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Digestive System > Upper GI Tract Disorders > Flashcards

Upper GI Tract Disorders Flashcards

Oesophagus Stomach

1
Q

what are the types of oesophageal cancers, and what’s most likely to cause each type?

A

squamous carcinoma - smoking, alcohol, diet

adenocarcinoma - obesity, Barrett’s oesophagus

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2
Q

what is Barrett’s oesophagus?

A

metaplasia of epithelium from stratified squamous to simple columnar due to recurrent acid reflux

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3
Q

what are the muscle types found in the oesophagus?

A

top third - skeletal
middle third - skeletal and smooth
bottom third - smooth

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4
Q

what nervous input controls oesophageal peristalsis and relaxation of the LOS?

A

vagus nerve - parasympathetic input

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5
Q

what are the two groups of oesophageal motility disease, and what are examples of each?

A

hypermotility - oesophageal spasm

hypomotility - caused by diabetes, neuropathy, connective tissue disorders

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6
Q

what are the main investigations for oesophageal disorders? (3)

A
  1. Endoscopy
  2. Barium swallow
  3. Oesophageal pH and manometry
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7
Q

what are the main symptoms of oesophageal disorders?

A

Dysphagia (with or without pain - odynophagia)

Heartburn (with or without water brash)

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8
Q

what is the surgical option for oesophageal cancer?

A

Oesophagectomy

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9
Q

what are the non-surgical treatment options for oesophageal cancer in patients with resectable tumours?

A

adjuvant chemo/radiotherapy following surgery

neoadjuvant radiotherapy prior to surgery

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10
Q

what are the non-surgical treatment options for oesophageal cancer in patients who are unfit for surgery/metastatic?

A

palliative radio/chemotherapy

oesophageal stenting

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11
Q

define water brash

A

acid taste in back of throat

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12
Q

define odynophagia

A

pain when swallowing

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13
Q

what is achalasia, what is it caused by and what is an important complication?

A

motility disorder of oesophagus, LOS doesn’t open so food sits in oesophagus
caused by loss of myenteric plexus
can cause respiratory infections due to food escaping oesophagus and lodging down trachea

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14
Q

what is GORD and what are its causes?

A 
gastro-oesophageal reflux disorder
possible causes: 
- diet
- certain drugs 
- obesity
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15
Q

what are possible causes of dysphagia?

A

oesophageal cancer (malignant stricture)
benign stricture (fibrosis, foreign object)
compression from other structures (cancer)
motility disorders
reflux
esinophilic oesophagitis

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16
Q

what are the causes, symptoms and treatment for oesophageal hypermobility disorders?

A

causes: normally idiopathic
symptoms: periodic dysphagia and chest pain
treatment: smooth muscle relaxants

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17
Q

what are the main symptoms of achalasia?

A

progressive dysphagia
regurgitation
recurrent chest infections
chest pain (not always)

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18
Q

what are the two main signs of achalasia to make a diagnosis?

A

absence of peristaltic waves in lower oesophagus

inability of LOS to relax after swallowing

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19
Q

what are the treatment options for achalasia?

A

pharmaceutical - nitrates, CCB’s

radiology/endoscopy - balloon dilation, surgical incision in LOS

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20
Q

what are some of the risk factors for developing GORD?

A 
smoking
obesity
alcohol
pregnancy
hypomotility
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21
Q

what are the three important symptoms that warrant the need of an endscopy in patients with oesophageal disorders?

A

dysphagia
weight loss
vomiting

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22
Q

what is the treatment of Barrett’s oesophagus?

A

depends on dysplasia

high grade dysplasia treated endoscopically/laparoscopically to remove dysplastic glandular epithelium

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23
Q

what is the surgical treatment for GORD?

A

fundoplication

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24
Q

what investigations are done for oesophageal cancer and what is the general purpose?

A

endoscopy/biopsy - diagnostic

EUS/CT scan/Xray/PET - staging

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25
Q

what is eosinophilic oesophagitis?

A

inflammation of oesophagus epithelium allergic response to a particular food/stimulant

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26
Q

what are the treatment options for achalasia?

A

nitrates, calcium channel blockers
endoscopic balloon widening of oesophagus
myotomy

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27
Q

what complications can arise from GORD? (4)

A

strictures
ulceration
Barrett’s oesophagus
carcinoma

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28
Q

why does oesophageal cancer often present with lymphatic spread?

A

because the lymph supply of the oesophagus is in the lamina propria of the mucosa

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29
Q

what are some of the common symptoms of oesophageal cancer?

A 
dysphagia
weight loss/anorexia
chest pain
voice box paralysis
haematemesis
odynophagia
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30
Q

what is a common finding in eosinophilic oesophagitis?

A

concentric rings with white patches in oesophageal lining

31
Q

what are the three main management steps in eosinophilic oesophagitis?

A

remove toxic stimulant
corticosteroids to reduce inflammation
endoscopic dilatation

32
Q

what are two common presentations of eosinophillic oesophagitis?

A

dysphagia

food obstruction

33
Q

what are the three main pathologies of gastritis?

A

autoimmune gastritis
bacterial gastritis
chemically induced gastritis

34
Q

which cells are affected in autoimmune gastritis?

A

parietal cells

35
Q

what is the most common cause of bacterial gastritis?

A

Helicobacter Pylori

36
Q

what are common causes of chemically induced gastritis?

A

drugs (eg NSAIDS)

alcohol

37
Q

what are complications of peptic ulcers?

A

bleeding (acute and chronic)
perforation (peritonitis)
fibrosis (obstruction)

38
Q

what is the pathology behind peptic ulcers?

A

imbalance between mucous secretion and gastric acid secretion

39
Q

where can peptic ulcers occur?

A

anywhere that has contact with acid

  • lower oesophagus
  • stomach
  • first part of duodenum
40
Q

what is a common cause for gastric ulcers, and how does it come about?

A

H Pylori infection. causes increased acid production, leads to imbalance

41
Q

what type of cancer is stomach cancer?

A

adenocarcinoma

42
Q

what is a difference in tumour spread between oesophageal and stomach cancer?

A

stomach cancer can spread through transcoelomic spread. oesophageal cancer doesn’t normally cross into other peritoneal structures

43
Q

what is a common area of metastasis for oesophageal and gastric cancer, and through what type of spread?

A

liver

through blood spread

44
Q

how does previous H Pylori infection increase risk of gastric cancer? what can the process be compared to?

A
  • because of the metaplasia of gastric epithelium following H Pylori infection
  • similar to Barrett’s metaplasia causing higher risk of oesophageal cancer
45
Q

what are the two types of hiatus hernia which may cause GORD?

A

sliding hernia

para-oesophageal hernia

46
Q

what are the symptoms of para-oesophageal hernia?

A

chest pain when swallowing

vomiting

47
Q

what are the preferred cancer staging investigations for oesophageal cancer and gastric cancer respectively?

A

oesophageal cancer - PET scan

gastric cancer - laparoscopy

48
Q

what are some side effects of fundoplication?

A 
dysphagia
belching/vomiting issues
gas bloating
flatulence
diarrhoea
49
Q

what are the important symptoms of gastric disease?

A 
ALARMS
Anaemia
Loss of weight
Anorexia
Recent onset/ >55yo
Malaena/haematemesis or Mass
Swallowing problems (Dysphagia)
50
Q

what should be the next step in diagnosing a gastric problem after establishing that there are no ALARMS symptoms?

A

Test for H Pylori

51
Q

what are the invasive and non-invasive tests for H Pylori infection?

A

invasive: biopsy and CLO test

non-invasive: urease breath test, IgG serology, stool test

52
Q

how does H Pylori cause gastric inflammation?

A

by sitting in gastric mucous layer and causing an inflammatory response in the underlying mucosa

53
Q

how does H Pylori survive acidic environment in stomach?

A

secretes urease, forms an alkaline bubble around it

burrows into mucous layer with flagellum

54
Q

what are possible H Pylori complications based on the location of the infection?

A

stomach antrum - risk of duodenal ulcers

stomach body - risk of stomach cancer

55
Q

what three main problems can H Pylori infection cause?

A

bacterial gastritis
gastric ulcer
gastric cancer

56
Q

how is a peptic ulcer treated?

A
  • antacids
  • eradication of H Pylori if infection present
  • stop NSAIDs/other precipitants
  • deal with complications as they arise
57
Q

what does the H Pylori eradication treatment involve?

A

7 day course dual antibiotic treatment

  • clarythromycin
  • amoxycillin* or metronidazole
  • tetracycline if penicillin allergy
58
Q

what are the main antacid treatments and which ones are most used?

A

H2 Receptor Antagonists - ranitidine, cimetidine
Proton Pump Inhibitors - omeprazole, lansoprazole
PPIs more effective than H2RA

59
Q

which type of oesophageal cancer is more responsive to radiotherapy?

A

squamous cell carcinoma

60
Q

what is the surgical treatment for gastric cancer?

A

gastrectomy (total or partial, depending on where the tumour is)

61
Q

why can peptic ulcers appear in lower oesophagus and upper duodenum?

A

because those are areas within reach of stomach acid

62
Q

what should be the main line investigation for gastric symptoms in patients under and over 55?

A

under 55 - H Pylori testing

over 55 - Endoscopy to look for malignancy

63
Q

list some common symptoms of peptic ulcers

A 
dyspepsia
epigastric pain
night pain/hunger pain
if bleeding ulcer, anaemia/haemorrage/haematemesis/malaena
nausea and vomiting
early satiety
anorexia
64
Q

what symptoms often present with gastric outlet obstruction?

A 
vomiting (no bile)
early satiety
metabolic alkalosis
low Cl, low Na, low calcium, low K
bloating
dehydration
acute kidney injury
65
Q

what could be some causes of gastric outlet obstruction?

A

cancer
fibrosis from healed peptic ulcer
inflammation/oedema from peptic ulcer

66
Q

what is malaena?

A

black tarry stools, made of digested blood from upper GI

67
Q

what is haematemesis?

A

vomiting blood

68
Q

what are possible aetiology factors for gastric cancer?

A 
smoking
diet
H Pylori infection
genetics
environment
69
Q

what bloods should be taken if someone presents with dyspepsia?

A 
FBC
U&E
LFT
ferritin
calcium 
glucose
coeliac serology
H Pylori serology
70
Q

what is the definition of metaplasia?

A

transformation of one mature cell type (stratified squamous) to another mature cell type (simple columnar)

71
Q

what investigation is used for gastric cancer staging?

A

laparoscopy

72
Q

name two structural characteristics of the oesophageal wall lining that make it more likely to spread to local lymph nodes and nearby structures

A
  • no serosal lining (more likely to spread into mediastinum)

- lymphatics in lamina propria (more likely to present with lymph node spread)

73
Q

where are the lymphatics found in the oesophagus compared to elsewhere in the GI tract?

A

in oesophagus - in lamina propria

rest of GI - submucosa

Digestive System (6 decks)

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