Wk 1 - Quiz + Case Study: Patient with Stomach Upset Flashcards
T or F: Simple antacids such as Rennies and Gaviscon are composed of magnesium trisilicate and/or aluminium hydroxide.
True
T or F: Alginate-containing antacids form a gel or ‘foam raft’ in the stomach.
True
T or F: Simple antacids work by neutralising stomach acid
True
In addition to GORD, can you name any other oesophageal disorders in which regurgitation can occur?
- Achalasia
- Oesophageal pouch
- Benign oesophageal strictures
- Rumination syndrome
T or F: Helicobacter pylori produces urease and a sheath.
True
T or F: Helicobacter pylori is a Gram-positive spirillum.
False (it is a gram-negative, spiral-shaped bacterium)
T or F: 95% of patients with duodenal ulcers are infected with Helicobacter pylori.
True
T or F: Animals can harbour their own species of Helicobacter that can be transmitted to humans.
True (e.g. H.Heilmannii in cats, dogs, pigs and cattle)
T or F: 30% of the world’s population carry Helicobacter pylori.
False (50-60% people world-wide carry Helicobacter pylori; up to 90% in developing countries)
What are the risk factors for hiatus hernia? List 6.
- Aged over 50
- Being overweight
- Being pregnant
- Smokers/cough that increase intra-abdominal pressure
- Weakening of the diaphragm muscle with age
- Present at birth due to developmental abnormality
What is the difference between a rolling hiatal hernia and a sliding hiatal hernia?
- In sliding HH, which is the most common type, the sphincter that forms a valve between the oesophagus and stomach slides up through the diaphragm.
- In rolling para-oesophageal HH, part of the stomach bulges up through the hole in the diaphragm alongside the oesophagus.
Which is more common sliding HH or rolling (para-oesophageal) HH?
Sliding hernia is more common
What are the two main forms of oesophageal cancer?
- Adenocarcinoma
- Squamous cell carcinoma
Squamous cell carcinoma occurs in the ________ of the oesophagus.
Squamous cell carcinoma occurs in the middle third of the oesophagus.
Adenocarcinoma occurs in the _____ of the ____ and at the ____.
Adenocarcinoma occurs in the lower third of the oesophagus and at the cardia.
In the oesophagus, which is more common adenocarcinoma or squamous cell carcinoma?
Adenocarcinoma
List a risk factor for both adenocarcinoma and squamous cell carcinoma.
Smoking
What are some risk factors for adenocarcinoma?
- Long-standing GORD
- Barrett’s Oesophagus
What are some risk factors for squamous cell carcinoma?
- Excess alcohol consumption
- Plummer-Vinson syndrome
- Achalasia
- Coeliac disease
- Tylosis (rare autosomal dominant disease
- Vitamin deficeint diet
Your patient is 55 years old and has indigestion but also presents with the following:
- Unintended weight loss
- Indigestion symptoms for the first time
- Severe pain
- Vomiting specks of blood
What is your initial diagnosis and what course of action do you suggest?
It is most likely to be dyspepsia. But they could be indicative of an ulcer or cancer. I would recommend hospital referral for gastroscopy and follow-up tests.
How does Omeprazole?
Proton pump inhibitor that inhibits gastric hydrogen-potassium-ATPase. PPI drugs will produce almost complete reduction in secretion of gastric acid.
What is usually the first line of investigation when someone presents with persistent GORD?
Gastroscopy - oesophagogastroduodenoscopy (OGD)
What is dysphagia?
Difficulty swallowing due to a local lesion. Pts often complain of ‘something sticking in my throat of chest’ during or immediately after swallowing.
List 7 ‘alarm signals’ associated with heartburn/dyspepsia type symptoms.
- Chronic GI bleeding
- Progressive unintentional weightloss
- Progressive difficulty swallowing
- Persistent vomiting
- Iron deficiency anaemia
- Epigastric mass
- Suspicious barium meal
Briefly describe the cellular changes that take place in Barrett’s oesophagus.
Barrett’s oesophagus is more correctly known as Barrett’s metaplasia. It involved a reversible change** in the **lower oesophagus from the normal non-keratinised stratified squamous epithelium of the oesophagus to a columnar type of epithelium with goblet cells.
Provide a brief definition of metaplasia and what its cause is in the lower oesophagus.
- Metaplasia is a reversible change in which one adult cell type is replaced by another cell type in response to stress (ie adaptive protective mechanism –> replaced cells better able to withstand the adverse environment).
- It is thought to arise by genetic ‘reprogramming’ of epithelial stem cells.
- The cause of metaplasia in the lower oesophagus is strongly linked to reflux and is therefore thought to be an adaptive response to acid in the lower oesophagus.
Describe what you see on the image - patient’s endoscopy results.
Barrett’s oesophagus with high-grade dysplasia and poorly differentiated adenocarcinoma.
Describe the sequence by which Barrett’s oesophagus might progress to adenocarcinoma.
- Metaplasia
- Low-grade dysplasia
- High-grade dysplasia
- Adenocarcinoma
T or F: The risk of progression to adenocarcinoma is independent of the length of Barrett’s segment involved.
False (pts with a segment length of 2-6cm are associated with lowest risk of cancer progression, those with a length of 6cm or more ar associated with the highest risk)
T or F: Patients who undergo fundoplication against acid reflux have the lowest risk of developing adenocarcinoma.
True
What does oesophagogastrectomy involve?
Surgery that involves removing the lower part of the oesophagus, nearby lymph nodes and upper part of stomach. Once removed, the oesophagus is reattached to the remaining part of the stomach.
What does pT2N0M0 describe in the staging of the patient’s adenocarcinoma? Attempt to give a prognosis base don this.
- T2: Tumour invades muscularis propria
- N0: No regional lymph node metastases
- M0: No distant metastases
- Prognosis: good with 5-year survival of 80%
