Upper GI Flashcards
what does a barium swallow show in achlasia?
dilated tapering of oesophagus
treatment of achlasia
endoscopic balloon dilatation
ALARMS pneumonic for red flags linked to dyspepsia
Anaemia Loss of weight Anorexia Recent onset/progressive Manaemia/haematemesis Swallowing difficulty
motility disorders causing dysphagia (
- systemic sclerosis
- achlasia
- neuromuscular bulbar palsy (myasthenia gravis, wilsons, parkinsons, pseudobulbar palsy)
- diffuse oesophageal spasm
malignant stricture causing dysphagia
- pharyngeal cancer
- gastric cancer
- oesophageal cancer
benign strictures causing dysphagia
- oesophageal web/ring
- peptic structure
extrinsic pressure causing dysphagia
- mediastinal lymph nodes
- lung cancer
- retrosternal goitre
- left atrial enlargement
- aortic aneurysm
which ulcer is more common (duodenal or gastric)
duodenal ulcer
factors contributing to increased acid (5)
- smoking
- alcohol
- too much caffeine
- stress
- spicy foods
eating worsens which ulcer
eating worsens a gastric ulcer
complications of peptic ulcers (3)
- perforation
- bleeding
- scarring & strictures
what (3) can breakdown the protective layer of the stomach mucosa?
- Medications (Steroids/NSADIs)
- Helicobacter Pylori
- increased acid
medications causing peptic ulcer disease
NSAIDs
Corticosteroids
Alcohol
Other causes of peptic ulcer disease
zollinger ellison syndrome
acute stress
malignancy
inflammatory - chrons
describe H pylori
gram negative, spiral shaped, flagellated, micro-aerophilic bacterium
mechanism of NSAIDs
COX 1 inhibitor
what causes zollinger ellison sydnrome?
hyper-secreting gastrinoma within the pancreas, leading to the development of multiple peptic ulcers
zollinger ellison syndrome is part of what genetic condition?
MEN type 1
what consists of 7-day course of triple-therapy
PPI
Amoxicillin
Clarithromycin/metronidazole
peptic ulcer eroding through which artery can lead to massive haemorrhage
gastroduodenal artery
type of lining in stomach
columnar epithelial lining
type of lining in oesopahgus
squamous epithelial lining
red flags indicating 2 week wait referral:
- Dysphagia at any age
- Age over 55
- Weight loss
- Upper abdo pain/reflux
- Treatment resistant dyspepsia
- N &V
- Low haemoglobin
- Raised platelet count
medication that is alternative to PPI
Ranitidine
Ranitidine mechanism?
H2 receptor antagonist
name of surgery for acid reflux
Laparoscopic fundoplication
PPI mechanism
inhibition of H+/K+ ATPases in parietal cells
thereby preventing acid production
what is a stricture
scarring and narrowing of the oesophagus due to repeated damage. Can cause dysphagia. May require dilatation or stenting.
what do chief cells secrete
pepsinogen
what cells are in the cardia & fundus of stomach?
peptic cells & chief cells
what do G cells secrete and where are they located
gastrin
located un pyloric antrum
role & location of brunner glands?
located in duodenum
secrete mucus & bicarbonate ions that neutralize the acid
blood vessel in stomach that can be eroded by gastric ulcers causing massive haemorrhage
left gastric artery, in lesser curvature of stomach
what is the metaplasia that occurs in barrets oesopahgus?
transformation of cells from squamous epithelium to columnar epithelium
2 cancers of the oesophagus
squamous cell carcinoma
adenocarcinoma
4 most common causes of upper GI bleeding
- oesophageal varices
- mallory weiss tear
- peptic ulcers
- cancers of stomach/duodenum
scoring system in suspected upper GI bleed
Glasgow-Blatchford score
what factors does Glasgow-Blatchford take into account?(6)
- Drop in Hb
- Rise in Urea
- Blood pressure
- Heart rate
- Melaena
- Syncopy
score used to calculate the risk of rebleeding & overall mortality in patients that have had an endoscopy
Rockall score
factors the Rockall score takes into account? (5) (ABCDE)
Age Blood pressure & HR Comorbidity Diagnosis Endoscopic findings
3 components of fresh frozen plasma
- blood
- platelets
- clotting factors
medical (2) & endoscopic (2) management of variceal upper GI bleeding
Medical
- Terlipressin
- Prophylactic abx
Endoscopic
- Band ligation
- TIPS
mechanism of terlipressin
terlipressin in a vasopressin analogue & causes splanchic vasoconstiction which reduces portal pressures
why give antibiotic prophylaxis in variceal bleeding?
reduces the risk of spontaneous bacterial peritonitis
