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Upper GI Flashcards

1
Q

How does Achalasia happen

A

failure of the LOS to relax and aperistalsis - degeneration of the myenteric plexus which produce NO and VIP for relaxation

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2
Q

Which one of these diseases can be a secondary cause of achalasia?

Buerger’s disease
Chagas disease
Lyme disease
Behcets disease
Crohn’s disease

A

Chagas diseas (trypanosoma cruzi)

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3
Q

Achalasia presentation

A

dysphagia - both solid and liquids
regurgitation - due to food trapped in oesophagus
gradual weight loss - due to lack of food ingestion

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4
Q

Achalasia investigations

A

gold standard:
high resolution oesophageal manometry - will demonstrate incomplete relaxation and aperistalsis

others:
1st line: upper GI endoscopy - can show retained food debris with dilated wall
barium swallow - “bird beak” appearance

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5
Q

Achalasia differentials and complications

A

differentials:
oesophageal cancer
benign stricture

complications:
aspiration pneumonia
GORD
oesophageal cancer

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6
Q

A 58 year old man presents to the GP. He complains of retrosternal chest pain after eating meals. His wife has noticed his breath is foul smelling and he often experiences a bitter taste in his mouth. What is the most likely diagnosis?

Barrett’s oesophagus
Plummer Vinson syndrome
Zenker’s diverticulum
GORD
Acute gastritis

A

GORD

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7
Q

GORD definition

A

symptoms or complications resulting from reflux of gastric contents into the oesophagus or beyond

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8
Q

GORD risk factors/causes

A

LOS hypotension
hiatus hernia
obesity
gastric acid hypersecretion
alcohol
smoking
pregnancy
LOS tone reducing drugs (TCAs, nitrates, anticholinergics)

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9
Q

GORD presentation

A

++ heartburn (pain in chest) usually after meals
++ acid regurg leaving bitter taste in mouth
+ increased salivation
+ odynophagia if oesophagitis or ulceration
+ chronic cough or nocturnal asthma

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10
Q

GORD investigations

A

gold standard:
- resolution of symptoms after 8 week PPI trial

other:
- OGD - will detect erosions and ulcerations (oesophagitis)
- oesophageal manometry with pH monitoring is useful if OGD shows nothing

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11
Q

GORD management

A

lifestyle:
weight loss
smoking cessation
small regular meals
avoid certain foods (acidic fruit, coffee, alcohol)

medical:
continue PPI that was working
consider adding H2 blocker
antacids may be useful for symptom relied

surgery:
Nissen fundoplication
all forms of surgery aim to increase LOS pressure

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12
Q

GORD differentials and complications

A

differentials:
ACS
stable angina

complications:
ulceration/perforation
barrett’s oesophagus
oresophageal cancer

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13
Q

Peptic ulcer disease definition

A

break in lining of stomach with obvious depth through the submucosa

duodenal ulcers > gastric ulcers

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14
Q

peptic ulcer risk factors

A

H.pylori
NSAIDs
smoking
increased/decreased gastric emptying

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15
Q

gastric specific ulcers

A

Cushing and Curling ulcers

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16
Q

peptic ulcer disease - presentation

A

epigastric pain that the patient can point towards
key difference is gastric directly after meals while duodenal manifests couple hours later
nausea and vomiting
mild weight loss

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17
Q

complications of peptic ulcer disease

A

haemorrhage, perforation or obstruction

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18
Q

peptic ulcer disease investigation

A

gold standard:
upper GI endoscopy - reveals ulcerations and can perform a biopsy of the tissue

other:
- h.pylori tests - most common are urea breath tests and stool antigen test (retest after 6-8 weeks)
- serum fasting gastrin level

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19
Q

peptic ulcer disease management

A

lifestyle:
reduce smoking and alcohol

medical: h.pylori +ve
triple therapy: ppi + 2 abx (normally amoxicillin or clarithromycin unless CI, then metronidazole) - 7 day eradication

medical: h.pylori -ve (maybe drug induced)
stop drug causing ulcer immediately
offer 4-8 weeks of ppi therapy

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20
Q

gastritis definition

A

histological presence of mucosal inflammation

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21
Q

gastritis risk factors

A

h.pylori
NSAIDs
alcohol
Zollinger Ellison syndrome
Menetrier disease
autoimmune

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22
Q

gastritis investigations

A

mainly h.pylori tests
other tests needed for other causes

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23
Q

gastritis management

A

tailor treatment towards each condition

24
Q

hiatus hernia types

A

sliding (80%) and rolling (20%)

25
risk factors for hiatus hernia
obesity anything increasing intra-abdominal pressure
26
hiatus hernia presentation
most are asymptomatic GORD symptoms may be the only reveal GORD usually worse when lying flat palpitation or hiccups indicate pericardial irritation
27
hiatus hernia investigations
gold standard: upper GI endoscopy other: CXR - retrocardiac bubble
28
hiatus hernia management
lifestyle and medical: similar to GORD - weight loss and PPI surgery: only refractory to medical therapy involves pushing the hernia back into the abdomen the stomach is also wrapped around the oesophageal junction to help tighten it
29
hiatus hernia differentials and complications
differentials: GORD complication: gastric volvulus Barrett's oesophagus
30
Barrett's oesophagus definition
metaplasia of normal stratified squamous epithelium to columnar epithelium
31
Barrett's oesophagus risk factors
GORD anything modulating GORD
32
Barrett's oesophagus presentation
symptoms of GORD
33
Barrett's oesophagus investigations
gold standard: upper GI endoscopy WITH BIOPSY
34
Barrett's oesophagus - management
non-dysplastic: maximise PPI therapy and surveillance every 2 years therapeutic intervention: radiofrequency ablation or endoscopic mucosal resection for nodular growths
35
Barrett's oesophagus differentials and complications
differentials: oesophagitis GORD complications: oesophageal cancer oesophageal stricture
36
oesophageal cancer definitions and types
cancer originating from the epithelial lining of the oesophagus split into two types: squamous (upper 2/3rd) adenocarcinoma (lower 1/3rd)
37
risk factors for squamous oesophageal cancer
alcohol smoking strictures achalasia nitrosamines
38
risk factors for adenocarcinoma oesophageal cancer
GORD Barrett's obesity achalasia
39
oesophageal cancer presentation
dysphagia - first solids then liquids (progressive) rapid weight loss hoarseness if recurrent laryngeal pressed
40
oesophageal cancer investigations
gold standard: upper GI endoscopy WITH BIOPSY other: CT/MRI for staging - important for treatment
41
oesophageal cancer differentials and complications
differentials: benign stricture achalasia complications: aspiration pneumonia fistulas
42
Gastric cancer definition
neoplasm originating in any portion of stomach most commonly adenocarcinoma others include lymphoma, GI stromal tumours, carcinoid
43
types of gastric cancers
intestinal - H.pylori associated diffuse - e-cadherin mutation associated
44
risk factors for gastric cancers
pernicious anaemia h.pylori nitrosamines smoking high salt/ low vit C blood type A
45
gastric cancer presentation
vague but usually epigastric abdominal pain weight loss lymphadenopathy
46
gastric cancer investigations
gold standard: upper GI endoscopy with biopsy showing signet ring cells other: CT/MRI for staging EUS with FNA - for staging *EUS- endoscopic US *FNA- fine needle aspirate
47
gastric cancer differentials and complications
differentials: PUD benign stricture complications: haemorrhage obstruction perforation
48
Mallory-Weiss tear definition
longitudinal lacerations in mucosa and submucosa near GOS usually self-limiting and resolves spontaneously
49
Mallory-Weiss tear risk factors
persistent retching. coughing, vomiting or straining found in alcoholics and bulimics
50
Mallory-Weiss tear presentation
haematemesis lightheaded/dizziness postural hypotension may experience dysphagia, odynophagia and melaena
51
Mallory-Weiss tear Ix
Gold standard: upper GI endoscopy to visualise tears points to note: risk assessments rockall score glasgow-blatchford score other: FBC- may show anaemia urea- elevation may indicate upper GI bleed CXR- to rule out perforation
52
Mallory-Weiss tear management
1st line: with endoscopy inject adrenaline or conduct band ligation to stop bleeding adjuncts: give anti-secretory therapy (PPIs) before endoscopy to reduce bleeding give anti-emetics to prevent recurrence 2nd line: Sengstaken-Blakemore tube
53
Mallory-Weiss tear differentials and complications
differentials: oesophageal varices oesophagitis complications Boerrhave's perforation re-bleeding
54
which one of these investigations would be used initially in achalasia? 1. colonoscopy 2. CXR 3. Upper GI endoscopy 4. Oesophageal manometry 5. Transoesophageal MRI
3. Upper GI endoscopy Although oesophageal manometry is the gold standard for diagnosing achalasia, with any new onset dysphagia, especially in older patients, an endoscopy to rule out insidious growths is needed
55
PPIs are often trialled and used as 1st line for GORD. which is an example of PPI 1. ketoconazole 2. albendazole 3. riluzole 4. Carbimazole 5. Omeprazole
5. Omeprazole ketoconazole is a commonly used antifungal albendazole is a commonly used anti-helminth riluzole is used for motor neurone disease carbimazole is used in Cushing's disease
56
A 50 yr old male presents to a+e with excruciating epigastric pain. the pain is also felt in his right shoulder. it is later revealed that he has been suffering from recurrent gastric ulcers lately. What sign is observed in CXR? 1. Rigler sign 2. McBurney's sign 3. Dome sign 4. Haemoperitoneum 5. Sail sign
3. Dome sign When gastric ulcers burst, free air is released into the peritoneum. Air will naturally rise on an erect CXR displacing the diaphragm causing a dome shape
57
A 60 yr old female presents with severe epigastric pain and retching without vomiting. Small bowel obstruction is suspected and a 'drip and suck' protocol is initiated. The NG however is unable to be passed into the stomach. What is the likely diagnosis? 1. large bowel obstruction 2. gastric cancer 3. oesophageal spasm 4. gastric volvulus 5. achalasia
4. gastric volvulus a gastric volvulus is a classic complication of a hiatus hernia. the triad is severe epigastric pain, retching without vomiting and not being able to pass ng tube into stomach

Phase 1c (13 decks)

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