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Upper GI Flashcards

1
Q

angular cheilitis

A 
candida infection 
fungus 
red swollen patches on corner of mouth 
due to iron deficient anaemia 
self limiting
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2
Q

apthous stomatitis

A

canker sores
erythematous macules develop into ulcers
yellow fibrinous membrane can be scraped away
reddish halo
go awy in a week
anaemic or haematinic deficiency
IBD, coeliac

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3
Q

oral thrush

A

acute pseudomembranous candidiasis

common in severe asthma, due to oral steroid

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4
Q

lichen planus

A

wickham’s striae

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5
Q

oral cancer aetiology

A

alcohol and tobacco - synergistic
HPV - 16 and 18
candida
low vitamin A, C and iron

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6
Q

oral cancer location

A 
high risk at soft sites 
non keratinizing squamous epithelium 
ventral and laterl tongue 
floor of mouth 
rarely dorsal tongue and hard palate
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7
Q

oral cancer warning signs

A 
red and white lesions, lump or thickening 
irregular shape and increasing size
persistent sores that do not heal 
numb feeling 
dysphonia, dysphagia 
facial palsy, double vision 
systemic symptoms of cancer
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8
Q

4 key questions for oral cancer

A

how long
painful
smoke/drink
colour

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9
Q

acute oesophagitis

A

rare
chemical ingestion
infection in immunocompromised
candidiasis, HSV, CMV

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10
Q

chronic oesophagitis

A

common
reflux oesophagitis GORD
rarer causes - Crohn’s

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11
Q

allergic oesophagitis

A

eosinophilic
history of atopic or autoimmune disease
similar presentation to GORD

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12
Q

allergic oesophagitis investigations

A

pH probe negative for reflux
increased eosinophils in blood
failed course of PPIs
endoscopy corrugated or spotty

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13
Q

allergic oesophagitis treatment

A

removal of antigen, steroids, cromoglycate

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14
Q

causes of GORD

A 
incompetent LOS
poor esophageal clearance 
barrier function/viscera; sensitivity 
obesity/pregnancy 
stress
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15
Q

GORD symptoms

A 
heartburn 
reflux 
watebrash
dysphagia 
odynophagia
weight loss
chest pain 
hoarsness
coughing
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16
Q

GORD investigation

A 
PPI trial 
endoscopy 
barium swallow 
oesophageal manometry 
ph studies 
nuclear studies
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17
Q

GORD complications

A

ulceration
stricture
Barrets

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18
Q

GORD treatment

A

lifestyle
antacids
PPIs, H2 antagonists
surgery - laparoscopic antireflux surgery - nissen fundoplication

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19
Q

Barrets cell change

A

stratified squamous epithelium to simple columnar epithelium with goblet cells

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20
Q

Barrets signs and symptoms

A 
chronic reflux
Dysphagia, odynophagia
weight loss
haematemesis
retrosternal pain
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21
Q

Barrets diagnosis

A

endoscopy and biopsy

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22
Q

Barrets pre malignant condition

A 
chronic reflux oesophagitis 
barrets metaplasia
low grade dysplasia 
high grade dysplasia 
adenocarcinoma
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23
Q

Barrets management

A

no dysplasia - surveillance
low grade - endoscopic radiofrequency ablation
high grade/intramucosal cancer - oesophagectomy
endoscopic therapy
endoscopic radiofrequency abblation
endoscopic mucosal resection

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24
Q

oesophageal cancer squamous cells aetiology

A 
smoking and alcohol 
HPV 16 and 18
Vita min A and zinc deficiency 
tannic acid 
oesophagitis 
genetic
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25
oesophageal cancer adenocarcinoma aetiology
commoner in white males obesity Barrets/GORD lower 1/3 of oesophagus
26
oesophageal cancer symptoms
``` progressive dysphagia anaemia anorexia, weight loss anaemia malaise pain hoarse voice, cough haematemesis ```
27
oesophageal cancer metastasis
direct invasion - laryngeal nerves lymphatic spread haematogenous spread - liver, lung, bone, brain TNM staging
28
oesophageal cancer management
nutritional support open or minimally invaive oesophagectomy alongside neoadjuvant or adjuvant chemo lymph node dissection palliative
29
acute gastritis causes
alcohol irritant chemical injury severe burns shock/trauma
30
chronic gastritis causes
chemical - alcohol, NSAIDs, bile reflux bacterial - h.pylori autoimmune - pernicious anaemia
31
causes of gastritis
lymphocytic - h.pylori and coeliac eosinophilic granulomatous
32
H.pylori
``` gram -ve flagellated bacilus often acquired in infancy consequences later in life direct contact, oral oral, faecal oral increased risk of duodenal ulcer, gastritis, gastric ulcer, carcinoma, lymphoma ```
33
peptic ulcer disease
breach in GI mucosa due to a failure of defense against acid and pepsin attack gastric duodenal ulcer 2-10 cm across edges clear cut, punched out
34
peptic ulcer disease microscopic
layer appearance floor of necrotic fibropurulent debris base of granulation tissue deepest layer fibrotic scar tissue
35
causes of PUD
H.pylori NSAIDs gastric dysmotility outflow obstruction
36
complications of PUD
``` pain predominant dyspepsia perforation penetration haemorrhage stenosis intractable pain ```
37
H.pylori and PUD
acute inflammatory response which can progress to chronic ammonia and proteases released damage epithelium H.pylori increased pH increases gastrin production excess acid can cause duodenal ulcers to form
38
H.pylori ammonia production
2H2O +H - urease - ammonium bicarbonate | urease us an enzyme produced by H.pylori
39
NSAIDs and PUD
decrease prostaglandin formation via COX inhibition PGE2 and PGI2 normally increase pH NSAIDs increase acid production and decrease protection
40
PUD symptoms
``` pain predominant dyspepsia often nocturnal aggravated or relieved by eating relapsing and remitting nausea and vomiting weight loss reflux ```
41
PUD investigations
first line - carbon 13 urea breath test, faecal antigen test second line - re-test urea breath test, serology IgA antibodies rarely gastroscopy and biopsy
42
treatment of PUD
tested positive for H.pylori - triple therapy for 7 days: PPI amoxicillin cllarithromycin/metrindazole people using NSAIDs - stop NSAIDs, PPI or H2RA, and H.pylori eradication negative for H.pylori and NSAIDs - PPI or H2RA
43
PUD complication
``` anaemia bleeding - haematemesis, melena perforation gastric outlet/duodenal obstruction cancer ```
44
PUD follow up
duodenal ulcer - only if ongoing symptoms | gastric ulcer - endoscopy at 6-8 weeks, ensure healing and no malignancy
45
dyspepsia
a collection of symptoms epigastric pain syndrome - bloating, epigastric pain/ burning in stomach/ abdomen, felux post prandial distress syndrome - post prandial fullness, early satiety, nausea and vomiting
46
dyspepsia causes
organic - PUD, GORD, NSAIDs, COX-2 inhibitor, gastric cancer functional - no evidence of structural disease, associated with IBS
47
ALARMS symptoms
``` anaemia loss of weight anorexia recent onset of progressive symptoms masses and melena/haematemesis swallowing dificulty over 55 anyone with dyspepsia/GORD that fits any of this criteria receives upper GI endoscopy ```
48
management of dyspepsia
absence of ALARMS lifestyle measures assess medication medical treatment - PPI, test for H.pylori
49
gastric cancer risk factors
infections - H.pylori smoking diet - processed meats obesity
50
gastric cancer histopathology
90% adenocarcinoma - intestinal or diffuse 5% lymphomas - MALT lymphomas cacinoid and stromal tumours may occur
51
gastric cancer symptoms
dyspepsia | ALARMS or >55 years
52
gastric cancer investigations
endoscopy and biopsy | CT scan
53
gastric cancer treatment
surgery is definitive treatment chemo and radiotherapy MALT lymphoma - treatment for H.pylori
54
Achalasia
oesophageal motility disorder failure of smooth muscle relaxation of LOS - increased LOS tone, lack of peristalsis, due to degradation of the myenteric plexus failure of distal inhibitory neurons
55
achalasia symptoms
dysphagia regurgitation of undigested food chest pain weight loss
56
achalasia investigations
x-ray may show dilated oesophagus barium swallow study will show a bird beak appearance oesophageal manometry endoscopy to rule out cancer
57
achalasia management
CCBs and nitrates young - heller's myotomy (cardiomyotomy) old - balloon dilation
58
gastroparesis
delayed gastric emptying that is not due to an obstruction can be caused by diabetes chemotherapy induced neuropathy can be caused by smoking weed
59
gastroparesis symptoms
``` feeling of fullness bloating weight loss caused by food fear nausea and vomiting after meals abdomen pain ```
60
gastroparesis investigations
gastric emptying studies | manometry
61
gastroparesis management
nutritional support metoclopramide implantable gastric stimulation vertical sleeve gastrectomy
62
haematemesis
blood in vomit
63
melena
black, foul smelling stool

GI (10 decks)

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