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GI > Upper GI > Flashcards

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
Q

oesophageal cancer adenocarcinoma aetiology

A

commoner in white males
obesity
Barrets/GORD
lower 1/3 of oesophagus

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26
Q

oesophageal cancer symptoms

A 
progressive dysphagia 
anaemia 
anorexia, weight loss
anaemia 
malaise 
pain 
hoarse voice, cough 
haematemesis
27
Q

oesophageal cancer metastasis

A

direct invasion - laryngeal nerves
lymphatic spread
haematogenous spread - liver, lung, bone, brain
TNM staging

28
Q

oesophageal cancer management

A

nutritional support
open or minimally invaive oesophagectomy
alongside neoadjuvant or adjuvant chemo
lymph node dissection
palliative

29
Q

acute gastritis causes

A

alcohol
irritant chemical injury
severe burns
shock/trauma

30
Q

chronic gastritis causes

A

chemical - alcohol, NSAIDs, bile reflux
bacterial - h.pylori
autoimmune - pernicious anaemia

31
Q

causes of gastritis

A

lymphocytic - h.pylori and coeliac
eosinophilic
granulomatous

32
Q

H.pylori

A 
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
Q

peptic ulcer disease

A

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
Q

peptic ulcer disease microscopic

A

layer appearance
floor of necrotic fibropurulent debris
base of granulation tissue
deepest layer fibrotic scar tissue

35
Q

causes of PUD

A

H.pylori
NSAIDs
gastric dysmotility
outflow obstruction

36
Q

complications of PUD

A 
pain predominant dyspepsia 
perforation 
penetration 
haemorrhage 
stenosis
intractable pain
37
Q

H.pylori and PUD

A

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
Q

H.pylori ammonia production

A

2H2O +H - urease - ammonium bicarbonate

urease us an enzyme produced by H.pylori

39
Q

NSAIDs and PUD

A

decrease prostaglandin formation via COX inhibition
PGE2 and PGI2 normally increase pH
NSAIDs increase acid production and decrease protection

40
Q

PUD symptoms

A 
pain predominant dyspepsia 
often nocturnal 
aggravated or relieved by eating 
relapsing and remitting 
nausea and vomiting 
weight loss
reflux
41
Q

PUD investigations

A

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
Q

treatment of PUD

A

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
Q

PUD complication

A 
anaemia 
bleeding - haematemesis, melena 
perforation 
gastric outlet/duodenal obstruction 
cancer
44
Q

PUD follow up

A

duodenal ulcer - only if ongoing symptoms

gastric ulcer - endoscopy at 6-8 weeks, ensure healing and no malignancy

45
Q

dyspepsia

A

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
Q

dyspepsia causes

A

organic - PUD, GORD, NSAIDs, COX-2 inhibitor, gastric cancer
functional - no evidence of structural disease, associated with IBS

47
Q

ALARMS symptoms

A 
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
Q

management of dyspepsia

A

absence of ALARMS
lifestyle measures
assess medication
medical treatment - PPI, test for H.pylori

49
Q

gastric cancer risk factors

A

infections - H.pylori
smoking
diet - processed meats
obesity

50
Q

gastric cancer histopathology

A

90% adenocarcinoma - intestinal or diffuse
5% lymphomas - MALT lymphomas
cacinoid and stromal tumours may occur

51
Q

gastric cancer symptoms

A

dyspepsia

ALARMS or >55 years

52
Q

gastric cancer investigations

A

endoscopy and biopsy

CT scan

53
Q

gastric cancer treatment

A

surgery is definitive treatment
chemo and radiotherapy
MALT lymphoma - treatment for H.pylori

54
Q

Achalasia

A

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
Q

achalasia symptoms

A

dysphagia
regurgitation of undigested food
chest pain
weight loss

56
Q

achalasia investigations

A

x-ray may show dilated oesophagus
barium swallow study will show a bird beak appearance
oesophageal manometry
endoscopy to rule out cancer

57
Q

achalasia management

A

CCBs and nitrates
young - heller’s myotomy (cardiomyotomy)
old - balloon dilation

58
Q

gastroparesis

A

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
Q

gastroparesis symptoms

A 
feeling of fullness
bloating 
weight loss caused by food fear
nausea and vomiting after meals 
abdomen pain
60
Q

gastroparesis investigations

A

gastric emptying studies

manometry

61
Q

gastroparesis management

A

nutritional support
metoclopramide
implantable gastric stimulation
vertical sleeve gastrectomy

62
Q

haematemesis

A

blood in vomit

63
Q

melena

A

black, foul smelling stool

GI (10 decks)

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