Upper GI Disease Flashcards
What 3 structures does the upper GI consist of?
Oesophagus, Stomach, Intestines
Define chronic gastritis
Ongoing inflammation of the stomach mucosa, it can provide an environment in which dysplasia and carcinoma can arise.
Whats the difference between chronic gastritis and acute gastritis?
Compared to acute gastritis, symptoms are less severe but more persistent.
What are the symptoms of chronic gastritis?
Upper abdo pain, indigestion or bloating, nausea & vomiting, belching, loss of appetite or weight loss.
What are the 3 main causes of chronic gastritis?
Autoimmune
Bacterial - H.pylori
Chemical - alcohol, tobacco, caffeine
Psychological stress
What is H.pylori?
Helicobacter pylori. Gram negative bacterium found in the stomach.
How is H.pylori infection acquired?
Probably through the faecal-oral route.
What can H.pylori infection cause?
Peptic ulcer disease, chronic gastritis, duodenal ulcer, gastric ulcers, gastric carcinoma and lymphoma.
What does peptic ulcer disease occur?
Usually occurs in D1 or antrum.
What are the common causes of PUD?
H.pylori infection and NSAIDs.
What are the symptoms of PUD?
Pain (gnawing, aching, burning), worse at night, worse after meals.
What are the complications of PUD?
Bleeding leading to iron deficiency anaemia. Massive haematemesis. Perforation leading to peritonitis. Long term cancer at edge of ulcer.
What is Barrett’s oesophagus?
Normal lining of the oesophagus is stratified squamous epithelium - in Barrett’s these are replaced by columnar epithelium with goblet cells.
Why does Barrett’s oesophagus occur?
Thought to be an adaptation to chronic acid exposure from reflux oesophagitis.
What can Barrett’s oesophagus lead to?
Process of dysplasia, strong association with oesophageal adenocarcinoma
What are the 2 types of oesophageal cancer?
Squamous cell carcinoma (Oesophageal SCC) and Adenocarcinoma
What are the risk factors for oesophageal SCC?
Adults over 45, more common in males, alcohol, tobacco, injury
What are the symptoms of oesophageal SCC?
Dysphagia, weight loss, haemorrhage, sepsis, respiratory fistula
What is oesophageal adenocarcinoma?
Largely from dysplastic change in Barrett’s oesophagus.
What are the risk factors and symptoms of oesophageal adenocarcinoma?
7:1 M:F ratio, dysphagia, weight loss, haematemesis, chest pain, vomiting.
How can oesophageal carcinoma spread?
Direct spread into surrounding tissues. Lymphatic to paraoesophageal and cervical node groups. Haematogenous to liver or lung.
What is adenocarcinoma of the stomach?
Stomach cancer. 90% of gastric malignancies. Precursor lesions involve intestinal metaplasia, neoplastic polyps and H.pylori associated gastritis.
What are the symptoms of adenocarcinoma stomach?
Early symptoms resemble gastritis. Advanced symptoms include: weight loss, anorexia, anaemia, haemorrhage.
How can adenocarcinoma stomach spread?
Direct infiltration into duodenum, pancreas, colon, liver and spleen. Lymphatic spread into local and regional nodes. Haematogenous into liver and lungs. Omentum and mesentery and ovary.
What is small bowel neoplasia?
Relatively rare bowel cancer compared to other GI malignancy. Different subtypes include: adenocarcinoma, GI stromal tumour, Lymphoma, Carcinoid tumour.
What are the risk factors for small bowel neoplasia?
Chron’s disease, Coeliac disease, Radiation exposure, Hereditary GI cancer syndromes.
What is Coeliac disease?
Extensive mucosal disease related to sensitive to gluten.
What are the symptoms of Coeliac Disease?
Pain and discomfort in the digestive tract, chronic constipation and diarrhoea, failure to thrive in children, anaemia, fatigue.
What can coeliac disease lead to?
Increased risk of both adenocarcinoma and lymphoma of the small bowel.
