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Gastro Finals > Upper GI disease > Flashcards

Upper GI disease Flashcards

1
Q

Describe the presentation of GORD

A
  • Heartburn occurring after meals/nighttime: central chest discomfort, burning character
  • Regurgitation
  • Bad taste in the mouth
  • Chronic dry cough
  • Hoarseness
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2
Q

Describe the signs of GORD

A

Usually no signs

-Dental erosion

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3
Q

Describe the investigations for GORD

A

Dx is clinical, no need for further Ix unless red flag symptoms

  • FIT test
  • Bloods: FBC, CRP, B12
  • OGD for alarm/atypical/relapsing
  • Oesophageal pH monitoring: rarely used
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4
Q

What are some red flag features in GORD?

A

Alarm symptoms:

  • Weight loss
  • Anaemia
  • Dysphagia
  • GI bleeding: melaena, haematemesis
  • Persistent vomiting
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5
Q

Describe the management of GORD

A

Conservative:

  • Lifestyle: weight loss, smoking and alcohol cessation
  • Dietary advice: avoidance, meal size etc

Medical:
-PPIs 1st line. 8 week trial is Dx -> H2R antagonists

Surgical:
-Laparoscopic Nissen fundoplication

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6
Q

Describe the complications of GORD

A

Short term:
-Oesophagitis

Long term:

  • Barrett’s oesophagus
  • Strictures
  • Carcinoma
  • Dental erosion
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7
Q

Define peptic ulcers

A

Breach in the lining of the stomach or duodenum to the depth of the muscularis mucosa

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8
Q

Describe the aetiology of peptic ulcer disease

A 
Top causes are NSAIDs and H pylori infection
Also:
-Smoking
-Alcohol 
-Stress ulcers e.g ITU patients 
-Zollinger-Ellison syndrome 
-Medications: bisphosphonates, steroids 
-Inflammation: Crohn's
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9
Q

Which are more common, gastric or duodenal ulcers?

A

Duodenal

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10
Q

Describe the presentation of peptic ulcers

A

Dyspepsia: intermittent dull aching epigastric pain
-Gastric: pain worse before and during meals
-Duodenal: relieved by eating
+ nausea, vomiting, early satiety rarely
Possible sudden onset in erosions:
-Haematemesis
-Shock
-Peritonitis

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11
Q

Describe the signs of peptic ulcer disease

A

Usually normal exam

Some mild epigastric tenderness

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12
Q

Describe the investigations for peptic ulcer disease

A

History and exam
Stool antigen test/urease breath test for H pylori
Bloods: FBC, iron studies if needed
OGD: gold standard for diagnosis
-2WW: for any pt with weight loss over 55 yrs + dyspepsia, epigastric pain, reflux

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13
Q

Describe the management of peptic ulcer disease

A

Conservative:

  • Avoid trigger: stop NSAIDs where possible
  • Lifestyle: stop smoking, alcohol, dietary modification

Medical:

  • H pylori eradication: triple therapy (amox + clari/metro + PPI)
  • PPI/H2RA: 8 week trial
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14
Q

What are the considerations for H pylori testing?

A
  • No PPI for 2 weeks
  • No Abx for 4 weeks
  • Confirm eradication after 6-8 weeks from treatment
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15
Q

What are the standard doses of common PPIs?

A

Omeprazole: 20mg OD
Lansoprazole: 30 mg OD
Pantoprazole: 40 mg OD

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16
Q

What are the common side effects and interactions of PPIs?

A

GI upset: diarrhoea, constipation, nausea
Headaches
Hypomagnesaemia
Increased risk of osteoporosis
Interactions: don’t give omeprazole with clopi

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17
Q

What are the common side effects and interactions of H2RA?

A

Usually v well tolerated

  • GI upset
  • Headaches
  • no interactions
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18
Q

Describe the aetiology of gastritis

A

Acute vs chronic gastritis
Acute: Same as peptic ulcer disease
-NSAIDs, H pylori
-Alcohol

Chronic:

  • Autoimmune
  • H pylori
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19
Q

Describe the presentation of acute gastritis

A

Essentially the same as peptic ulcer disease

  • Dyspepsia: dull aching epigastric pain
  • Nausea and vomiting
  • Loss of appetite
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20
Q

Describe the investigations for gastritis

A

The same as for peptic ulcer disease

  • H pylori testing: breath test or stool Ag test
  • Consider bloods: FBC, B12, antibodies
  • OGD: in >55s with weight loss + dyspepsia/reflux/ epigastric pain
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21
Q

Describe the management of gastritis

A

As for peptic ulcer disease

22
Q

Describe the complications of peptic ulcer disease + gastritis

A

Acute:

  • Perforation
  • Erosion + haemorrhage

Chronic:

  • Carcinoma, lymphoma
  • Strictures
23
Q

Define achalasia

A

Oesophageal motor disorder caused by aperistalsis and impaired relaxation of the oesophageal sphincter -> narrowing of the distal oesophagus

24
Q

Describe the presentation of achalasia

A
  • Progressive dysphagia to solids + liquids, with posturing to aide swallowing
  • Regurgitation
  • Weight loss
  • Recurrent infections
25
Q

Describe the signs of achalasia on examination

A

Normal examination- ?weight loss

26
Q

Describe the investigations for achalasia

A
  • History and examination

- OGD is 1st line -> barium swallow (aperistalsis, beaked oesophagus) and oesophageal manometry

27
Q

Describe the management of achalasia

A

Medical:

  • OGD: Pneumatic dilatation is 1st line
  • Pharm: CCBs (verapamil) or nitrates if unsuitable for intervention

Surgical:
-Heller myotomy (cardiomyotomy)

28
Q

Describe the complications of achalasia

A

Aspiration pneumonia

Weight loss + nutritional deficiency

29
Q

Define dyspepsia

A

Dyspepsia (indigestion) is a group of symptoms that suggest an upper GI problem, including:

  • Epigastric pain
  • Nausea
  • Bloating, belching
30
Q

What are the causes of dyspepsia?

A
  • Peptic ulcer disease
  • Gastritis
  • Functional dyspepsia
  • Gastric carcinoma
31
Q

Define functional dyspepsia

A

Dyspepsia without a cause found on OGD

32
Q

Describe the epidemiology of functional dyspepsia

A

Common

Typically affects young F, co-exists w IBS + mental health conditions

33
Q

Describe the management of functional dyspepsia

A

Conservative:

  • Dietary advice: small meals, avoid high fat
  • Reduce smoking, alcohol, NSAIDs

Medical:

  • Acid suppression: PPIs/H2RA
  • Prokinetic drugs: metoclopramide
  • Antidepressants
34
Q

Describe the epidemiology of Barrett’s oesophagus

A

Common in developed countries

35
Q

Describe the pathophysiology of Barrett’s oesophagus

A

Chronic reflux -> squamous metaplasia (Z line or SCJ migrates further up)
Barrett’s oesophagus is reversible with treatment, but can progress to dysplasia if not treated

36
Q

When would you consider investigating for Barrett’s oesophagus? How would you do this?

A

In pt with longstanding reflux

  • Stop any PPIs for min 2 weeks
  • OGD and biopsy
37
Q

Describe the management of Barrett’s oesophagus

A

Conservative:
-Lifestyle advice: weight loss, reduce alcohol + smoking, dietary advice

Medical:
-PPIs/H2RA long term

Monitoring:
-Consider OGD surveillance

38
Q

Describe the presentation of a Mallory-Weiss tear

A
  • Haematemesis following repeated vomiting
  • Usually streaks of fresh red blood
  • Retrosternal pain, odynophagia
39
Q

Describe the management of Mallory-Weiss tear

A

Conservative:
-Most will resolve spontaneously

Medical:

  • PPIs/H2RA
  • Endoscopy
40
Q

Describe the investigations for a Mallory-Weiss tear

A
  • History and examination (including PR)
  • Bloods: FBC, clotting, U+Es
  • OGD if indicated
41
Q

Describe the process of endoscopy (patient friendly)

A

A camera test of the oesophagus and stomach, put a tube through your mouth.
Come in to the hospital for a few hours, procedure takes about 30 minutes.
Give sedation to relax you.

42
Q

Describe the risks of endoscopy

A

Common:

  • Discomfort
  • Nausea from sedative

Rare:

  • Infection
  • Perforation/bleeding
43
Q

Describe the indications for OGD

A
  • Any dysphagia
  • Reflux/dyspepsia + >55 + weight loss
  • Treatment resistant/persistent reflux/dyspepsia
  • Suspected upper GI malignancy
  • Melaena/haematemesis
44
Q

Describe the epidemiology and risk factors for oesophageal cancer

A

Epidemiology: commoner in China, Japan. M > F
RFs:
-Non-modifiable: genetics, M, older age
-Modifiable: smoking, alcohol, GORD

45
Q

Describe the types of oesophageal carcinoma

A

Most are adenocarcinoma (lower 1/3). Assoc with GORD and Barrett’s
SCC in upper 2/3. Assoc with smoking, alcohol

46
Q

Describe the causes of dysphagia

A
  • Infection/inflammation: oesophagitis, pharyngitis
  • Structural: oesophageal cancer, strictures, pharyngeal pouch
  • Motility issues: achalasia, nutcracker oesophagus, CN palsy, MG
47
Q

What is a nutcracker oesophagus?

A

A condition in which high amplitude oesophageal contractions cause dysphagia and chest pain

48
Q

Describe the causes of upper GI bleeding

A

Infection/inflammation: gastritis, oesophagitis, ulcers
Malignancy
Vascular: varices
Trauma: Mallory-Weiss tear

49
Q

Describe the epidemiology and risk factors for gastric cancer

A

Epidemiology: M >F. Japan, China + Eastern Europe
RFs:
-Non-modifiable: geographical location, M, older age, autoimmune gastritis/PA
-Modifiable: smoking, alcohol, diet, H pylori

50
Q

Describe the presentation of gastric cancer

A

Usually late

  • Weight loss and anorexia
  • Dyspepsia: epigastric discomfort, N+V, belching
  • Upper GI bleeding
51
Q

Describe some locations of gastric cancer metastases

A

Lymph nodes: Virchow’s node/ Troisier’s sign
Liver + lung
Ovaries: Krukenberg tumour
Umbilicus: Sister Mary Joseph nodule

52
Q

Describe the presentation of Zollinger- Ellison syndrome

A

Persistent + refractory PUD
Persistent diarrhoea
Dyspepsia + abdo pain

Gastro Finals (4 decks)

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