W3: Pathologies of upper GI; hepatobiliary; colon; oesophageal; and H Pylori and Gastric Disease Flashcards
Common upper GI tract disorders
- upper abdo pain
- retrosternal discomfort
- pain/indigestion
OESOPH. REFLUX dt hiatus hernia => oesoph. sphinct compromise
- ulceration: fibrosis, stricture, ↓motility, OBSTRUCTION
- barrett’s oesophagus: metaplasia and pre-malignant
GASRITIS d/t
TYPE A - Au-Ab P cell and intrinsic factor
TYPE B - helicobacter -ve; acute/chronic ↑acid prod.
TYPE C - NSAIDs, alcohol, bile reflux
PEPTIC ULCERATION (d/t H. pylori) ↑acid prod.
=> bleeding: acute GI haemorrhage/chronic anaemia
=> perforations: peritonitis
=> fibrosis: stricture; obstruction
* zollinger-ellison syndrome
* hyperparathyroidism
*CD
Benign and malignant disorders affecting the oesophagus
- Squamous carcinoma: smoking alc. dietary carcinogens
2. Adenocarcinoma: Barrett’s + obesity
Describe the role that H Pylori has in gastric disease
H pylori ↑acid prod
- childhood acquired, colonise mucosal surface
=> induction of immune response in underlying mucosa + toxin release
pre-disposition to duodenal ulcer disease (antral predominant gastritis)
pre-disposition to stomach cancer (corpus predominant gastritis)
Dyspepsia
upper abdo pain and discomfort: retro pain; anorexia; nausea for 4 weeks
(ALARMS) Anorexia Loss of Wt Anaemia: Fe def. Recent onset Melaena (GI bleed) / Mass Swallowing Problems
H pylori diagnositc
non-invasive
IgG - prev infection
Urea breath
ELISA stool
invasive
biopsy
culture
rapid slide urease test (ammonia)
Treatment of H pylori gastric disease
TRIPLE Tx
- Clarithromycin
- Amox or Metronidazole
- PPI: omeprazole
- H2R ant. (ranitidine)
- NSAID cessation
Motility Disorders
- ACHALASIA (oesoph muscl dysfunction) - myenteric plexus ganglion loss. distal obstruction & dysphasia, wt. loss., regurgitation. + chest pain
=> pneumatic balloon dilatation; Nitrates + CCB; Endoscope botulinum; sx myotomy
- Hypermotility: DIFFUSE OESOPH SPASM
- corkscrew pattern via swallow
- chest pain +++
=> smc relaxant
- Hypomotility
- connective tissue disease
- DM - neuropathy
GORD
acidic and bile exposure in lower oesoph.
- Hiatus hernia: sliding VS para-oesoph
- hypotense LOS: transient relaxation
=> inflamm -> erosive oesophagitis
=> ALGINATES: protective coating
OMEPRAZOLE
OESOPH CANCER
SCCa: dysphagia and carcinoma in-situ; proximal and middle 1/3
=> achalasia, caustic strictures
Adenoca.: young. DISTAL oesoph. Barretts pre-disp.
=> oesophagectomy +/- adjuvant or neoadjuvant
Bilirubin circulation
PRE-HEPATIC: haemolysis, bilirubin released
HEPATIC: hepatocyte bilirubin conjugation ↑water-sol
POST-HEPATIC: breakdown of conjugate in intestin; reabs
Pre-hepatic jaundice
Haemolysis
Hepatic Jaundice
- CHOLESTASIS (extra-hepatic)
accum. of bile d/t viral/alcoholic hep.;/liver failure => swelling - 1º BILIARY CHOLANGITIS
females, ↑alkaline phosphatase, organ-specific AuImm.
granulomatousinflamm of bile ducts - 1º SCLEROSING CHOLANGITIS
ibd. , chronic inflamm and fibrous obliteration.
- > cholangiocarcinoma - Liver Tumours
Post-Hepatic Jaundice
- CHOLELITHIASIS
acute cholecystisis; chronic: fibrosis of gall bladder
fatty foods pain - EXTRAHEP BILE DUCT OBSTRUCTION
* common bile duct* prevent excretion = jaundice
- > jaundice, ascending cholangitis (proximal obstruction), biliary cirrhosis
HEPATIC CIRRHOSIS
Diffuse process
=> portal HT, SPLENOMEGALY; OESOPHAGEAL VARICES
risk to hepatocellular carcinoma
Metabolic causes:
1º Haemochromatosis: excess Fe
Wilson’s Disease: copper excess
DM: obesity
colon cancer aetiology, pres., and dysplasia
RF: sedentary, low diet hight fat & processed, obestiy, alcohol, tobacco,
DYSPLASIA: uncontrolled replication of epithelial cells - precursor to malignancy
ADENOMA POLYP: colon.
- low grade: darker, pleomorphic, ↑stain
- high grade: carcinoma in-situ, irregular. pre-cursor
COLORECTAL ADENOCARCINOMA
+IBD: UC+CD, FAP, HNPCC, Peutz-Jeghers
- RHS: anaemica, blood PR, vague pain, weak, OBSTRUCTION
- LHS: annular, fresh blood, altered bowel habit, slight obstruction.
