Upper GI Flashcards
What is Dyspepsia?
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
How does Peptic Ulcer Disease typically present?
Recurrent Epigastric pain related to eating
Early Satiety
Nausea & Vomiting
Potential Weight Loss
Signs of Blood Loss (Anaemia)
How do you differentiate between Duodenal and gastric Ulcers?
Duodenal - 2-3 Hours after eating, commonly awakens patients at night
Gastric - Pain shortly after eating
What are the most common Risk Factors for Peptic Ulcer Disease?
H.Pylori & NSAIDS
Bisphosphonates
Smoking
Head Trauma (Cushing Ulcer)
Zollinger-Ellison Syndrome
How would you investigate H.Pylori as a proposed cause of Peptic Ulcer Disease?
Breath test (13C Urea, measure 13-CO2) - Stop PPI beforehand
Stool Antigens
How would you manage a Peptic Ulcer caused by H.Pylori?
Triple Therapy
PPI + 2x Antibiotics
Amoxicillin with either Clarithromycin or Metronidazole
What is Zollinger-Ellison Syndrome?
Neuroendocrine tumour in the Pancreas.
Produces Gastrin = Higher levels of Gastric Acid secretion
May be associated with MEN1
How would you investigate a possible case of Zollinger-Ellison Syndrome?
Fasting serum gastrin
Serum Calcium - MEN1
Imaging
What causes Cushing’s Ulcers?
Raised ICP post-head trauma leads to increased Vagal stimulation and gastric acid secretion
What causes Curling Ulcers?
Severe burn injuries lead to reduced plasma volume, ichaemia and necrosis of the Gastric Mucosa
How would you manage H.Pylori negative Peptic Ulcer DIsease?
PPI (-oprazoles) or H2 Antagonist (-tidines)
What are the main complications of Peptic Ulcer Disease?
Bleeding
Perforation (Leading to air under the diaphragm)
Gastric Cancer
Which form of Gastric Cancer is most common?
Adenocarcinoma
How does Gastric Cancer present?
Epigastric Pain
Nausea & Vomiting (+/- Blood)
Anorexia
Weight Loss
OE - Palpable Mass, Virchow’s Node, Sister Mary Joseph Node
How does GORD typically present?
Heartburn
Regurgitation
Dysphagia
Chest Pain
(Minor = Coughing, Hoarseness)
What are the main Risk Factors for GORD?
Obesity, Pregnancy
Drugs (Anti-Muscarinics, CCBs, Nitrates)
Hiatus Hernia
Diet, smoking
What is a Hiatus Hernia?
Prolapse of the stomach through the Diaphragmatic Oesophageal Hiatus.
Predisposes patients to GORD.
How would you investigate a suspected Hiatus Hernia?
Barium Swallow
CXR
Endoscopy
How would you manage a Hiatus Hernia?
Risk factor modification
PPI
Fundoplication
How would you investigate a patient with Dyspepsia and Red Flag Signs?
OGD
How would you investigate and manage a potential case of GORD?
Trial of PPI
Success = both therapeutic and diagnostic
What are the main complications of GORD?
Barrett’s Oesophagus
Adenocarcinoma
Strictures
What is Barrett’s Oesophagus?
Metaplasia of the oesophagus from squamous epithelium to columnar epithelium.
High chance of developing into Adenocarcinoma - require regular endoscopy.
How would you manage a patient with Barrett’s Oesophagus?
High Grade - Radiofrequency Ablation
Nodule - Nedoscopic Mucosal Resection
PPI for both
How does Oesophageal Cancer present?
Progressive Dysphagia from solids to liquids.
Burning Chest Pain
FLAWS
How would you investigate possible Oesophageal Carcinoma?
OGD and Biopsy
CT for staging
What are the main types of Oesophageal Cancer?
Lower Third (Adenocarcinoma) - Most common
Middle third (Squamous Cell)
How would you classify the potential causes of Dysphagia?
High - Throat & Mouth
Low - Oesophagus
Functional - Motility/Neurological Issue
Structural - Obstruction
What are the main structural causes of High Dysphagia?
Cancer
Pharyngeal Pouch
What are the main functional causes of High Dysphagia?
Stroke
Parkinson’s
Myasthenia Gravis
MS
MND
What are the main structural causes of Low Dysphagia?
Cancer
Stricture
Plummer-Vinson
Foreign Body
What are the main functional causes of Low Dysphagia?
Achalasia
Oesophageal Spasm
Limited Cutaenous Scleroderma
What is Achalasia?
The absence of Oesophageal peristalsis and the failure of the lower oesophageal sphincter to relax.
How does Achalasia typically present?
Dysphagia to both solids and liquids
Regurgitation
Dyspepsia
Weight Loss
What is the most concerning cause of Dysphagia?
Oesophageal Cancer
New-Onset Dysphagia in over-55s is Carcinoma until proven otherwise.
How would you investigate Dysphagia?
Barium Swallow
Endoscopy
Videofluroscopy
Manometry
How does Achalasia look on a Barium Swallow?
Birds Beak Appearance
How do the presentations of Achalasia and Oesophageal Cancer differ?
Oesophageal Cancer - Old, new onset, Progressive, Structural, FLAWS
Achalasia - Younger, Long-term, functional, intermittent.
Which signs and symptoms would point towards a Neurological cause of Dysphagia?
Coughing
Choking
Slow Eating
Early Dysphagia for liquids
What is a Mallory-Weiss tear?
Tear in the Oesophageal Mucosa
Usually occurs due to vomiting.
Presents as fresh blood smears in the vomit
What is Boerhaave Syndrome?
Complication of a Mallory-Weiss Tear where the full oesophageal wall is torn.
Shows Pneumomediastinum on CXR
AKA Oesophageal Rupture
How does Boerhaave’s Syndrome typically present?
Chest Pain
Shock
Subcutaneous Emphysema
Crunching sound upon auscultation of the heart (due to Pneumomediastinum)
What are Oesophageal Varices?
Dilated sub-mucosal veins in the lower third of the oesophagus
How do Oesophageal Varices present?
Extreme Heamatemesis
Loss of consciousness
Shock
Malaena
What are the main Risk factors for the development of Oesophageal Varices?
Liver Cirrhosis - Portal Hypertension & Decreased Clotting Factors
Alcohol use
How would you investigate a suspected case of Oesophageal Varices?
FBC - Macrocytic Anaemia & Thrombocytopenia
LFTs - Raised GGT & Bilirubin, Lowered Albumin
U&Es - Raised Urea
How would you manage a patient with Oesophageal Varices?
ABCDE
Fluids
Terlipressin IV (for Portal HTN)
Endoscopy (Band Ligation)
How does a Ruptured Peptic Ulcer present?
Coffee Ground emesis
Malaena
How would you manage a Ruptured Peptic Ulcer?
Endoscopy, injection of IM Adrenaline
Treatment of underlying ulcer & cause
