Upper GI Flashcards
ΔΔ dysphagia
intraluminal • infection (candidiasis, pharyngitis, retropharyngeal abscess) • oesophagitis • foreign body • polyps
intramural • benign strictures (GORD) • CA • achalasia • spasm • systemic sclerosis • web (Plummer Vinson) or ring (Schatzi)
extramural • pharyngeal pouch • rolling hiatus hernia • CA • retrosternal goitre • thoracic AA
neuro • stroke • myaesthenia gravis • MS • MND • PD
key Qs in a dysphagia Hx?
“MUNCH LOT”
• M - difficult to make swallow Movement? (ΔΔ bulber palsy) • U - underweight • N - neck bulges when drinking (ΔΔ pharyngeal pouch) • C - cough on lying (ΔΔ achalasia, pharyngeal pouch) • H - heartburn (ΔΔ GORD) • L liquids a problem from start? - YES = motility problem (ΔΔ sclerosis, myeasthenia, bulbar palsy, achalasia) - NO, solids 1st = ΔΔ stricture • O - odynophagia (painful swallow) (ΔΔ CA, ulcer, spasm • T time pattern: - intermittent (ΔΔ spasm) - constant/worsening (ΔΔ CA) - both ^ (ΔΔ achalasia)
odynophagia relieved by GTN?
oesophageal spasm
ΔΔ dyspepsia
- functional dyspepsia
- PUD
- oesophageal: GORD, oesophagitis, CA
- gastric: gastritis, CA
ΔΔ N, V (GI causes)
- GE
- cholecystitis
- pancreatitis
- obstruction
- gastric CA
- PUD
ΔΔ N, V (non-GI causes)
“ABCDEFGHI”
- AKI, Addison’s
- brain (migraine, ↑ICP)
- cardiac (MI)
- DKA
- ears (labyrinthitis, Meniere’s)
- foreign substance (alcohol, drugs)
- gravid (pregn)
- hyper↑Ca+, hypoNa+, ↑thyroid
- infection (UTI, sepsis)
ΔΔ weight loss
“FIND THAT MAN”
GI • Flour (coeliac) • IBD • Neoplasia (CA) • Dysphagia
endocrine
• TH-yrotoxicosis
• Addison’s
• T1DM
psychiatric
• ↓ Mood
• Anorexia
Nervosa
ΔΔ upper GI bleed
- PUD* (erodes into blood vessel)
- inflammation: oesophagitis, gastritis, duodenitis
- varices
- Mallory-Weiss tear
- CA
Hx: patient comes in with Sx of epigastric pain and vomiting fresh red blood, and passed a bowel movement which was tarry black and foul smelling?
active upper GI bleed
coffee ground V?
upper GI bleed that has settled
black and foul smelling stool?
malaena
(upper GI bleed, or ascending colon CA)
(can be from Fe tablets - less smelly)
Ix upper GI bleed?
BEDSIDE:
• ECG (tachycardia)
BLOODS: • FBC (Hb, may be normal before resusc) • crossmatch, coag • urea (GI absorption and metabolism of blood) • LFTs (varices)
IMAGING:
• erect CXR (perforated PUD)
• AXR
• CT abdo-chest (CA, etc)
risk assessment of upper GI bleed?
Blatchford score Rockall score (post-endo)
Tx upper GI bleed?
- ABCDE
- resuscitation, IVT, O2 +/- transfuse
- terlipressin (ADH) + Abx (if variceal)
- NBM
- urgent endo
- clipping/diathermy with Adr
- band ligation if variceal
- surgery if unsuccessful
• post-endo IV PPIs, then oral
Hx: patient presents with fluid regurgitation, SOB, and pleuritic chest pain?
achalasia
aspiration pneumonia
can achalasia lead to CA?
YES
5 percent risk of oesophageal squamous cell CA
Ix achalasia?
upper GI endo
Ba swallow shows “bird’s beak”
Tx achalsia
medical:
• CCBs
• botox
surgery
• endoscopic dilatation of lower oesophageal spinchter
• myotomy (cut through muscle)
what’s achalasia?
failure of SM relaxation in lower oesophagus (impaired nerve supply)
Hx: patient presents with bad breath, a cough at night, regurgitation and difficulty swallowing?
pharyngeal pouch
Tx pharyngeal pouch?
- excision
* endo + stapling
Hx: patient presents with GORD, and O/E bowel sounds are heard in the left chest?
hiatus hernia
Tx hiatus hernia?
conservative: • weight • smoking • avoid large meals late • raise head of bed
medical
• PPIs
surgical
• fundoplication (fundus wrapped around lower oes)
Hx: patient presents having swallowed a fish bone, with neck and epigastric pain, dysphagia, SOB, V and heamatemesis?
O/E S/C emphysema
oesophageal perforation
