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Gastroenterology > Upper GI > Flashcards

Upper GI Flashcards

1
Q

What is dyspepsia?

A

Inexact term used to describe collection of UPPER GI symptoms eg. heartburn, acidity, pain or discomfort, nausea, wind, fullness or bleching

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2
Q

Which symptoms of dyspepsia are suggestive of serious disease?

A

ALARM symptoms

Anaemia
Loss of weight
Anorexia
Recent onset of progressive symptoms
Melaena or Haematemesis (black, tarry faeces associated with upper GI bleeding)
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3
Q

What does faeculent vomit suggest?

A

Low intestinal obstruction or presence of gastrocolic fistula

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4
Q

Contraindications to OGD

A

Severe COPD, recent MI, severe instability of atlantoaxial joints

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5
Q

What is Behcets disease?

A

Rare condition causing inflammation of small blood vessels, aka small-vessel vasculitis

Often presents with mucous membrane ulceration and eye problems

Also ache, headache and joint problems

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6
Q

What is pemphigus vulgaris?

A

Pemphigus vulgaris - autoimmune blistering disease of skin and mucosa. Due to autoantibodies to desmogleins. Therefore attack desmosomes causing skin to blister.

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7
Q

What is pemphigoid?

A

Group of autoimmune skin blistering diseases but no acantholysis (targeting of desmosomes)
Believed to be IgG or IgA mediated. IgA rarely affect the mouth.

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8
Q

What is lichen planus?

A

Disease of skin and mucosal surfaces that resembles lichen – cause unknown (autoimmune?), no cure but can have symptomatic control

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9
Q

Treatment of mild aphthous ulcers?

A

Avoid trauma, avoid acidic food and drink

tetracycline or antimicrobial mouthwashes = chlorhexidine

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10
Q

Treatment of serious aphthous ulcers?

A

Corticosteroids (prednisolone)

Biopsy any ulcer not clearing after 3 weeks - query malignancy

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11
Q

What is oral hairy leucoplakia?

A

Shaggy white patch on side of tongue, benign

Seen in HIV with EBV

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12
Q

Risk factors for candidiasis?

A

Extremes of age
DM
Immunosuppressed
Antibiotics

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13
Q

Treatment of candidiasis?

A

Nystatin
Amphotericin
Fluconazole

All anti-fungals

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14
Q

What is chelitis - what caused by?

A

Also called angular stomatitis
Fissuring of mouth corners

Caused by denture problems, candidiasis, B12 or iron deficiency

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15
Q

What is gingivitis?

A

Gum inflammation and hypertrophy

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16
Q

Causes of gingivitis?

A 
Poor oral hygiene
Pregnancy
Vit C deficiency
Acute myeloid leukaemia 
Systemic sclerosis/scleroderma
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17
Q

What is microstomia and causes?

A

Small narrow mouth

Caused by thickening and tightening or perioral skin

Caused by:

  • Burns
  • Epidermolysis bullosa - connective tissue disease
  • Scleroderma
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18
Q

What is Peutz-jeghers syndrome?

A

Hamaratmous polyps in GIT

Hyperpigmented macules on lips and oral mucosa

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19
Q

What are fordyce glands?

A

Creamy yellow spots at border of oral mucosa and lips - sebaceous cysts - common and benign

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20
Q

What is xerostomia? - causes?

A

Dry tongue

Dehydration, TCA’s, after radiotherapy, Crohn’s disease, Sjogren’s

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21
Q

What is glossitis? - cause?

A

Smooth, red, sore tongue

Caused by iron, B12 or folate deficiency

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22
Q

Causes of macroglossia?

A

Myxoedema (hypothyroidism)
Acromegaly
Amyloid

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23
Q

How does tongue cancer present?

A

On tongue edge, raised ulcer with firm edges

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24
Q

Main risk factors for tongue cancer? x2

A

Smoking and alcohol

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25
Q

Treatment of tongue cancer?

A

Radiotherapy or surgery

5year survival of early disease = 80%

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26
Q

What is odynophagia and what does it suggest?

A

Pain during swallowing and suggests oesophagitis

eg. due to reflux
Infection
Chemical oesophagitis due to drugs such as bisphosphonates, or slow-release potassium

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27
Q

Causes of GORD

A

Lower oesophageal sphincter hypotension
Hiatus hernia
Loss of peristalsis function
Gastric acid hypersecretion

Obesity, overeating, smoking, alcohol and pregnancy

Surgery for achalasia

Drugs - TCAs, anticholinergics, nitrates

Helico bacter pylori

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28
Q

Symptoms of GORD

A

Heartburn - retrosternal burning discomfort - worse on stooping, eating, lying down or straining

Belching
Acid brash
Waterbrash (increased salvation)
Odynophagia

Asthma, nocturnal cough, laryngitis, voice hoarseness

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29
Q

Complications of GORD

A

Oesophagitis
Ulcers
Benign stricture
Malignancy

Iron-deficiency

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30
Q

Tests in GORD

A

Endoscopy if ALARM signs or symptoms persisting despite treatment, or >55

Barium swallow may show hiatus hernia

Oesophageal manometry

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31
Q

Conservative treatment of GORD

A

Raise bed head
Loose weight, stop smoking, reduce alcohol
Regular meals and avoid trigger food/drink
Avoid eating 3 hours before bed

Avoid drugs which affect GI motility - nitrates, anticholinergics, Calcium channel blockers

Avoid drugs that damage mucosa - NSAIDs, K+ salts, bisphosophonates

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32
Q

Medical treatment of GORD

A

Antacids - neutralise stomach acid eg. alginate containing - Gaviscon

PPI - lansoprazole

H2 receptor antagonists - cimetidine, ranitidine, famotidine

33
Q

When is surgery implicated in GORD?

A

If drugs not working, concern of long-term side effects

Recurrent hiatus hernia

34
Q

What is the surgery for GORD?

A

Fundoplication - tighten the crura in diaphragm
Nissen - 360 degree wrap and others are less

Done laparoscopically

35
Q

What is Barrett’s oesophagus?

A

When normal oesophageal squamous epithelium is replaced by metaplastic columnar mucosa

Almost always a hiatus hernia present

From acid exposure by GORD

36
Q

Diagnosis of Barrett’s oesophagus? Treatment?

A

Endoscopy and biopsies

Can do mucosectomy or oesophageal resection

37
Q

Risk with Barrett’s oesophagus?

A

Oesophageal adenocarcinoma - quantity of increased risk is debated

38
Q

What is achalasia?

A

Impaired peristalsis of oesophagus and impaired relaxation of lower oesophageal sphincter

39
Q

How does achalasia present?

A

Long history of intermittent dysphagia

Both liquids and solids from onset

Regurgitation of food - especially at night

Chest pain + heartburn

Weight loss but not loads of marked weight loss

Difficulty belching

40
Q

Investigations in achalasia

A

Chest x ray - dilated oesophagus and widened mediastinum

Barium swallow - lack of peristalsis and failure of sphincter to relax

CT scan - exclude distal cancer

41
Q

Treatment of achalasia?

A

Drug therapy rarely effective (nifedipine, sildenafil)

1) Endoscopic dilatation of LOS with a balloon - needs redoing as wears off after a few years
2) Botox injections into sphincter - wears off after a few months - less chance of perforation than balloon
3) Surgical division of LOS - Heller’s operation - surgical treatment of choice

42
Q

What is diffuse oesophageal spasm?

A

Oesophageal dysmotility - bizarre contractions of oesophagus without normal peristalsis when swallowing
- Causes chest pain and dysphagia

Nutcracker oesophagus - variant of this - very high amplitude peristalsis
- Chest pain more common than dysphagia

Treatment - antispasmodics, nitrates, Calcium channel blockers and GABA agonists (baclofen)

43
Q

What is pharyngeal pouch?

A

Oesophageal diverticulum just above upper oesophageal sphincter - dysphagia and regurgitation

May see visible pouch

Also get diverticulum in middle of oesophagus or just above lower sphincter

44
Q

What is most common cause for benign oesophageal stricture?

A

Peptic stricture secondary to reflux

Also after ingestion of corrosives, after radiotherapy, after sclerosis of varices, prolonged NG tube intubation

45
Q

2 types of hiatus hernia

A

Sliding - 80% - where gastro-oesophageal junction slides up into the chest through the diaphragm
acid reflux common

Rolling - 20% - gastro-oesophageal junction in the abdomen but bulge of stomach herniates into chest alongside oesophagus
as GO junction remains intact - gross acid reflux is uncommon

46
Q

When are hiatus hernia more common?

A

Obesity

47
Q

Imaging in hiatus hernia

A

Barium swallow

48
Q

Treatment of HH

A

Lose weight, treat reflux symptoms

Surgery if intractable symptoms - rolling HH may strangulate therefore surgery advised

49
Q

Which is more common duodenal ulcer or gastric ulcer?

A

Duodenal = 4x more common

50
Q

2 x major risk factors for duodenal ulcer

A

H.pylori - 90%

Drugs - NSAIDs, steroids, SSRI

51
Q

Minor risk factors for duodenal ulcer

A

Increased gastric acid secretion, increased gastric emptying (lower duodenal ph), blood group 0, smoking

52
Q

Symptoms/signs of duodenal ulcer

A

Epigastric pain - before meals or at night
Relieved by eating or having milk
Worse several hours later

Epigastric tenderness

50% asymptomatic

Mean age 30s

53
Q

Diagnosis of DU

A

Upper GI endoscopy
Test for h.pylori - C-Urea breath test
IgG antibody against H.pylori confirms exposure but not eradication

54
Q

What is Zollinger-Elson syndrome and how do you test for it if suspected?

A

Gastrin secreting tumour of pancreas

Stimulates stomach parietal cells

Causes GI mucosal ulceration

Measure gastrin concentrations when off PPI for diagnosis - Secretin test (IV Secretin causes a rise in serum gastrin in ZE patients but not normal)

55
Q

Treatment of duodenal ulcer

A

PPI

56
Q

Where do gastric ulcers most commonly occur?

A

Lesser curvature of stomach - if elsewhere, often malignant

GU mostly in elderly

57
Q

Risk factors for GU

A 
H pylori - 80%
Smoking 
NSAIDs
Delayed gastric emptying 
Stress
58
Q

Presentation of GU

A

Pain - epigastric - relieved by antacids
Weight loss
Mean age 50s
Worse soon after eating

59
Q

Diagnosis of GU

A

Endoscopy - exclude malignancy

Biopsy of ulcer

60
Q

Treatment of ulcers

A

Purge stress, avoid aggravating foods

Decrease smoking and drinking

61
Q

Treatment of h-pylori

A

Triple therapy
PAC500 regimen - PPI, amoxicillin, clarithromycin

PMC250 regimen - PPI, metronidazole and clarithromycin

62
Q

Medical treatment of ulcers

A 
PPIs
H2 blockers (ranitidine)
63
Q

When do you do surgery for ulcers?

A

Only really for complications - haemorrhage, perforation

Or if don’t respond to medical therapy

64
Q

Emergency surgery for ulcer haemorrhage

A

Adrenaline injection, laser coagulation, heat probe

65
Q

What is pyloric stenosis

A

Late complication of duodenal ulcers - vomiting large amounts of food some hours after meals

Treat with endoscopic balloon dilatation

66
Q

What type of oesophageal carcinomas occur where?

A

Squamous cell carcinoma can occur throughout
Adenocarcinoma only in distal third

20% in upper, 50% in middle, 30% in lower

67
Q

Risk factors for oesophageal carcinoma?

A 
Smoking and alcohol 
Diet (nitrosamines)
Vitamin A & C deficiency 
Achalasia 
Coeliac disease

Barrett’s oesophagus + GORD (adeno)

68
Q

Presentation of oesophageal carcinoma

A

Often insidious

Dysphagia, solid and then liquid

Weight loss

Coughing or choking after food
upper 1/3 - hoarseness (may indicate recurrent laryngeal nerve palsy)

69
Q

Diagnosis of O carcinoma

A

Barium swallow
Endoscopy - biopsy
CT scan

70
Q

Treatment of O carcinoma

A

25% of patients are operable - can do radical oesophagectomy

Can do early endoscopic mucosal resection

SSC more radiosensitive than adenocarcinoma

Pre-op chemotherapy may be useful but morbidity

Palliation - stent or dilation

71
Q

Prognosis of o carcinoma

A

5% have 5 year survival

72
Q

What type of cancer is stomach cancer normally?

A 
85% = adenocarcinoma 
15% = lymphoma
73
Q

Risk factor for stomach cancer

A

Nitrites
Nitrosamine exposure

H.pylori exposure
Lower social class

Smoking
Alcohol
Diet - high nitrate, low vit c

74
Q

Presentation of stomach cancer

A

Insidious
Early satiety
Nausea, weight loss, anorexia, fatigue, anaemia (bleeding) - haematemesis

Dyspepsia

75
Q

Presentation from stomach cancer mets

A

Transperitoneal - ascites

Ovarian masses - Krukenberg tumour

Virchow’s node - Troisiers sign

Acanthosis nigrans - hyperpigmentation of skin

76
Q

Diagnosis of stomach cancer

A

Barium and endoscopy

Gastroscopy and biopsy

Endoscopic ultrasound - depth of invasion

CT/MRI - staging

77
Q

Treatment of stomach cancer

A

30% - surgery for potential cure - gastrectomy (can be partial - Bilroth 1 and 2 partial gastrectomy)

Chemotherapy - 30% partial response - therefore combine with surgery

Endoscopic mucosal resection - for early tumours confined to mucosa

78
Q

Prognosis for stomach cancer

A

5 year 5% survival

79
Q

Prevalence of small intestine tumour

A

Rare

Gastroenterology (5 decks)

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