Upper GI Flashcards
Define peptic ulcer
Break in the epithelial lining of the stomach or duodenum
Symptoms of peptic ulcer disease (5)
Recurrent epigastric pain related to eating
Early Satiety
Nausea & Vomiting
Potential anorexia & weight loss
Signs of peptic ulcer disease
Epigastric tenderness
Pointing sign
Duodenal vs gastric ulcer pain and weight
Duodenal
Pain 2-3 hours after and commonly awakens patients at night
Often overeat and causes weight gain
Gastric
Pain shortly after eating
Often avoid eating - weight loss
RF of peptic ulcer (4)
H pylori
NSAIDs
Bisphosphonates
Smoking
Ix for H pylori (2)
Breath test - need to stop PPI first
Stool antigen test
Mx of H pylori (4)
Triple therapy
PPI, Clarithromycin,
Amoxicillin OR Metronidazole
Define Zollinger-Ellison syndrome
Neuroendocrine tumour in the pancreas secreting gastrin leading to increased gastric acid secretion and so peptic ulcers
Association of Zollinger Ellison syndrome
MEN1
When to consider Zollinger Ellison syndrome
Multiple ulcers refractory to treatment
FHx of MEN
Ix for Zollinger Ellison syndrome (3)
Fasting serum gastrin
Serum calcium
Gastric acid secretory tests, stimulation tests, Imaging
Mx for Zollinger Ellison syndrome (2)
PPI
Surgical resection if required
What is a Cushing ulcer
patients suffering head trauma developed peptic ulcers.
Why?
Raised ICP thought to stimulate vagus nerve – leads to increased gastric acid secretion
Why do Cushing’s ulcers occur
patients suffering head trauma developed peptic ulcers.
Why?
Raised ICP thought to stimulate vagus nerve – leads to increased gastric acid secretion
What is a Curlings ulcer
Following severe burn injuries
Why?
Reduced plasma volume leads to ischaemia and necrosis of gastric muscosa
Why do Curlings ulcers occur
Following severe burn injuries
Why?
Reduced plasma volume leads to ischaemia and necrosis of gastric muscosa
What are red flags indicating endoscopy (7)
over 55, weight loss, bleeding, anaemia, vomiting, early satiety, or dysphagia
H pylori negative Mx of peptic ulcer disease
H. Pylori negative: PPI or H2 antagonist
Complications of peptic ulcer disease (20
Haemorrhage
Perforation
Most common type of gastric cancer
Adenocarcinoma
Symptoms of gastric cancer (5)
Epigastric pain
Nausea, vomiting ±blood
Anorexia
Weight loss
RF of gastric cancer (3)
Smoking
H. Pylori
Chronic gastritis – and therefore peptic ulcer disease
Signs of gastric cancer (3)
Palpable epigastric mass
Virchow’s node/Troisier’s sign
Sister Mary Joseph node
Ix for gastric cancer (2)
Endoscopy
Biopsy and histology
Causes of increased gastric acid secretion (3)
Diet
Smoking
Zollinger Ellison syndrome
Which drugs can cause lower oesophageal sphincter hypotension and so GORD
anti-muscarinics, CCBs, nitrates, smoking
Ix for hiatus hernia (3)
Barium swallow
Chest X-ray
Endoscopy
Mx of hiatus hernia (3)
Conservative – risk factor modification
Pharmacological (PPI)
Surgery – Nissen fundoplication
Suspected GORD is untreated with PPI, next step?
UGI endoscopy
Define Barretts oesophagus
Metaplasia of the oesophagus due to chronic oesophagitis
What is the change in Barretts oesophagus
squamous epithelium changes to columnar epithelium
Oesophageal cancer symptoms (3)
Progressive dysphagia from solids to liquids
Burning Chest pain
Red flag symptoms – particularly weight loss, anaemia
2 types of oesophageal cancer
Adenocarcinoma
SCC
Where in oesophagus is adenocarcinoma most common
Lower third
Where in oesophagus is SCC most common
Middle third
What are the RF/s for oesophageal adenocarcinoma
Barretts
What are the RF/s for oesophageal SCC
Smoking, alcohol
What is high dysphagia associated with
MND
What is low dysphagia associated with
Obstruction/achalasia
What is the issue in achalasia (2)
Absence of oesophageal peristalsis
Failure of lower oesophageal sphincter (LOS) to relax
Ix for achalasia
Barium swallow
What is seen in the barium swallow of achalasia
Birds beak appearance
Neurological causes of dysphagia (2)
Mainly Stroke and Parkinson’s
Clues that it a neurological cause of dysphagia (4)
Coughing: Immediately on swallow
Choking: Also implies problem with swallow process.
Slow eating
Early dysphagia for liquids – functional problem
Sign of Mallory-Weiss tear over other causes of haematemesis
Usually seen as blood streaked in vomit
Vomiting precedes bleeding
What is Boerhaave syndrome
Complication of Mallory Weiss Tear – also know as oesophageal tear due to vomiting
Ix for Boerhaave syndrome
CXR
Oesophageal varices presentation (3)
Extreme Haematemesis
May be unconscious or in shock
Melaena
Ix for oesophageal varices (6)
FBC: Macrocytic anaemia, ↓ platelets
LFTs: ↑GGT, ↑bilirubin ↓albumin
U&Es: ↑Urea
Endoscopy
Mx of oesophageal varices
ABCDE approach Fluids, regular monitoring. Reduce portal HTN: Terlipressin Endoscopy Band ligation is first line
Presentation of ruptured peptic ulcer (3)
Background of PUD Long-term NSAID use H. pylori infection “Coffee ground” emesis Melaena
Ix for ruptured peptic ulcer (2)
Observations: ↓BP
FBC & LFTs: normal
Endoscopy
Mx of ruptured peptic ulcer (3)
Endoscopy
IM adrenaline at site of ulcer
PPI, e.g. Omeprazole
Triple therapy (if H. pylori)
