx smoking male old age chronic pancreatitis
what is a malignancy of the bie dicts called
cholangiocarcinoma
what are the 2 forms of oesophageal cancer
adenocarcinoma
squamous cell carcinoma
what are adenocarcinomas linked to
barretts oesophagus
what are the most common form of pancreatic malignacies
ductal adenocarcinomas`
what are most colerectal cancers
adenomas
what is familial adenomatous polyposis
autosomal dominant condition caused by a mutation in the APC gene( tumour suppressor gene) where invariably the
numerous polyps arise which can undergo dysplasia and become a cancer
what are colorectal cancers linked to
several genetic events such as the
activation of oncogenes, ineffective DNA repair and the loss of tumour
suppressor genes
where do most colorectal cancers occur
sigmoid colon -30%
rectum - 50%
how do small bowel obstructions present compared with large
vomiting in small bowel wheres constipation in large bowel
benign causes of PR bleeding
haemorrhoids anal fissures IBS diverticular disease infective gastroenteritis
what is tenesmus
feeling the need to pass stools even though bowel is empty
how do right sided malignancies grow
fungating, gow out into lumen
where is obstruction more likely on the right or left side
left -descending colon
how do malignanies grow in left side
stenosing- obstruct lumen
lumen is narrower
how do we investigate large bowel cancer
colonoscopy
endoscopy
blood tests for large bowel cancer
FBC
Tumour marker
CEA
CA19-9
risk factors of small nowel cancer
FAP
IBD
coeliac
anything that causes the growth of polyps/inflammation
what is common cause of chronic gastritis
infection with H pylori
How does autoimmune gastritis result in Vit B12 deficiency?
Antibodies to the parietal cells not only affect the acid production, but also the release of intrinsic factor.
Intrinsic factor is required for the binding of B12 and its subsequent absorption.
State one way that H-pylori can interfere with the mucus layer lining the stomach epithelium
It releases mucinases (enzymes that breakup mucus)
Colonisation of which region of the stomach, by H-pylori, can increase the likelihood of duodenal
ulceration?
antrum
To qualify as a peptic ulceration, what layer of the gastric or duodenal wall must the erosion pass
through?
muscularis mucosae
In basic terms, what causes Malaena?
Slow upper gastrointestinal bleed. Blood is oxidised as it passes through gut turning stool black
where are meckels diverticuli commonly situated
middle to distal ileum
where in the oesophagus do you get adenocarcinomas
lower third
