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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

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2
Q

odynophagia

A

Painful swallowing

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3
Q

Regurgitation

A

Expulsion of undigested food from the oesophagus

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4
Q

reflux

A

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

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5
Q

What is an example of hypermotility?

A

Achalasia

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6
Q

Why does achalasia occur?

A

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

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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

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8
Q

How does the oesophagus appear in achalasia?

A

Bird’s beak - dilation of oesophagus

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9
Q

Why does the oesophagus dilate in achalasia?

A

Muscles contracted, food cannot pass through, stuck in oesophagus

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10
Q

What condition is much higher in risk with achalasia?

A

Oesophageal Cancer (28 times)
sp squamous cell

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11
Q

Disease course of achalasia

A

Insidious onset - symptoms for years

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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

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13
Q

What is the efficacy of this pneumatic dilatation like?

A

Most patients respond initially but relapsing is common

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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

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15
Q

Risks of surgery for achalasia

A

Oesophageal and gastric perforation
division of vagus nerve
splenic injury

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16
Q

What is an example of hypomotility?
starting with S

A

Scleroderma - autoimmune disease

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17
Q

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

A

Decreased

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18
Q

What condition can develop as a result of scleroderma?

A

GORD

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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

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20
Q

How would you treat scleroderma?

A

Exclude obstructions // Improve peristalsis with prokinetics (cisapride)

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21
Q

What is an example of disordered coordination?

A

Corkscrew Oesophagus

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22
Q

What is incoordinate contraction of the oesophagus known as?

A

Diffuse oesophageal Spasm

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23
Q

What muscle do you see hypertrophy of in corkscrew oesophagus?

A

Circular muscle

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24
Q

What symptoms do you see in corkscrew oesophagus?

A

Dysphagia and chest pain

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25
How can you treat corkscrew oesophagus?
Forceful pneumatic dilation of cardia
26
Which areas of the oesophagus are more prone to oesophageal perforations?
Areas of anatomical contraction (cricopharyngeal, aortic/bronchial, diaphragmatic)
27
What is the most common aetiology of oesophageal perforation?
Iatrogenic (usually from OGD - Oesophagogastroduodenoscopy) more common in derverticula or cancer
28
Which is the most common site of oesophageal perforation?
Killian's Triangle (near cricopharyngeal)
29
What are other conditions that cause oesophageal perforation?
Boerhaave's Syndrome, Foreign Body, Trauma
30
What is happens in Boerhaave's Syndrome, and what is pressure like?
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
What foreign objects are particularly harmful when causing oesophageal perforation?
Disk batteries - cause electrical burns magnets sharp objects dishwasher tablets acid/alkali - cause burning or stricture of the oesophagus
32
Trauma causing oesophageal perforation presentation
dysphagia blood in saliva haematemesis surgical emphysema
33
What are the most common presentations of oesophageal perforations?
Pain, Fever, Dysphagia, Emphysema Gas in the mediastinum
34
What is the primary management for oesophageal perforation?
Surgical emergency Nil by mouth, IV fluids ITU Bloods (type) Tertiary referral
35
What is a conservative management of oesophageal perforations?
Cover the oesophagus with a metal stent, allows eating Temporary
36
What is a operative management of oesophageal perforations?
Primary repair is optimal oesophagectomy, oesophagus joined to the stomach
37
What is the stomach's main protective mechanism against reflux?
Closing of Lower OS as a result of increased pressure caused by parasympathetic nervous system
38
What are the other protective mechanisms against reflux?
Oesophageal Peristalsis Reflex (volume clearance) Saliva (pH clearance) Epithelium (barrier)
39
Disruptions that lead to increase in risk of GORD
Decreased sphincter pressure Decreased saliva production
40
What type of hernia causes GORD?
Sliding Hiatus Hernia
41
What is the difference between a sliding hernia and a rolling hernia?
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
What is the other name for rolling hiatus hernias?
Paraoesophageal Hiatus Hernia
43
What investigations would you do for GORD?
OGD, Manometry, 24H pH recording
44
What medical treatments would you do for GORD?
Lifestyle Change (weight loss, smoking) PPIs
45
What surgical treatments would you do for GORD?
Dilatation peptic strictures, Laparoscopic Nissen's Fundoplication (wrap fundus over oesophagus)
46
Functions of the stomach
- Breakdown of food - Holds food, releasing it at a steady state tot he duodenum - kills parasites and certain bacteria
47
What are the five regions of the stomach?
Cardia (at junction), - mucus Fundus (top), - mucus, HCL, pepsinogen Body, - mucus, HCL, pepsinogen Antrum, - gastrin Pyloric Region - mucus
48
What are 4 types of gastritis?
Erosive&Haemorrhagic Nonerosive Chronic Atrophic Reactive
49
What is a cause for each type of gastritis?
E&H (acute ulcer) NC (H. Pylori) Atrophic (autoantibodies) Reactive (alcohol, steroids)
50
What can stimulate gastric secretion?
Neural - ACh // Endocrine - Gastrin // Paracrine - Histamine
51
What can inhibit gastric secretion?
Endocrine - Secretin // Paracrine - Somatostatin // Paracrine & Autocrine - Prostaglandins, TGF-Alpha
52
What is an ulcer?
A damage to epithelium
53
What are four elements of mucosal protection against ulcers?
Mucus film, HCO3- secretion, Epithelial barrier, Mucosal blood perfusion
54
What are the three mechanisms of repairing epithelial damage in ulcers?
Migration of epithelial cells // Cell growth (by TGF) // Acute wound healing (regeneration of ECM)
55
What is the primary medical treatment for ulcers?
PPI or H2 Blocker, Triple Treatment (amoxicillin, clarithromycin, pantoprazole)
56
What are the surgical indications for ulcers?
If medical treatment doesn't work Continual need of NSAIDs, Complications (haemorrhage, obstruction, perforation)
57
Oesophagus origins and musculature
Made of both skeletal and smooth muscle. Becomes smooth as it decreases Origin C4-C5 Ends at T10, oesophageal hiatus
58
Blood supply of the oesophagus
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
Lower Oesophageal Sphincter
Surrounded by diaphragm Supported by the Phrenoesophageal ligament, anchors oesophagus to the diaphragm
60
What is the angle at which the oesophagus enters the diaphragm at called?
Angle of His Allows valve like action, to prevent reflux
61
What are the four phases of swallowing?
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
What reflex opens the Lower Oesophageal Sphincter?
Vasovagal Reflex - Receptive Relaxation Reflex
63
How can you measure the pressure of the oesophagus?
Manometry determines oesophageal motility
64
What neurons maintain the Lower OS pressure?
Inhibitory NCNA (non-cholinergic, non-adrenergic) Neurons in myenteric plexus
65
What is a stricture?
A restriction in movement
66
What are the causes of absent strictures?
Hyper/Hypomotility , Disordered Coordination , GORD
67
What do you test for in ulcer treatment?
Serum gastrin (Zollinger-Ellison Syndrome)

Gastro (10 decks)

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