upper GI conditions Flashcards
What is achalasia?
condition whereby the lower oesophageal sphincter fails to relax
What are the symptoms of achalasia?
- gradual onset of dysphagia
- regurgitation of undigested food
- aspiration
- weight loss (often mild)
What is the sign of achalasia seen in barium swallow called?
“birds beak appearance”
What does endoscopy in achalasia show?
dilated oesophagus
contains residual material e.g. food regurgitations
How is achalasia managed?
botox injections
calcium channel blockers
surgical cleavage of the muscle, called Heller’s Myotomy
What is Barrett’s oesophagus?
a condition that patients with long term gastro-oesophageal reflux get.
It is caused by chronic acid exposure leading to squamous epithelium becoming metaplastic columnar epithelium
What is the biggest complication of Barrett’s oesophagus?
oesophageal adenocarcinoma
What is the management for patients who have low grade dysplasia barrett’s?
high dose PPI
endoscopic surveillance
What is the management for patients who have high grade dysplasia barrett’s?
endoscopic resection of the abnormal areas e.g. ablation and if fit for surgery can have an oesophagectomy
What is pharyngeal pouch?
herniation of the pharyngeal mucosa through a weakness between the thyropharyngeus and the cricopharyngeus muscles of the pharynx
How does pharyngeal pouch present?
- dysphagia
- regurgitation of undigested food
- aspiration
- chronic cough
- weight loss
Why is endoscopy avoided if suspected pharyngeal pouch
there is a risk of perforation to the lesion
What is seen in barium swallow of pharyngeal pouch?
a residual pool of contrast within the pouch
How is pharyngeal pouch managed?
if small and asymptomatic, no tx
resection of the diverticulum or incision of cricopharyngeus muscle can be performed
What are the main symptoms of peptic ulcers?
- epigastric pain
- fullness
- bloating
- nausea
- intolerance to fatty foods
What is GORD?
reflux of gastric contents into the oesophagus caused by a defective lower oesophageal sphincter
what are the MAIN symptoms of GORD?
“heart burn” - dyspepsia
sensation of acid regurgitation
What are the associated symptoms of GORD which are less common?
epigastric pain
bloating
belching
tooth erosion
What are the risk factors of GORD?
obesity, smoking, alcohol and trigger foods e.g. spicy, coffee, citrus fruits
What are the 3 main investigations of GORD?
PPI trial
oesophagogastroduodenoscopy if patient has relapsing symptoms
oesophageal manometry
Management of GORD
- weight loss, change in diet
- PPI for 8 weeks
- antiacids for relief
- anti reflux surgery if needed
name the 4 complications of GORD
- oesophageal ulcer
- barrett’s oesophagus
- oesophageal stricture
- adenocarcinoma of the oesophagus
RED FLAG symptoms for GORD associated with oesophageal adenocarcinoma
weight loss anaemia dysphagia melaena persistent vomiting
What is a hiatus hernia?
abdominal contents protrude through an enlarged oesophageal hiatus in the diaphragm
Sliding hiatial hernia
most common type
slides up into the chest
less competent sphincter results in acid reflux
treatment is similar for GORD
rolling hiatial hernia
the gastro-oesophageal junction remains in the abdomen
part of the stomach protrudes into the chest
can result in necrosis
risk factors for hiatus hernia
obesity
previous hiatial surgery
increased intra-abdominal pressure
Clinical features of hiatus hernia
a. heart burn
b. dysphagia
c. SOB
d. chronic cough
e. chest pain
How are hiatus hernias diagnosed?
barium swallows
how is hiatus hernia managed conservatively?
- weight loss
- elevation of head off the bed
- avoid eating at night
- avoiding alcohol and acidic foods
- avoiding nicotine
medical management of hiatus hernia
PPI use for 4-8 weeks then looking at response
Nissen’s fundolication = closing the defect by tightening and wrapping fundus around oesophageal sphincter
what are possible causes of candida infection?
- old age
- DM
- immunosuppression
- long term corticosteroids
- malignancy
- antibiotics
Treatment of candida
fluconazole
What causes hairy leukoplakia?
epstein-barr virus
suggestive of HIV infection
What do apthous oral ulcers suggest?
iron, b12 and folate deficiencies
crohn’s disease
cause(s) of glossitis
iron deficiency
What is oesophageal variceal bleeding?
varices are enlarged blood vessels due to portal hypertension.
this condition is when they bleed and this carries a high mortality risk.
Management of variceal bleeding via ABCDE approach
- blood transfusions if lost a large amount of blood
- Terlipressin is a vasopressin used to cause vascoconstriction
- Broad spectrum abx are used to reduce risk of bacterial peritonitis
