Yr 3 MedEd > Upper GI > Flashcards

Upper GI Flashcards

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1
Q

What 6 symptoms combined can be described as dyspepsia

A 
Epigastric pain/ burning
Early satiety
Belching
Bloating
Nausea 
Discomfort in upper abdomen
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2
Q

Where can peptic ulcer disease occur?

A

Stomach (20%) or duodenum (80%)

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3
Q

Name 4 symptoms of Peptic Ulcer disease

A

Epigastric pain related to eating
Early satiety
Nausea and vomiting
Anorexia and weight loss

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4
Q

Name 3 signs of peptic ulcer disease

A

Epigastric tenderness
Pointing sign
Signs and symptoms of blood loss/ anaemia

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5
Q

Give 2 ways to differentiate duodenal and gastric ulcers

A

Pain:

  • Duodenal 2-3 hours after eating. Awakens patients at night.
  • Gastric shortly after eating

Weight change:

  • Duodenal over-eat, weight gain
  • Gastric: avoid eating, weight loss.
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6
Q

Name 4 things that can cause a peptic ulcer

A
  • H. Pylori
  • Gastric acid
  • Pepsin
  • NSAIDs
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7
Q

Name 8 risk factors for peptic ulcer disease

A
  • H. Pylori
  • Smoking
  • NSAIDs
  • Bisphosphonates
  • Head trauma: can lead to cushing ulcer
  • Age
    Burns- can lead to curling ulcer
  • Zollinger Ellison syndrome
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8
Q

What is the basic mechanism of action of NSAIDs?

What effect does this have on GI mucosa?

A

Inhibition of COX 1 and COX 2 suppresses prostaglandin synthesis.

Barrier properties of GI mucosa impaired, reduction of gastric mucosal blood flow also.

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9
Q

Describe 2 investigations for H. Pylori.

What gram stain is H. Pylori?

A
  • 13c Urea breath test: ingest 13c urea. Measure 13-CO2 in breath using mass spectrometry (H. Pylori produces urease)
  • Stool antigen test

Gram negative flagellate.

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10
Q

What is the management for H. Pylori?

A

1 week Triple therapy:

  • PPI
  • Clarithromycin
  • Amoxicillin or Metronidazole
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11
Q

What is Zollinger-Ellison syndrome?

What condition may it be a part of?

A

Gastrin secreting neuroendocrine tumour in pancreas.
(gastronoma). 0.1-1% of all duodenal ulcers.

May be part of Multiple Endocrine Neoplasia 1 (MEN1)

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12
Q

What are the 3 pathophysiological steps of Zollinger- Ellison syndrome

A
  1. Hypergastrinaemia
  2. Hypertrophy of gastric mucosa and stimulation of acid secreting cells.
  3. Damaged mucosa and Ulceration

+ Malabsorption due to damage of GI mucosa
+ inactivation of pancreatic enzymes.

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13
Q

When should you consider Zollinger- Ellison Syndrome?

A
  • Multiple ulcers refractory to treatment.

- Family history of MEN1

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14
Q

Name 3 investigations for Zollinger-Ellison syndrome.

A
  • Fasting serum gastrin
  • Serum calcium
  • Gastric acid secretory tests, stimulation tests, imaging.
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15
Q

Name 2 management steps for Zollinger- Ellison syndrome.

A
  • PPI

- Surgical resection of tumour.

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16
Q

What is a Cushing ulcer?

What is a Curling ulcer?

A
  • Raised ICP stimulates vagus nerve after head injury- leads to gastric acid secretion.
  • Reduced plasma volume following sever burn injury leads to ischaemia and necrosis of gastric mucosa..
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17
Q

Name 2 investigations for PUD under 55.

Name 3 investigations for PUD over 55, or red flag symptoms.

A

Under 55:

  • Breath test/ stool antigen
  • FBC, stool occult blood, serum gastrin.

Over 55 - suspect malignancy:

  • UGI endoscopy
  • Histology + biopsy, urease testing
  • Repeat endoscopy after 6-8 weeks.
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18
Q

For management of PUD, name 3 risk factor modifications.

Name 2 pharmacological management steps.

A

RFM:

  • Diet
  • Smoking
  • NSAIDs and bisphpsphonates

Pharm.

  • H. pylori positive: triple therapy
  • H. pylori negative: PPI (-oprazole) or H2 (-tidine) antagonist
  • May need to treat anaemia
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19
Q

How do you manage a bleeding peptic ulcer? 3 steps.

A
  • Endoscopy (+/- therapy e.g. adrenaline)
  • IV PPI e.g. omeprazole
  • Triple therapy if H. Pylori.
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20
Q

How do you manage a perforated peptic ulcer? 3 steps.

A
  • NBM
  • IV antibiotics
  • Surgery
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21
Q

What is the relation between PUD and gastric outlet obstruction?

A
  • Active ulcer causes inflammation and oedema/ scarring
  • Blocked outflow causes full stomach of gastric juice and ingested food.
  • This causes vomiting without pain.
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22
Q

Name two complications of a perforated ulcer.

A
  • Pneumoperitoneum- air under diaphragm.

- Peritonitis.

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23
Q

Name 4 symptoms of gastric cancer.

A
  • Epigastric pain
  • Nausea/ vomiting (+/- blood)
  • Anorexia
  • Weight loss
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24
Q

Name 3 risk factors for gastric cancer:

A
  • Smoking
  • H. Pylori
  • Chronic gastritis and therefore PUD.
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25
Name 3 signs of gastric cancer.
- Palpable epigastric mass - Virchow's node/ Troisier's sign - lymphadenopathy in left supraclavicular fossa. - Sister Mary Joseph node- metastatic node on umbilicus Both nodes suggestive of metastatic abdominal cancer
26
Name 2 investigations for gastric cancer.
- endoscopy | - biopsy and histology.
27
Give 3 oesophageal (typical) symptoms of GORD
Heartburn Regurgitation: return of gastro-oesophageal contents to pharynx. Dysphagia (difficulty swallowing), sensation food is stuck retrosternally.
28
Give 4 Extra-oesophageal signs of GORD
- Coughing/ wheezing - Hoarseness, sore throat - Noncardiac chest pain - Enamel erosion or other dental manifestations
29
What are the risk factors for GORD relating to: - Increase Intra-abdominal pressure (2). - Lower oesophageal sphincter hypotension (3) - Gastric hypersecretion (3).
Raised IAP: - Obesity - Pregnancy LOS hypotension: - Drugs: anti-muscarinics, CCBs, nitrates, smoking. - Treatment of achalasia - Hiatus hernia Gastric hyper secretion: - Diet - Smoking - Zollinger- Ellison syndrome
30
What is a hiatus hernia and what does it predispose to? How does patient present?
Portion of stomach prolapses through diaphragmatic oesophageal hiatus, predisposing to reflux/ worsening of existing reflux. Patient presents with symptoms of GORD (most hiatus hernias are asymptomatic)
31
Name 4 risk factors for hiatus hernia
- Muscle weakening/ lack of elasticity with age. - Pregnancy - Obesity - Abdominal ascites
32
Name 3 investigations for a hiatus hernia, with most important first.
- Barium swallow - Chest X-ray - Endoscopy BS may show: - out pouching of barium at lower end of oesophagus - Wide hiatus through which gastric folds are seen in continuum with those in stomach. - Free reflux of barium. - Distinguish sliding and paraoesophagheal hernia.
33
Name 3 management steps for a hiatus hernia.
- Conservative: risk factor modification- change diet, loose weight, stop smoking. - Pharmacological: PPI. - Surgery: Nissen fundoplication.
34
What are the two main complications for hiatus hernia?
- GORD | - Paraoesophageal hernia incarceration (blood supply gets cut off)
35
What is the list of investigations for GORD in order?
``` Clinical diagnosis => Trial of PPI => UGI endoscopy => Biopsy => Consider other tests ```
36
What is the management of GORD - Conservative (3) - Pharmacological (1) - Surgical (2)
Conservative: - Diet - Sleep - Stop smoking/ drugs Pharmacological: - PPI or H2 antagonist Surgical: - Nissen fundoplication (for hiatus hernia) - Endoluminal gastroplication
37
How many times is risk of oesophageal cancer increased by Barret's oesophagus? What type of cancer can it become?
11 times increased risk of oesophageal cancer. Adenocarcinoma. Requires regular surveillance- endoscopy and biopsy.
38
What is the management for Barret's oesophagus with high grade dysplasia? 2 steps
- Radiofrequency ablation | - PPI
39
What is the management for Barret's oesophagus with nodule(s)? 2 steps
- Endoscopic mucosal resection | - PPI
40
What are two symptoms and two red flags of oesophageal cancer?
- Progressive dysphagia from solids to liquids - Burning chest pain Red flags: - Weight loss - Anaemia
41
Differentiate oesophageal adenocarcinoma and squamous cell cancer by location and risk factors.
Adenocarcinoma: - Lower third - Barret's oesophagus Squamous cell: - Middle third - Smoking, alcohol, nitrosamines/ nitrates (Chinese, Iranian and South African diets)
42
What are the purposes of endoscopy and CT in oesophageal cancer.
- UGI endoscopy and biopsy to diagnose/ grade/ | - CT to stage cancer.
43
What are the 4 domains of dysphagia classification? Name one condition from each domain
High dysphagia Low dysphagia Functional Structural - High functional: Stroke, Parkinson's (neuromuscular disease) - Low functional: Achalasia - High structural: cancer, pharyngeal pouch. - Low structural: cancer, plummer-vinson syndrome.
44
Give 4 symptoms of achalasia
Dysphagia- solids and liquids Regurgitation Dyspepsia Weight loss
45
Give the aetiology of Achalasia (2 points).
- Absence of oesophageal peristalsis - Failure of lower oesophageal sphincter to relax 'reverse GORD'
46
Give 4 investigations for dysphagia and their purposes
- Barium swallow: Avoid perforation on endoscopy, suspect achalasia. - Endoscopy: low dysphagia, first line - Videofluroscopy: High dysphagia, SALT to modify swallow technique. - Manometry: Assess pressure of LOS and wave of peristalsis in rest of oesophagus. Useful for achalasia, oesophageal spasm, motility disorders.
47
Give the pathophysiology of achalasia. What would you see in Barium swallow? Which disease has identical pathophysiology?
- Absence of ganglion cells in myenteric plexus - Peristalsis Failure of LOS to relax. Birds beak on barium swallow. Chagas disease results in identical pathophysiology.
48
Differentiate oesophageal cancer and achalasia by: - Age - onset - Structural/ functional - Progressive/ intermittent - Presence of red flags. - 1st line investigation
``` Cancer vs achalasia Old vs young New onset vs long term Structural vs functional Progressive vs intermittent Red flags vs no red flags UGI endoscopy vs barium swallow ```
49
Name 2 neurological causes of dysphagia and 4 clues.
Stroke, parkinson's. - Coughing immediately on swallow - Choking - Slow eating - Early dysphagia for liquids
50
What is Plummer-Vinson syndrome a combination of?
Oesophageal webs and Iron deficiency anaemia- - Cheilosis - atrophic glossitis Koilonychia.
51
What acronym is used for the signs of limited cutaneous scleroderma? What does it stand for?
CREST: - Calcinosis- calcium deposits in skin. - Raynaud's - Esophageal dysfunction- acid reflux, motility dysfunction. - Sclerodactyly- thickening and tightening of skin on fingers - Telangiectasia
52
What sign is seen on barium swallow in Limited cutaneous scleroderma (CREST)?
Corkscrew oesophagus
53
When can Mallory-Weiss tears occur? Where do they occur? What does it look like in vomit?
- After any event raising intragastric pressure, particularly vomiting. - After episode of sever vomiting, e.g. alcohol, bulimia - Usually seen as blood streaked in vomit - Episode of vomit always precedes bleeding - Occur at Gastro-oesophageal junction.
54
What investigation is used to diagnose Mallory-Weiss tears? How long do tears take resolve?
Endoscopy 24-48 hours
55
What is Boerhaave syndrome? What investigations are used to diagnose Boerhaave syndrome? What will be seen? What is Mackler's triad?
A full tear in the oesophageal wall as a complication of a Mallory-Weiss tear, 35% mortality. Surgical management. Diagnosis by CXR/ CT shows pneumomediastinum. Chest pain, vomiting, subcutaneous emphysema.
56
What is an oesophageal varix and where does it occur? What is it a consequence of?
An extremely dilated vein in sub-mucosa of lower third of oesophagus. Consequence of portal hypertension due to cirrhosis.
57
Give 3 presenting features of a ruptured oesophageal varix.
- Extreme haematemesis - unconscious or in shock - Melaena if minor bleed.
58
Give 3 factors promoting rupture of oesophageal varies.
- Cirrhosis, reduced clotting factors, increased bleeding risk - Cirrhosis, extra hepatic blood shunting, portal hypertension. - Continued alcohol use, oesophageal irritation.
59
Oesophageal varices: what would you see in these investigations: - FBC - LFT - U&E
All signs of alcoholism/ cirrhosis. - FBC: Macrocytic anaemia, reduced platelets. - LFTS: raised GGT, bilirubin, decreased albumin. - U&Es: raised urea.
60
What drug is used to reduce portal hypertension in a patient with ruptured oesophageal varices? What investigation is first line? What treatment is first line?
- Terlipressin - Endoscopy - Band ligation It is an emergency, ABCDE approach necessary.
61
What picture of emesis is expected from ruptured peptic ulcer? What other blood related sign?
- Coffee ground emesis | - Melaena
Yr 3 MedEd
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