Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

gastro > Upper GI tract > Flashcards

Upper GI tract Flashcards

1
Q

Dysphagia

A

difficulty swallowing
different types, solids vs fluids, intermittent vs progressive, precise vs vague
Can be either in the cricopharyngeal sphincter or distal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

odynophagia

A

Painful swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Regurgitation

A

Expulsion of undigested food from the oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

reflux

A

passive return of gastroduodenal contents to the mouth.
Very acidic, can cause decay of teeth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is an example of hypermotility?

A

Achalasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why does achalasia occur?

A

Loss of ganglion cells in Aurebach’s myenteric plexus, decreased activity of inhibitory NCNA neurons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can achalasia be caused secondary to?

A

Immune dysfunction/diseases causing oesophageal motor abnormalities
Chagas’ Disease - parasitic usually endemic to south america
Protozoa Infection
oesinophilic oesophagitis- young children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does the oesophagus appear in achalasia?

A

Bird’s beak - dilation of oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why does the oesophagus dilate in achalasia?

A

Muscles contracted, food cannot pass through, stuck in oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What condition is much higher in risk with achalasia?

A

Oesophageal Cancer (28 times)
sp squamous cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Disease course of achalasia

A

Insidious onset - symptoms for years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the treatment for achalasia?

A

Pneumatic Dilatation - stretching of oesophagus and sometimes tearing muscle fibres
Radiologically or endoscopically

Can also have botox to the oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the efficacy of this pneumatic dilatation like?

A

Most patients respond initially but relapsing is common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the two surgical techniques for achalasia?

A

Heller’s Myotomy - slight incision on oesophagus and stomach to loosen pressure. Longitudinal incision.
Dor Fundoplication - wrapping fundus of stomach around oesophagus to prevent reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Risks of surgery for achalasia

A

Oesophageal and gastric perforation
division of vagus nerve
splenic injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is an example of hypomotility?
starting with S

A

Scleroderma - autoimmune disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the resting pressure of the Lower OS in scleroderma compared to normal?

A

Decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What condition can develop as a result of scleroderma?

A

GORD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What syndrome is often associated with scleroderma?

A

CREST Syndrome
C - calcinosis, calcium deposits
R - raynaud’s, blood flow issues
E - esophageal dysmotility, dysphagia
S - sclerodactyly, thickening of finger skin
T - telangiectasia, red spots due ot wide blood vessels

systemic sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How would you treat scleroderma?

A

Exclude obstructions // Improve peristalsis with prokinetics (cisapride)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is an example of disordered coordination?

A

Corkscrew Oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is incoordinate contraction of the oesophagus known as?

A

Diffuse oesophageal Spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What muscle do you see hypertrophy of in corkscrew oesophagus?

A

Circular muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What symptoms do you see in corkscrew oesophagus?

A

Dysphagia and chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How can you treat corkscrew oesophagus?

A

Forceful pneumatic dilation of cardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which areas of the oesophagus are more prone to oesophageal perforations?

A

Areas of anatomical contraction (cricopharyngeal, aortic/bronchial, diaphragmatic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the most common aetiology of oesophageal perforation?

A

Iatrogenic (usually from OGD - Oesophagogastroduodenoscopy)
more common in derverticula or cancer

28
Q

Which is the most common site of oesophageal perforation?

A

Killian’s Triangle (near cricopharyngeal)

29
Q

What are other conditions that cause oesophageal perforation?

A

Boerhaave’s Syndrome, Foreign Body, Trauma

30
Q

What is happens in Boerhaave’s Syndrome, and what is pressure like?

A

Spontaneous oesophageal perforation due to ^ oesophageal pressure + -ve intrathoracic pressure. Usually as a result of forced vomiting
Results in leak of contrast with CT/barium swallow, usually into the left chest

Common in alcoholics

31
Q

What foreign objects are particularly harmful when causing oesophageal perforation?

A

Disk batteries - cause electrical burns
magnets
sharp objects
dishwasher tablets
acid/alkali - cause burning or stricture of the oesophagus

32
Q

Trauma causing oesophageal perforation presentation

A

dysphagia
blood in saliva
haematemesis
surgical emphysema

33
Q

What are the most common presentations of oesophageal perforations?

A

Pain, Fever, Dysphagia, Emphysema
Gas in the mediastinum

34
Q

What is the primary management for oesophageal perforation?

A

Surgical emergency
Nil by mouth, IV fluids
ITU
Bloods (type)
Tertiary referral

35
Q

What is a conservative management of oesophageal perforations?

A

Cover the oesophagus with a metal stent, allows eating
Temporary

36
Q

What is a operative management of oesophageal perforations?

A

Primary repair is optimal
oesophagectomy, oesophagus joined to the stomach

37
Q

What is the stomach’s main protective mechanism against reflux?

A

Closing of Lower OS as a result of increased pressure caused by parasympathetic nervous system

38
Q

What are the other protective mechanisms against reflux?

A

Oesophageal Peristalsis Reflex (volume clearance)
Saliva (pH clearance)
Epithelium (barrier)

39
Q

Disruptions that lead to increase in risk of GORD

A

Decreased sphincter pressure
Decreased saliva production

40
Q

What type of hernia causes GORD?

A

Sliding Hiatus Hernia

41
Q

What is the difference between a sliding hernia and a rolling hernia?

A

Rolling hernias - stomach is next to the oesophagus and. moves up in the chest
Sliding hernia - stomach and oesophagus move up and down. stomach moves up into the oesophagus

42
Q

What is the other name for rolling hiatus hernias?

A

Paraoesophageal Hiatus Hernia

43
Q

What investigations would you do for GORD?

A

OGD,
Manometry,
24H pH recording

44
Q

What medical treatments would you do for GORD?

A

Lifestyle Change (weight loss, smoking)
PPIs

45
Q

What surgical treatments would you do for GORD?

A

Dilatation peptic strictures,
Laparoscopic Nissen’s Fundoplication (wrap fundus over oesophagus)

46
Q

Functions of the stomach

A
  • Breakdown of food
  • Holds food, releasing it at a steady state tot he duodenum
  • kills parasites and certain bacteria
47
Q

What are the five regions of the stomach?

A

Cardia (at junction), - mucus
Fundus (top), - mucus, HCL, pepsinogen
Body, - mucus, HCL, pepsinogen
Antrum, - gastrin
Pyloric Region - mucus

48
Q

What are 4 types of gastritis?

A

Erosive&Haemorrhagic
Nonerosive Chronic
Atrophic
Reactive

49
Q

What is a cause for each type of gastritis?

A

E&H (acute ulcer)
NC (H. Pylori)
Atrophic (autoantibodies)
Reactive (alcohol, steroids)

50
Q

What can stimulate gastric secretion?

A

Neural - ACh // Endocrine - Gastrin // Paracrine - Histamine

51
Q

What can inhibit gastric secretion?

A

Endocrine - Secretin // Paracrine - Somatostatin // Paracrine & Autocrine - Prostaglandins, TGF-Alpha

52
Q

What is an ulcer?

A

A damage to epithelium

53
Q

What are four elements of mucosal protection against ulcers?

A

Mucus film, HCO3- secretion, Epithelial barrier, Mucosal blood perfusion

54
Q

What are the three mechanisms of repairing epithelial damage in ulcers?

A

Migration of epithelial cells // Cell growth (by TGF) // Acute wound healing (regeneration of ECM)

55
Q

What is the primary medical treatment for ulcers?

A

PPI or H2 Blocker,
Triple Treatment (amoxicillin, clarithromycin, pantoprazole)

56
Q

What are the surgical indications for ulcers?

A

If medical treatment doesn’t work
Continual need of NSAIDs,
Complications (haemorrhage, obstruction, perforation)

57
Q

Oesophagus origins and musculature

A

Made of both skeletal and smooth muscle. Becomes smooth as it decreases
Origin C4-C5
Ends at T10, oesophageal hiatus

58
Q

Blood supply of the oesophagus

A

Thoracic oesophagus supplied by the aorta, superior aspect also supplied by the inferior thyroid artery
Venous drainage via azygous vein - systemic circulation

Abdominal oesophagus supplied by the left gastric artery and the phrenic artery
venous drainage via portal vein

59
Q

Lower Oesophageal Sphincter

A

Surrounded by diaphragm
Supported by the Phrenoesophageal ligament, anchors oesophagus to the diaphragm

60
Q

What is the angle at which the oesophagus enters the diaphragm at called?

A

Angle of His
Allows valve like action, to prevent reflux

61
Q

What are the four phases of swallowing?

A

Stage 0: Oral (preparing bolus, sphincters constricted)
- chewing, saliva breakdown
Stage 1: Pharyngeal (Upper OS opens, pharyngeal muscles push bolus down, Lower OS opens via vasovagal reflex)
Stage 2: Upper Oesophageal (Upper OS closes, Superior circular muscle rings contract, inferior rings dilate; sequential contraction of longitudinal muscle)
Stage 3: Lower Oesophageal (lower sphincter closes as soon as food passes through)

62
Q

What reflex opens the Lower Oesophageal Sphincter?

A

Vasovagal Reflex - Receptive Relaxation Reflex

63
Q

How can you measure the pressure of the oesophagus?

A

Manometry
determines oesophageal motility

64
Q

What neurons maintain the Lower OS pressure?

A

Inhibitory NCNA (non-cholinergic, non-adrenergic) Neurons in myenteric plexus

65
Q

What is a stricture?

A

A restriction in movement

66
Q

What are the causes of absent strictures?

A

Hyper/Hypomotility , Disordered Coordination , GORD

67
Q

What do you test for in ulcer treatment?

A

Serum gastrin (Zollinger-Ellison Syndrome)

gastro (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions