Upper GI Flashcards
List the RFs for GORD (7)
Hiatus hernia Raised IAP (preg/obesity) Fatty foods Large meals Caffeine Smoking Drugs: antiACh / nitrates / TCAs / CCBs
What are the 2 different types of hiatus hernias and how do they present?
Sliding: GOJ slides above diaphragm (T10)
Presents as reflux/asymp (30% adults >50)
Para-oesophageal rolling: fundus (sphincter competent/below)
Presents (rarely) as severe pain (gastric volvulus/strang)
What are the sx of oesophagitis? (4 + 2)
Heartburn/indigestion
Regurgitation food/acid (poss aspiration)
Waterbrash
Odynophagia
Atypical chest pain (distal oesophageal spasm)
Nocturnal cough/wheeze - asthma type sx
What further Ix can be done in GORD? (2)
Barium swallow (if suspect hiatus hernia) 24hr pH/manometry (sphincter competence)
What are the red flag sx for dyspepsia?
Anorexia Loss of wt Anaemia (Fe defc) Recent onset/progressive sx Malaena/haematemesis Swallowing difficulties 55yrs+
Describe the management of GORD
If no red flags: empirical full-dose PPI 4-8wks
Lifestyle: wt loss / smoking
smaller meals + >3hr before bed (+ w. hot drinks/alc)
raise head of bed
avoid exac drugs
Medical: (stepwise - for chronic)
1st - antacids (gaviscon)
2nd - PPI/H2RA
Adjunct - metoclopramide/domperidone
Surgical: only for hiatus hernia w. refractory sx + pH evidence
What are the complications of GORD (5)
Oesophagitis Ulcers Benign strictures Barrett's Oesophageal cancer
Describe the differences b/wn oropharyngeal dysphagia + oesophageal dysphagia
Oropharyngeal:
Neuromuscular cause
Difficult initiating swallowing ± Choking/Aspiration
Oesophageal:
Dysmotility/Stricture/Oesophagitis/Pouch
Food sticks ± regurg
List 3 causes of oesophageal motility disorder
Achalasia
DM
Scleroderma
What further Ix are done for confirmed oesophageal cancer?
OGD + Biopsy
CT Thorax/Abdo
PET – assess mets
Laparoscopy – exclude peritoneal mets before resection
How may achalasia present?
Younger pt ~30
Dysphagia ± regurg
Nocturnal cough
What effects do H.Pylori have on peptic ulcers?
What effects do smoking have on peptic ulcers?
What effects do NSAIDs have on peptic ulcers?
H.Pylori:
Acid secrn↑
Abnormal mucus prodn → epithelial damage
Smoking:
Nicotine ↑acid secrn
↓Gastric mucosal healing
NSAIDs:
↓PGs thus ↓inhibitory effect → Acid↑
What are the diff methods for testing for H.Pylori
13C urea breath test (must be off Abx/PPIs prior)
Stool/serum antigen test
Gastric biopsy - add phenol red - colour change
Outline the further management of H.Pylori if Triple Therapy hasn’t worked
Bismuth chelate
2Abx (2wks)
Prolonged PPI
Still persists:
Re-scope / Re-check H.Pylori tests / Consider DDx
What does triple therapy of H.Pylori consist of
PPI
2 of: Amoxi / Clarithro / Metro
For 7d
List some causes for UGI bleeding (5 common; 3 rare)
Peptic ulcer (40%) Gastric-duod erosion (15%) Oesophagitis (15%) Mallory-Weiss (15%) Varices (10%)
Oesophageal malignancy (1%)
Vascular malformn
Coagulopathy
List some complications of peptic ulcers (4)
Haemorrhage
Perforation
Malignant change
Strictures
What are some RFs for gastric cancer (7)
H.Pylori
Smoking
High salt/nitrate diet (red meat)
Low socio-economic
Genetic (e.g. HNPCC, Blood GrpA)
Adenomatous polyps
Pernicious anaemia
Outline the management of gastric cancers
Gastrectomy:
Partial if lower 1/3
OR Total ± lymph clear
Other:
Endoscopic mucosal resection (confined)
Wide local excision (stromal)
Pylorus stenting (palliative)
PLUS: Combo Chemo
