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TCD Gastrointestinal > Swallowing Difficulties > Flashcards

Swallowing Difficulties Flashcards

1
Q

Which portion of the oesophagus contains involuntary smooth muscle only?

A

The inferior third of the oesophagus.

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2
Q

Which epithelial cells line the lower oesophagus?

A

Stratified squamous epithelium (to resist abrasion)

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3
Q

Which cells line the stomach?

A

Columnar epithelium

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4
Q

What symptoms can be used to indicated whether dysphagia is due to a structural lesion or due to myomotility/neurological disorders?

A

Dysphagia to primarily solid foods = indicative of structural lesion
Dysphagia to both solid and liquid from onset of symptoms = indicative of myomotility/neurological disorders.

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5
Q

What may rapid progression of dysphagia symptoms be suggestive of?

A

Malignancy

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6
Q

What is odynophagia?

A

Pain on swallowing

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7
Q

What may a long history of vomiting accompanying dysphagia suggest?

A

A Mallory-Weiss tear

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8
Q

What type of oesophageal cancer is most prevalent in developed countries?

A

Oesophageal adenocarcinoma

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9
Q

What is the predominant type of gastric cancer?

A

Adenocarcinoma

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10
Q

What are the typical symptoms of gastric cancer? (3)

A

-Epigastric pain
-Weight loss
-Dysphagia (in patients with proximal or gastro-oesophageal junction tumours)

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11
Q

What is Barrett’s Oesophagus?

A

A metaplastic change of epithelium in the oesophagus from stratified squamous to columnar glandular epithelium (as found in the stomach).

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12
Q

What is Virchow’s Node?

A

Enlargement of a left-sided supraclavicular node that can be indicative of gastric cancer.

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13
Q

When does NICE guidance recommend a 2 week wait pathway referral for oesophageal/gastric cancer? (2)

A

For patients with dysphagia
OR
For patients aged 55 and over with weight loss and any of following: upper abdominal pain, reflux or dyspepsia.

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14
Q

What is the first line investigation for dysphagia?

A

Oesophagogastroduodenoscopy (OGD), to differentiate between oesophageal cancer and benign causes of dysphagia.

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15
Q

What symptoms are indicative of gastritis? (6)

A

-Epigastric pain (sometimes worse with hunger)
-Loss of appetite
-Bloating
-Nausea
-Vomiting
-Early satiety

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16
Q

What are the main symptoms indicative of peptic ulcers? (3)

A

Chronic, upper abdominal pain related to hunger.
Nausea
Distention and bloating

17
Q

What symptom is classically taught to be helpful in distinguishing between a gastric and duodenal ulcer?

A

Nature of the pain:
Worse pain with food = gastric ulcer
Worse pain with hunger = duodenal ulcer

18
Q

What is Grey Turner’s Sign?

A

Haematoma around around the flanks, characteristic of haemorrhagic pancreatitis.

19
Q

What symptoms and signs are indicative of pancreatic cancer? (5)

A

-Obstructive jaundice signs (pale stools, dark urine, itching)
-Unintentional weight loss
-Nausea and vomiting
-Vague epigastric/back pain
-Epigastric mass

20
Q

What is Courvoisier’s Law?

A

A principle stating that a painless palpably enlarged gallbladder accompanied by mild jaundice is unlikely to be caused by gallstones (and is usually cholangiocarcinoma or pancreatic cancer).

21
Q

What is Trousseau’s Sign of Malignancy?

A

Refers to migratory thrombophlebitis (blood clots appearing unexpectedly in superficial veins and migrating over time to different locations) as a sign of malignancy.

22
Q

How does a Mallory-Weiss Tear (MWT) typically present?

A

Haematemesis after an episode of forceful or recurrent retching, vomiting, coughing or straining.

23
Q

What are oesophageal varices?

A

Dilated collateral blood vessels that develop as a complication of portal hypertension.

24
Q

When is retesting for H. pylori after completing eradication treatment indicated?

A

Only if patient has had poor compliance with medications, have an associated peptic ulcer, or are experiencing persistent symptoms despite treatment.

25
Q

How long following a course of antibiotics should you wait before attempting H. pylori testing?

A

4 weeks

26
Q

For how long should a patient have stopped PPI treatment prior to H. pylori testing?

A

At least 2 weeks

27
Q

What is reported haematemesis and malena suggestive of?

A

An upper GI bleed.

28
Q

What is meant by ‘coffee ground vomit’?

A

Haematemesis, presenting as dark red/brown/black vomit due to presence of clotted blood. Indicative of an upper GI bleed.

29
Q

What is terlipressin?

A

A vasopressin analogue, which acts as a vasoconstrictor predominantly in splanchnic circulation to reduce pressure in the portal vein, subsequently slowing or stopping variceal bleeding.

30
Q

What is terlipressin used to treat? (2)

A

Variceal bleeding (licensed)
Hepatorenal syndrome (unlicensed)

31
Q

What are the endoscopic treatment options for variceal bleeds? (2)

A

Bands can be used to cut off blood supply around varices (rubber band ligation)
Trans-jugular intrahepatic portosystemic shunt (TIPS)

32
Q

What is involved in trans-jugular intrahepatic portosystemic shunt (TIPS)?

A

An interventional radiologist inserts a stent to connect the portal vein to the hepatic vein; this allows blood to be brought back from the bowel to the heart, bypassing the liver thus reducing pressure in the portal vein.

33
Q

What are the endoscopic treatment options for a peptic ulcer bleed? (4)

A

-Injection of vasoconstrictors (such as adrenaline)
-Mechanical control of bleeding (such as clips)
-Thermal coagulation (via a heat probe)
-Haemostatic adjuncts (such as fibrin and thrombin)

34
Q

What is the Rockall Score?

A

A scoring system used to estimate the risk of rebleeding and of overall mortality from an upper GI bleed, in patients who have had a completed endoscopy.

35
Q

What are the two most common vascular sources of upper GI bleeding?

A

Gastroduodenal artery (with posterior duodenal ulcers)
Branches of left gastric artery (at lesser curve of stomach)

36
Q

What is involved in ‘embolisation’?

A

‘Blocking’ an artery to stop the flow of blood, usually by deploying some small metallic coils directly into the artery that then clot the vessel.

37
Q

What is the timeframe for the healing of peptic ulcers?

A

Generally, peptic ulcers heal within 8 weeks with PPI use.

TCD Gastrointestinal (6 decks)

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