Upper GI problems Flashcards
What is reflux oesophagitis?
Inflammation of the lining of the oesophagus often due to acid reflux
What are the symptoms of GORD?
Retrosternal pain relieved by eating Dysphagia Odynophagia Sour taste in mouth Bad breath Bloating Nausea Vomiting Gum disease Persistent cough
Why is GORD worse in asthma patients?
Acid reflux can irritate the airways too
Give 4 causes of GORD
Oesophageal laxity Hiatus hernia Smoking Pregnancy Obesity Certain foods NSAIDs
Give 3 conservative ways to manage GORD
Eat smaller meals Lose weight Reduce anxiety Sit upright Stop smoking Reduce alcohol Avoid trigger foods
How can GORD be managed conservatively?
Antacids
PPI (Omeprazole, Lansoprazole)
H2 antagonist (Ranitidine, Cimetidine)
What is a laparoscopic nissen fundoplication?
Keyhole surgery to tighten the oesophageal sphincter via wrapping the cardia of the stomach around the gastrooesophageal junction.
Give 3 complications of GORD
Oesophageal ulcers
Oesophageal strictures
Barrett’s oesophagus
Oesophageal cancers
What is Barrett’s oesophagus?
Stratified squamous epithelium converts to a simple columnar epithelium to cope with excess acid in lower oesophagus.
What are the symptoms of Barrett’s oesophagus?
Severe GORD symptoms New-onset asthma Chronic cough Bronchitis Sore throat Dysphagia (oesophageal ulcers and strictures)
How is Barrett’s oesophagus diagnosed?
Endoscopy and biopsy
How is Barrett’s oesophagus treated?
Cannot be reversed
Conservative management (same as GORD)
PPI
H2 antagonists
How often are Barrett’s oesophagus patients screened for oesophageal cancer?
Endoscopy between every 3 months and every 3 years depending on grade
What is dysplasia?
Presence of abnormal cells within a tissue which often precedes a cancer
What are the 2 types of oesophageal cancer?
Squamous cell carcinoma
Adenocarcinoma
Give the 2 main causes of oesophageal adenocarcinoma
GORD
Barrett’s oesophagus
Give the 2 main causes of oesophageal squamous cell carcinoma
Achalasia
Coeliac disease
Give 5 symptoms of oesophageal cancer
Dysphagia Heartburn Vomiting after eating Weight loss Loss of appetite Epigastric pain
How is oesophageal cancer diagnosed?
Endoscopy
Barium swallow
Staging CT
PET scan
What is an oesophagectomy?
Removal of part or all of the oesophagus.
What is an Ivor-Lewis procedure?
Removal of all of the lower oesophagus, stomach pulled up into chest and anastomosed to the upper oesophagus.
What is an oesophageal stricture?
Narrowing of the oesophagus
Give 4 causes of oesophageal strictures
Acid reflux Autoimmune Infections Iatrogenic Malignancy
What are oesophageal varices?
Abnormal, enlarged dilated veins in the lower oesophagus secondary to portal hypertension.
How will an oesophageal varices present?
Haematemesis Melaena Lightheadedness Jaundice Ascites Bruising
How are bleeding oesophageal varices managed?
ABCDE Correct clotting Vasoactive agent (terlipressin) Prophylactic antibiotics Variceal band ligation TIPS (connect hepatic vein and portal vein)
What prophylactic treatment for oesophageal varices can be given?
Propranolol
Endoscopic variceal band ligation
PPI
What is achalasia?
Failure of lower oesophageal sphincter to open during swallowing.
How does achalasia present?
Dysphagia of solids and liquids
Vomiting of undigested food shortly after eating and when sleeping
Heartburn
Give 3 complications of achalasia
Aspiration pneumonia
Fits
Chest pain
What is the main cause of achalasia?
Damage to the nerves around the oesophagus post viral infection
Give 2 conditions which are commonly associated with achalasia
SLE
Sjogren’s
How is achalasia treated?
Nitrates or nifedipine to relax oesophageal muscles
Oesophageal dilation surgery
Botox injection
Laparoscopic surgery to divide oesophageal muscle fibres
What is a peptic ulcer?
Open sore on the lining of the stomach and duodenum
How does a peptic ulcer present?
Burning epigastric pain Heartburn Nausea Weight loss Indigestion after a few hours of eating
Give 2 causes of peptic ulcers
H. pylori infection
NSAIDs
Smoking
Excess alcohol
How is a H.pylori infection diagnosed?
Urease breath test
Stool antigen screen
If NSAIDs are causing gastric ulcers how can this be opposed?
Co-prescribe a PPI
How is H.pylori treated?
Triple therapy
PPI + metronidazole (or penicillin) + clarithromycin
Give 2 complications of peptic ulcers
Anaemia from bleeding
Bowel perforation
Peritonitis
Small bowel obstruction
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
Give 3 risk factors for gastric cancer
Male
>55 yrs old
Smoker
Eat a lot of red meat and salted foods
What is the main type of gastric cancer?
Adenocarcinoma
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
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.
What is a hiatus hernia?
When the stomach protrudes through the diaphragm and into the chest cavity.
How does a hiatus hernia present?
Heartburn
Sour taste in the mouth
Dysphagia
Give 3 risk factors for hiatus hernias
Overweight
Over 50 years old
Pregnant
New born babies
What is a sliding hernia?
Some of the stomach moves up into the chest cavity
What is a rolling hernia?
Stomach pushes through oesophageal hiatus to create a bulge in the chest cavity. Risk of strangulation
How is a hiatus hernia treated conservatively?
Eat smaller meals Avoid lying flat after eating Avoid alcohol Avoid caffeine Lose weight Stop smoking
How is a hiatus hernia treated medically?
Antacids
H2 antagonists
PPIs
How is a hiatus hernia treated surgically?
LNF surgery
