Upper GI Conditions Flashcards
What is Cirrhosis?
Chronic Liver injury givens ongoing inflammation leading to structural changes
What does Liver Cirrhosis lead to?
Portal Hypertension
Impairment of function
What are some common causes of Liver Cirrhosis?
Alcoholic Liver Disease
Viral Hepatitis
Non-Alcoholic Fatty Liver Disease
What causes the liver changes in alcoholic liver disease?
Build up of Acetaldehyde leading to fatty liver changes and eventual Cirrhosis
What can fatty liver lead to?
Rapid Onset Jaundice
Hepatomegaly
RUQ Pain
What is NAFLD due to?
Accumulation of triglycerides and other lipids in hepatocytes
What are some less-common causes of cirrhosis?
Hereditary Haemochromatosis
Wilson’s Disease
Primary Sclerosing Cholangitis
Primary Biliary Cirrhosis
What is Hereditary Haemochromatosis?
An autosomal recessive condition giving abnormal iron metabolism and increased serum iron
What is Wilson’s Disease?
A disease giving abnormal copper metabolism leading to copper build-up. Presents with Kayser-Fleischer rings around the eyes
What is Primary Schlerosing Cholangitis?
A condition giving fibrosis of Intrahepatic/Extrahepatic bile ducts
What is Primary Biliary Cirrhosis?
A condition giving destruction of intrahepatic bile ducts
Why does liver cirrhosis lead to Portal Hypertension?
The fibrotic liver is not expandable and compresses the portal venous system.
What are varices?
Shunts of blood from the portal venous system to the systemic venous system leads to venous distension at the point of anastomoses
What are three common sites of varices?
Oesophageal
Umbilical
Anorectal
What are Gallstones?
Small stones formed from Bile
What are Gallstones made of?
Cholesterol
Bile Pigments
Phospholipids
What are some potential complications of Gallstones?
Biliary Colic
Acute Cholecystitis
Ascending Cholangitis
Pancreatitis
What is Biliary Colic?
RUQ pain due to temporary obstruction of the Cystic/Common Bile duct by a stone
What is the management of biliary colic?
Analgesia +/- Cholecystectomy
What is Acute Cholecystitis?
Impaction of a stone in the cystic duct
How does Acute Cholecystitis present?
Inflammatory features
Murphy’s +ve
What is Ascending Cholangitis?
Infection of the biliary tree
How does Ascending Cholangitis present?
Features of Charcot’s Triad:
Pain
Features of Inflammation
Jaundice
What is the management of Ascending Cholangitis?
IV Antibiotics
Fluid resuscitation
What is Pancreatitis?
Acinar cell injury and necrosis evokes an inflammatory response giving epigastric pain that radiates posteriorly
What clinical sign can pancreatitis demonstrate?
Cullens and Grey Turners signs
What is the management for Pancreatitis?
Fluids
Manage Gallstones
Organ support
What is the investigation of choice for suspected gallstones?
MRCP
How can impacted gallstones be treated?
ERCP +/- stent
What are some causes of pancreatitis?
Gallstones Ethanol Trauma Scorpion Bite Mumps Autoimmune Steroid use Hyperlipidaemia ERCP Drugs
What is haematemesis?
Vomiting of blood due to bleeding from the Upper GI tract
Which causes of haematemesis require emergency treatment?
Oesophageal Varices
Gastric Ulceration
What are Oesophageal varices?
Dilation of the porto-systemic venous anastomoses in the oesophagus
How are perforated oesophageal varices managed?
Endoscopic Banding
What is the Glasgow-Blatchford bleeding score?
A scoring system used to assess the need for intervention in patients with an Upper GI bleed
How does gastric ulceration lead to haematemesis?
Leads to erosion of the blood vessels supplying the upper GI tract
Which causes of haematemesis do not require emergency treatment?
Mallory-Weiss Tear
Oesophagitis
What is a Mallory-Weiss Tear?
A tear in the epithelial lining of the oesophagus after episodes of vomiting. Often benign and self-healing
What is oesophagitis?
Inflammation of the intraluminal epithelium layer of the oesophagus. Usually due to GORD.
What is Dyspepsia?
Complex of upper GI tract symptoms that are present for more than 4 weeks, that include upper abdo pain, heartburn, acid reflux, nausea and/or vomiting
What is GORD?
Reflux due to abnormality of the lower oesophageal sphincter which is tonically contracted
What is Acute Gastritis?
Exposure of gastric mucosa to chemical injury leads to damaged epithelial cells and reduced mucus production. The mucosa responds with vasodilation +/- oedema
What is Chronic Gastritis?
Similar to acute gastritis, only over a longer timeframe
What are some causes of Chronic Gastritis?
H.Pylori
Auto-Immune
Chemical/Reactive
What is Peptic Ulcer disease?
Defects in the gastric/duodenal mucosa extending through the muscularis mucosa. Most commonly in the first part of the duodenum
What are some causes of Peptic Ulcer disease?
Stomach acid H.Pylori NSAIDs Smoking Stress Burns
What are the symptoms of Peptic Ulcer disease?
Epigastric Pain - Burning/Knawing, following meals
Anaemia
Satiety
Weight Loss
What is a Hiatus hernia?
The protrusion of an organ from the abdominal cavity into the thorax through the oesophageal hiatus
Which organ usually herniates in a hiatus hernia?
Stomach
What are the subtypes of hiatus hernia?
Sliding Hiatus Hernia
Rolling Hiatus Hernia
What is a sliding hiatus hernia?
The abdominal part of the oesophagus and the cardia of the stomach frequently move into the thorax
What is a rolling hiatus hernia?
Just the fundus of the stomach herniates, creating a stomach bubble within the chest
What are risk factors for a Hiatus hernia?
Age
Pregnancy
Obesity
Ascites
What are clinical features of a hiatus hernia?
Asymptomatic GORD - Epigastric pain, worse when lay flat Vomiting/Weight loss Hiccups/Palpitations Swallowing difficulties
What are some differentials for a hiatus hernia?
Cardiac CP
Gastric Cancer
What investigations are appropriate for a suspected hiatus hernia?
OGD - Disruption to “Z” line visible
Contrast swallow
What are some conservative management options for hiatal hernias?
PPIs
Lifestyle changes
Smoking and Alcohol cessation
What are surgical management options for hiatal hernias?
Cruroplasty
Fundoplication
What is a Mallory-Weiss tear?
A linear mucosal tear occuring at the oesophagogastric junction due to a sudden increase in intra-abdominal pressure
What are some common causes of a Mallory-Weiss tear?
Coughing
Retching
Alcoholic “Dry Heaves”
What is the primary treatment recommended for a Mallory-Weiss tear?
Conservative, usually self resolving
What is Boerhaave’s Syndrome?
Transmural perforation of the oesophagus typically after forceful emesis
What is Boerhaave’s Syndrome also known as?
Spontaneous Oesophageal Rupture
How does Boerhaave’s Syndrome present?
Mackler’s Triad:
Chest Pain
Vomiting
Subcutaneous Emphysema
