Upper GI tract diseases Flashcards
what is dysphagia
swallowing disorder, red flag for any other symptoms
what are the 2 classes of dysphagia
neuromuscular: myasthenia gravis, stroke, MS etc (Weakened muscles) = struggle liquids and solids
narrowing of oesophagus (food gets stuck) = cancer, GORD, barretts, sacs/ring in oesophagus = problems swallowing just solid
what is progressive dysphagia
suggestive of mechanical obstruction or peptic stricture
what questions do you ask in dysphagia?
PC: problems swallowing hard food, soft food, drinks or the progression through all these? Odynophagia? (this is panful swallowing)
HPC: weight loss, vomiting, bleeding anywhere and how much blood??, bowel habit changes, pain, anaemia symptoms
Background: taken any NSAIDs? Omeprazole? Prev abdo surgery? FH?
• Smoking/drinking?
what is barretts oesophagus
constant reflux of acid in lower oesophageal epithelium changing from sqaumous –> columnar
= typically develops after GORD of 5 years
middle aged, caucasian man
premalignant condition for aenocarcinoma
what would you see on clinical examination of barretts oesophagus
weight loss
abdo exam: scaphoid abdomen, abdominal tenderness, hepatomegaly
candida, dry mouth
may have virchows node
what investigations would you do for barretts oesophagus
upper GI endoscopy FBC for anaemia U&Es for renal function for CT contrast LFTs for metastases barium swallow - site of stricture but does not allow biopsy
how do you monitor barrett’s?
- regular endoscopy
no dysplasia = low grade = dysplasia = high grade = adenocarcinoma
how do you treat barrett’s
- PPI’s
- ablation therapy
what are the risk factors for oesophageal cancer?
male, age, smoking, alcohol, consumption of pickles, high BMI for reflux, GORD (once a week for 5 years = 8x risk)
how does oesophageal cancer?
dysphagia, weight loss and anorexia, persistent vomiting, maleana, hoarse voice
how do you investigate for oesophogeal cancer?
2 week wait endoscopy, bloods, u&es, LFTs, CT/PET scan if positive for it
what is the management for oesophageal cancer?
surgical resection
chemo
radio for squamous cell carcinoma
palliative: PEG, PEJ, jejunal feeding, surgical bypass
what are the types of feeding tubes?
NG tube: bypasses stricture, used to increase nutrition before surgery or chemo
(pass through nose, into oeseophagus and stomach)
PEG tube = through skin into stomach
what are the NICE guidelines for 2 week wait?
2 week wait for people with dysphagia, OR people >55 with weight loss and pain, reflux or dyspepsia, OR treatment resistant dyspepsia, or pain with low Hb
what is the normal physiology of the stomach?
pareital cells release HCL
chief cells secrete pepsinogen
mucous cells in gastric pits = mucin which coats stomach lining
G cells produce gastrin
D cells produce somatostatin
what is a peptic ulcer
involves ulceration of mucosa of stomach or duodenum
what are the differentials for peptic ulcers
inflammation of mucosa
dyspepsia,
>1 week of symptoms = pancreatitis or cholecystitis
what is the pathophysiology of a peptic ulcer
breakdown of mucosa/lining due to NSAIDs or H.pylori
and increase in stomach acid due to stress, alcohol, caffeine, smoking, spicy foods or hypersecretory syndromes like zollinger-ellison
how does a peptic ulcer present
epigastric pain, dyspepsia, nausea and vomiting, haematemesis or malaena
what causes peptic ulcers
H.pylori or NSAIDs
stress, spicy foods, caffeine, smoking, alcohol
how do you investigate a peptic ulcer
endoscopy
bloods for haemodynamic instability, Hb, BP, etc
how do you treat a peptic ulcer
stop NSAIDs and give 4-8w of PPI
what are the complications of a peptic ulcer?
bleeding = inject adrenaline and haemoclips
perforation = surgery, can lead to acute abdomen and pneumoperitoneum
scarring of mucosa leading to stasis of food in stomach, presents with distention and abdo pain
what is H.pylori
gram negative bacteria that burrows in lining, causes increased acid production = peptic ulcer
how do you investigate for HP?
UREA breath test
stool antigen
how do you treat HP infection and peptic ulcers?
triple therapy: PPI, clarithromycin and amoxicillin
what are the other causes of upper GI bleeds
MW tear
oesophageal varices
ulcers
cancer of stomach or duodenum
how does a GI bleed present
coffee ground vomit/haematemesis
malaena
haemodynamic instability eg tachycardia or low BP
what are the GB and rockall scores?
GB: score to check if endoscopy is needed= risk of upper GI bleed
includes: urea, Hb, BP, malaena, syncopy, HR
rockall: risk of re-bleed after endoscopy
how do you manage a major bleed?
major haemorrhage protocol
ABCDE Bloods = Hb, crossmatch 2 units, platelets Access 2 large bore cannulas Tranfuse 6 units Endoscopy within 24h Drugs = stop anti-coag and NSAIDs
