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Year 3 - MedEd Lectures > Upper GI > Flashcards

Upper GI Flashcards

1
Q

What is Dyspepsia?

A

General term for a number of symptoms indicating an Upper GI Problem - Typically described as ‘Indigestion’

Epigastric pain/burning

Early Satiety

Belching

Bloating

Nausea

General Discomfort

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2
Q

How does Peptic Ulcer Disease typically present?

A

Recurrent Epigastric pain related to eating

Early Satiety

Nausea & Vomiting

Potential Weight Loss

Signs of Blood Loss (Anaemia)

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3
Q

How do you differentiate between Duodenal and gastric Ulcers?

A

Duodenal - 2-3 Hours after eating, commonly awakens patients at night

Gastric - Pain shortly after eating

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4
Q

What are the most common Risk Factors for Peptic Ulcer Disease?

A

H.Pylori & NSAIDS

Bisphosphonates

Smoking

Head Trauma (Cushing Ulcer)

Zollinger-Ellison Syndrome

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5
Q

How would you investigate H.Pylori as a proposed cause of Peptic Ulcer Disease?

A

Breath test (13C Urea, measure 13-CO2) - Stop PPI beforehand

Stool Antigens

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6
Q

How would you manage a Peptic Ulcer caused by H.Pylori?

A

Triple Therapy

PPI + 2x Antibiotics

Amoxicillin with either Clarithromycin or Metronidazole

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7
Q

What is Zollinger-Ellison Syndrome?

A

Neuroendocrine tumour in the Pancreas.

Produces Gastrin = Higher levels of Gastric Acid secretion

May be associated with MEN1

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8
Q

How would you investigate a possible case of Zollinger-Ellison Syndrome?

A

Fasting serum gastrin

Serum Calcium - MEN1

Imaging

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9
Q

What causes Cushing’s Ulcers?

A

Raised ICP post-head trauma leads to increased Vagal stimulation and gastric acid secretion

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10
Q

What causes Curling Ulcers?

A

Severe burn injuries lead to reduced plasma volume, ichaemia and necrosis of the Gastric Mucosa

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11
Q

How would you manage H.Pylori negative Peptic Ulcer DIsease?

A

PPI (-oprazoles) or H2 Antagonist (-tidines)

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12
Q

What are the main complications of Peptic Ulcer Disease?

A

Bleeding

Perforation (Leading to air under the diaphragm)

Gastric Cancer

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13
Q

Which form of Gastric Cancer is most common?

A

Adenocarcinoma

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14
Q

How does Gastric Cancer present?

A

Epigastric Pain

Nausea & Vomiting (+/- Blood)

Anorexia

Weight Loss

OE - Palpable Mass, Virchow’s Node, Sister Mary Joseph Node

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15
Q

How does GORD typically present?

A

Heartburn

Regurgitation

Dysphagia

Chest Pain

(Minor = Coughing, Hoarseness)

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16
Q

What are the main Risk Factors for GORD?

A

Obesity, Pregnancy

Drugs (Anti-Muscarinics, CCBs, Nitrates)

Hiatus Hernia

Diet, smoking

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17
Q

What is a Hiatus Hernia?

A

Prolapse of the stomach through the Diaphragmatic Oesophageal Hiatus.

Predisposes patients to GORD.

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18
Q

How would you investigate a suspected Hiatus Hernia?

A

Barium Swallow

CXR

Endoscopy

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19
Q

How would you manage a Hiatus Hernia?

A

Risk factor modification

PPI

Fundoplication

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20
Q

How would you investigate a patient with Dyspepsia and Red Flag Signs?

A

OGD

21
Q

How would you investigate and manage a potential case of GORD?

A

Trial of PPI

Success = both therapeutic and diagnostic

22
Q

What are the main complications of GORD?

A

Barrett’s Oesophagus

Adenocarcinoma

Strictures

23
Q

What is Barrett’s Oesophagus?

A

Metaplasia of the oesophagus from squamous epithelium to columnar epithelium.

High chance of developing into Adenocarcinoma - require regular endoscopy.

24
Q

How would you manage a patient with Barrett’s Oesophagus?

A

High Grade - Radiofrequency Ablation

Nodule - Nedoscopic Mucosal Resection

PPI for both

25
Q

How does Oesophageal Cancer present?

A

Progressive Dysphagia from solids to liquids.

Burning Chest Pain

FLAWS

26
Q

How would you investigate possible Oesophageal Carcinoma?

A

OGD and Biopsy

CT for staging

27
Q

What are the main types of Oesophageal Cancer?

A

Lower Third (Adenocarcinoma) - Most common

Middle third (Squamous Cell)

28
Q

How would you classify the potential causes of Dysphagia?

A

High - Throat & Mouth

Low - Oesophagus

Functional - Motility/Neurological Issue

Structural - Obstruction

29
Q

What are the main structural causes of High Dysphagia?

A

Cancer

Pharyngeal Pouch

30
Q

What are the main functional causes of High Dysphagia?

A

Stroke

Parkinson’s

Myasthenia Gravis

MS

MND

31
Q

What are the main structural causes of Low Dysphagia?

A

Cancer

Stricture

Plummer-Vinson

Foreign Body

32
Q

What are the main functional causes of Low Dysphagia?

A

Achalasia

Oesophageal Spasm

Limited Cutaenous Scleroderma

33
Q

What is Achalasia?

A

The absence of Oesophageal peristalsis and the failure of the lower oesophageal sphincter to relax.

34
Q

How does Achalasia typically present?

A

Dysphagia to both solids and liquids

Regurgitation

Dyspepsia

Weight Loss

35
Q

What is the most concerning cause of Dysphagia?

A

Oesophageal Cancer

New-Onset Dysphagia in over-55s is Carcinoma until proven otherwise.

36
Q

How would you investigate Dysphagia?

A

Barium Swallow

Endoscopy

Videofluroscopy

Manometry

37
Q

How does Achalasia look on a Barium Swallow?

A

Birds Beak Appearance

38
Q

How do the presentations of Achalasia and Oesophageal Cancer differ?

A

Oesophageal Cancer - Old, new onset, Progressive, Structural, FLAWS

Achalasia - Younger, Long-term, functional, intermittent.

39
Q

Which signs and symptoms would point towards a Neurological cause of Dysphagia?

A

Coughing

Choking

Slow Eating

Early Dysphagia for liquids

40
Q

What is a Mallory-Weiss tear?

A

Tear in the Oesophageal Mucosa

Usually occurs due to vomiting.

Presents as fresh blood smears in the vomit

41
Q

What is Boerhaave Syndrome?

A

Complication of a Mallory-Weiss Tear where the full oesophageal wall is torn.

Shows Pneumomediastinum on CXR

AKA Oesophageal Rupture

42
Q

How does Boerhaave’s Syndrome typically present?

A

Chest Pain

Shock

Subcutaneous Emphysema

Crunching sound upon auscultation of the heart (due to Pneumomediastinum)

43
Q

What are Oesophageal Varices?

A

Dilated sub-mucosal veins in the lower third of the oesophagus

44
Q

How do Oesophageal Varices present?

A

Extreme Heamatemesis

Loss of consciousness

Shock

Malaena

45
Q

What are the main Risk factors for the development of Oesophageal Varices?

A

Liver Cirrhosis - Portal Hypertension & Decreased Clotting Factors

Alcohol use

46
Q

How would you investigate a suspected case of Oesophageal Varices?

A

FBC - Macrocytic Anaemia & Thrombocytopenia

LFTs - Raised GGT & Bilirubin, Lowered Albumin

U&Es - Raised Urea

47
Q

How would you manage a patient with Oesophageal Varices?

A

ABCDE

Fluids

Terlipressin IV (for Portal HTN)

Endoscopy (Band Ligation)

48
Q

How does a Ruptured Peptic Ulcer present?

A

Coffee Ground emesis

Malaena

49
Q

How would you manage a Ruptured Peptic Ulcer?

A

Endoscopy, injection of IM Adrenaline

Treatment of underlying ulcer & cause

Year 3 - MedEd Lectures (29 decks)

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