upper GI symposium Flashcards
how does pancreatitis present?
- epigastric pain
- sudden onset, sharp and radiating to the back
- 80% also present with vomiting
what blood tests help to diagnose pancreatitis?
- serum lipase and amylase 3x upper list of normal
what are the 2 main causes o pancreatitis?
- alcohol
- gallstones
what does the IGETSMASHED mnemonic stand for in pancreatitis?
I idiopathic G gallstones E ethanol T trauma S steroids M mumps A utoimmune S scorpion H hyperlipidemia/hypothermia/ hypocalcaemia E ERCP D drugs
what is the modified glasgow coma score for pancreatitis?
P- PO2 <8 A- Age >55 N- Neutrophilia WCC >15 C- Ca+ <2mmol/L R- Renal Function- Urea >16mmol/L E- Enzymes- AST LDH > 600, AST >200 A- Albumin <32g/L S- Sugar- >10mmol
1= Mild
2 = Moderate ≥3 = Severe
what is the mortality of severe pancreatitis?
10-50%
what would you see on a car if a peptic ulcer had perforated?
- air collections under the diaphragm
- this can irritate the phrenic nerve and send referred pain up to the shoulder
what are the major complications of peptic ulcers?
perforation
ulcer erodes all the way through the wall of the stomach or duodenum, allowing gastrointestinal contents to get into the peritoneal space - which is usually sterile.
- surgical emergency requiring laporoptomy
haematemisis:
- erosion into the blood vessel
- Two well-known dangerous spots are when there’s a gastric ulcer on the lesser curvature of the stomach eroding into the left gastric artery, and a duodenal ulcer on the posterior wall of the duodenum eroding into the gastroduodenal artery
surgical emergency requiring endoscopy, and laparotomy if that fails
what are risk factors for gastric ulcers?
H.Pylori NSAIDS Smoking Spiced foods Blood group O
what are the different types of ulcers?
- Stress Ulcers
- Zollinger-Ellison syndrome
Gastrinomas leading to hypersecretion of HCL - Curling ulcers
- Cushing ulcers
what are stress ulcers?
hey develop after shock, sepsis, and trauma and are ofter found in patients with peritonitis and other chronic medical illness
what is a curling ulcer?
Curling’s ulcer is an acute gastric erosion resulting as a complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis
what are cushing ulcers?
ulcers forming due to increased intracranial pressure, usually as a result of the injury
this puts pressure on the vagus nerve and stimulates the production of
what is zollinger ellison syndrome?
caused by a gastrinoma, a neuroendocrine tumor that secretes a hormone called gastrin
Too much gastrin in the blood (hypergastrinemia) results in the overproduction of gastric acid by parietal cells in the stomach.
n 75% of cases Zollinger-Ellison syndrome occurs sporadically, while in 25% of cases it occurs as part of an autosomal dominant syndrome called multiple endocrine neoplasia type 1 (MEN 1)
compare gastric and duodenal ulcers
gastric:
3:1 males
peak at 50yrs
45% Hpylori
exacerbated by food
duodenal: 5:1 males 25-30 yrs peak 85% H pylori relived by eating food
what is murphy’s sign?
Murphy’s sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.
how sensitive is use for detecting gallstones?
95% its the gold standard
can all stones be seen on imaging?
90% radiolucent
no
which pathogen is responsible for the infection in acute cholecystitis?
- E.coli gram - rod bactericides
what are complications of cholecystitis?
- Empyema/Mucocoele
- GB perforation (rare)
But more common in diabetics - GS ileus
Gallstone ileus is obstruction of the bowel due to impaction of one of more gallstones - Pancreatitis
what is ascending cholangitis?
inflammation of the bile caused by bacteria ascending from its junction with the duodenum (first part of the small intestine).
It tends to occur if the bile duct is already partially obstructed by gallstones
why is the common presentation of cholangitis?
- charcot’s triad:
- abdominal pain
- jaundice
- pyrexia
what are causes of cholangitis?
- Gallstones
- Strictures (benign/malignant)
- Malignancy (CBD/pancreas)
- Iatrogenic (eg ERCP)
Oesophageal vs Oropharyngeal dysphagia?
oropharyngeal dysphagia have difficulty transferring food from the mouth into the pharynx and esophagus to initiate the involuntary
- oesophageal dysphagia is difficulty swallowing- several seconds after initiating a swallow and a sensation of food getting stuck
what are causes of oropharyngeal dysphagia?
- Neurological
Stroke, Parkinsons disease, Myasthenia Gravis - Pharyngeal pouch
- Pharyngitis (sore throat)
- Radiotherapy
how are the main two ways that you can assess a swallow?
- OGD (gastroscopy)
- barium swallow
what is the epidemiology of oesophageal cancer?
8th most common cancer worldwide
2x more common in males, 80% > 60years
10- 15% 5year survival rate
Tends to present late
what is the main treatment for oesophageal cancer?
- Surgical
Oesophagectomy - Medical
Chemotherapy/radiotherapy - Palliative
Stenting
what are the 2 types of oesophageal cancer?
Sonoma and adenocarcinoma
what are features of squamous cell carcinoma?
Tends to affect upper 2/3
- Risk factors…
Smoking
Alcohol
Features of adenocarcinoma?
Tends to affect lower 1/3
- risk factors
GORD
Barrett’s oesophagus
Obesity
which oesophageal cancer is more prevelant in east vs west?
SCC- east
adenocarcinoma- west
what is an alginate?
Alginate is used as an ingredient in various pharmaceutical preparations, such as Gaviscon, in which it combines with bicarbonate to inhibit reflux.
what is the treatment for achalasia?
- Ca channel blockers,
- dilatation- with OGD
- Heller myotomy
Heller myotomy is a surgical procedure in which the muscles of the cardia (lower esophageal sphincter or LES) are cut, allowing food and liquids to pass to the stomach. - POEM
is a relatively new procedure that uses endoscopic technology and stands for Peroral Endoscopic Myotomy
is GORD caused by increase or decrease in LES tone/
decrease
wha is it called when t it is painful to swallow?
odynophagia
what should you suspect with painful swallow?
- cancer
- oesophageal ulcer
- spasm
intermitent- spasm
getting worse- malignant strictures
what should you suspect if there is a neck bulge or gurgle when drinking?
- pharyngeal pouch
what 3 As would suggest insidious onset in people developing dyspepsia after 40?
- Anaemia
- Anorexia
- Asthenia- abnormal physical weakness or lack of energy
what are risk factors for gastric carcinomas?
- Chronic gastritis
- smoking
- Hypochlorhydria (low level stomach acid)
- Infection with H.pylori
- Previous partial
- gastrectomy – stump carcinoma
what are environmental risk factors for gastric carcinoma?
Nitrites
smoked & salted foods
pickeled vegetables.
what type of oesophageal dysphasia do you have if you can eat solids and liquids?
- neuromuscular
progressive:
- scleroderma
- achalasia
intermittent:
- diffuse oesophageal spasm
what type of oesophageal dysphagia do you have if you can’t swallow solids only?
- mechanical
obstruction
progressive:
- cancer
- peptic stricture
intermittent:
- lower oesophageal ring (schatzi’s ring)
what is scleroderma?
Scleroderma, or systemic sclerosis, is a chronic connective tissue disease generally classified as one of the autoimmune rheumatic diseases
characterized by an accumulation of mucin (a jelly-like complex carbohydrate substance) in the skin.
Signs and symptoms of this condition include hardening and thickening of the skin which may restrict movement.
what happens to a pharyngeal pouch when it is palpated?
it is a fluctuating swelling which gurgles when palpated
