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Phase 2- Periop > Upper GI problems > Flashcards

Upper GI problems Flashcards

(53 cards)

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1
Q

What is reflux oesophagitis?

A

Inflammation of the lining of the oesophagus often due to acid reflux

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2
Q

What are the symptoms of GORD?

A 
Retrosternal pain relieved by eating 
Dysphagia 
Odynophagia
Sour taste in mouth 
Bad breath 
Bloating 
Nausea 
Vomiting 
Gum disease
Persistent cough
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3
Q

Why is GORD worse in asthma patients?

A

Acid reflux can irritate the airways too

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4
Q

Give 4 causes of GORD

A 
Oesophageal laxity 
Hiatus hernia 
Smoking
Pregnancy 
Obesity 
Certain foods
NSAIDs
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5
Q

Give 3 conservative ways to manage GORD

A 
Eat smaller meals 
Lose weight 
Reduce anxiety 
Sit upright 
Stop smoking 
Reduce alcohol 
Avoid trigger foods
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6
Q

How can GORD be managed conservatively?

A

Antacids
PPI (Omeprazole, Lansoprazole)
H2 antagonist (Ranitidine, Cimetidine)

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7
Q

What is a laparoscopic nissen fundoplication?

A

Keyhole surgery to tighten the oesophageal sphincter via wrapping the cardia of the stomach around the gastrooesophageal junction.

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8
Q

Give 3 complications of GORD

A

Oesophageal ulcers
Oesophageal strictures
Barrett’s oesophagus
Oesophageal cancers

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9
Q

What is Barrett’s oesophagus?

A

Stratified squamous epithelium converts to a simple columnar epithelium to cope with excess acid in lower oesophagus.

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10
Q

What are the symptoms of Barrett’s oesophagus?

A 
Severe GORD symptoms 
New-onset asthma 
Chronic cough 
Bronchitis 
Sore throat
Dysphagia (oesophageal ulcers and strictures)
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11
Q

How is Barrett’s oesophagus diagnosed?

A

Endoscopy and biopsy

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12
Q

How is Barrett’s oesophagus treated?

A

Cannot be reversed
Conservative management (same as GORD)
PPI
H2 antagonists

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13
Q

How often are Barrett’s oesophagus patients screened for oesophageal cancer?

A

Endoscopy between every 3 months and every 3 years depending on grade

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14
Q

What is dysplasia?

A

Presence of abnormal cells within a tissue which often precedes a cancer

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15
Q

What are the 2 types of oesophageal cancer?

A

Squamous cell carcinoma

Adenocarcinoma

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16
Q

Give the 2 main causes of oesophageal adenocarcinoma

A

GORD

Barrett’s oesophagus

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17
Q

Give the 2 main causes of oesophageal squamous cell carcinoma

A

Achalasia

Coeliac disease

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18
Q

Give 5 symptoms of oesophageal cancer

A 
Dysphagia 
Heartburn 
Vomiting after eating
Weight loss
Loss of appetite
Epigastric pain
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19
Q

How is oesophageal cancer diagnosed?

A

Endoscopy
Barium swallow
Staging CT
PET scan

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20
Q

What is an oesophagectomy?

A

Removal of part or all of the oesophagus.

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21
Q

What is an Ivor-Lewis procedure?

A

Removal of all of the lower oesophagus, stomach pulled up into chest and anastomosed to the upper oesophagus.

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22
Q

What is an oesophageal stricture?

Study These Flashcards
A

Narrowing of the oesophagus

23
Q

Give 4 causes of oesophageal strictures

Study These Flashcards
A 
Acid reflux 
Autoimmune 
Infections 
Iatrogenic 
Malignancy
24
Q

What are oesophageal varices?

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A

Abnormal, enlarged dilated veins in the lower oesophagus secondary to portal hypertension.

25
How will an oesophageal varices present?
``` Haematemesis Melaena Lightheadedness Jaundice Ascites Bruising ```
26
How are bleeding oesophageal varices managed?
``` ABCDE Correct clotting Vasoactive agent (terlipressin) Prophylactic antibiotics Variceal band ligation TIPS (connect hepatic vein and portal vein) ```
27
What prophylactic treatment for oesophageal varices can be given?
Propranolol Endoscopic variceal band ligation PPI
28
What is achalasia?
Failure of lower oesophageal sphincter to open during swallowing.
29
How does achalasia present?
Dysphagia of solids and liquids Vomiting of undigested food shortly after eating and when sleeping Heartburn
30
Give 3 complications of achalasia
Aspiration pneumonia Fits Chest pain
31
What is the main cause of achalasia?
Damage to the nerves around the oesophagus post viral infection
32
Give 2 conditions which are commonly associated with achalasia
SLE | Sjogren's
33
How is achalasia treated?
Nitrates or nifedipine to relax oesophageal muscles Oesophageal dilation surgery Botox injection Laparoscopic surgery to divide oesophageal muscle fibres
34
What is a peptic ulcer?
Open sore on the lining of the stomach and duodenum
35
How does a peptic ulcer present?
``` Burning epigastric pain Heartburn Nausea Weight loss Indigestion after a few hours of eating ```
36
Give 2 causes of peptic ulcers
H. pylori infection NSAIDs Smoking Excess alcohol
37
How is a H.pylori infection diagnosed?
Urease breath test | Stool antigen screen
38
If NSAIDs are causing gastric ulcers how can this be opposed?
Co-prescribe a PPI
39
How is H.pylori treated?
Triple therapy | PPI + metronidazole (or penicillin) + clarithromycin
40
Give 2 complications of peptic ulcers
Anaemia from bleeding Bowel perforation Peritonitis Small bowel obstruction
41
How can gastric ulcers and duodenal ulcers be distinguished from the history?
Gastric ulcers --> epigastric pain 30 mins to 1 hr after eating, haematemesis, less common, older people Duodenal ulcers --> epigastric pain 2-4 hrs after eating, melaena, more common, younger people
42
Give 3 risk factors for gastric cancer
Male >55 yrs old Smoker Eat a lot of red meat and salted foods
43
What is the main type of gastric cancer?
Adenocarcinoma
44
How will gastric cancer present?
``` Persistent heartburn and stomach pain Trapped wind Burping Feeling bloated after meals Blood in the stools Loss of appetite Weight loss ```
45
How is a gastric cancer treated?
If just in the lining can do a endoscopic mucosal resection If cancer in lower stomach a subtotal gastrectomy can be done If cancer is in the upper stomach and oesophagus an esophagogastrectomy can be done and then an Ivor-Lewis procedure If the cancer is in the middle of the stomach a total gastrectomy is done and the oesophagus is attached to the duodenum in a Roux-en-Y reconstruction.
46
What is a hiatus hernia?
When the stomach protrudes through the diaphragm and into the chest cavity.
47
How does a hiatus hernia present?
Heartburn Sour taste in the mouth Dysphagia
48
Give 3 risk factors for hiatus hernias
Overweight Over 50 years old Pregnant New born babies
49
What is a sliding hernia?
Some of the stomach moves up into the chest cavity
50
What is a rolling hernia?
Stomach pushes through oesophageal hiatus to create a bulge in the chest cavity. Risk of strangulation
51
How is a hiatus hernia treated conservatively?
``` Eat smaller meals Avoid lying flat after eating Avoid alcohol Avoid caffeine Lose weight Stop smoking ```
52
How is a hiatus hernia treated medically?
Antacids H2 antagonists PPIs
53
How is a hiatus hernia treated surgically?
LNF surgery

Phase 2- Periop (5 decks)

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