Mouth → Duodenum

Front 1

what's leukoplakia

Back 1

mucous membrane disorder characterised by white patches

Front 2

which cancer makes up 95% of oral cancers

what sex, & age likely

risk factors

Back 2

squamous cell carcinoma (SCC)

male 50+

smoking, UV, alcohol, immunosuppression, poor nutrition

Front 3

presentation of oral cancer (signs)- SCC

Back 3

appearance: leukoplakia, red/velvety, speckled
granular irregular
exophytic (protrudes)
non-healing ulcer 3wks+
swollen
mobile teeth
lymphadenopathy

Front 4

when would urgent referral for oral cancer suspicion be approriate (1)

Back 4

HOARSEness 3wks+

particularly in 50+ smokers/ heavy drinkers

Front 5

oral manifestations of systemic diseases

Back 5

ULCERS: chron's, coeliac, infections
ANGULAR STOMATITIS: iron def
GINGIVITIS: vit C def
GLOSSITIS: iron/ folate/ B12 def
THRUSH: DM, HIV.....loads

Front 6

apart from systemic diseases, why else might someone have oral manifestations
- e.g.

Back 6

side effects of drugs:
- NICORANDIL (K-channel openr) for angina

Front 7

screen for colorrectal ca

Back 7

FOBT

Front 8

what physiological mechanisms cause nausea

Back 8

LOS & stomach RELAX
upper s.int & pyloric sphincer contract
move into body of stomach

Front 9

wheres the vomiting centre

Back 9

medulla oblongata

Front 10

what symptoms precede vomiting

Back 10

nausea
sweating
pale
profuse salivation
tachycardia

Front 11

what's the major consequence of severe vomiting

Back 11

DEHYDRATION (lose gastric protons H+) & Cl-
→ METABOLIC ALKALOSIS
- H+ accompanied by K+ excretion = hypokalaemia

Front 12

which 4 areas can vomiting triggers signal to in the brain

Back 12

VC, Vestibular nucleus, NTS or CTZ

Front 13

vomiting triggers: sight, pain & smells signal to where in the brain

Back 13

direct to VC

Front 14

vomiting triggers: motion and vestibular disorders signal to where in the brain

Back 14

Vestibular nucleus

Front 15

vomiting triggers: pharyngeal/ gastric/ duodenal stimulation signal to where in the brain

Back 15

NTS (nucleus tractus solitarus) or CTZ (chemoreceptor trigger zone)

Front 16

how do drug & radiation chemotherapy induce emesis

Back 16

release 5-HT from ENTEROCHROMAFFIN cells lining gut → 5-HT receptors in gut → vagal afferent → signal to CTZ

Front 17

how does dopamine cause emesis (vomiting)

Back 17

D2 receptors prevalent in CTZ

Front 18

which receptors are prevalent in the CTZ for vomiting

Back 18

5-HT3 & D2 (receives dopamine)

Front 19

5 major classes of anti-emetic drugs (anti-vomiting)

Back 19

5-HT3 antagonists
muscarinic antagonists
H1-antagonists
Dopamine-receptor antagonists (D2)
Cannabinoids

Front 20

eg of 5-HT3 antagonists used in vomiting
uses
SE's

Back 20

ONDANSTERON
chemo & radio-induced
✔ well tolerated
x. constipation
x. headaches

Front 21

eg muscarinic antagonists use in vomiting
uses
SE's

Back 21

HYOSINE/ SCOPOLAMINE
prophylaxis motion sickness
x. burry vision
x. urinary retention
x. dry mouth
x. sedation

Front 22

eg H1-antagonists use in vomiting
uses
SE's

Back 22

CYCLIZINE (also blocks M receptors)
motion sickness
x. drowsy

Front 23

eg dopamine antagonists use in vomiting
uses
SE's

Back 23

DOMPERIDONE & metoproclamide
drug-induced vomiting, Gi disorders (e.g. GORD)
x. reduced GI transit

PENZOTHIAZINE used in severe vomiting

Front 24

eg of a cannabinoid used last resort in chemo-induced vomiting unresponsive to other agents

SE's

Back 24

NABILONE--> opiate receptors
x. dry mouth
x. drowsy
x. dizzy
x. mood changes

Front 25

2 eg's acute inflam oesophagus

Back 25

infection (in immunocompromised)
corrosive after chemical indigestion

Front 26

common cause of chronic oesophagus inflam

Back 26

GORD/ reflux oesophagitis

Front 27

3 causes of GORD

Back 27

defective sphincter mechanisms

abnormal oesophageal motility (achalasia, spasm, HTN peristalsis)

increased intra-abdominal pressure

Front 28

3 complications of GORD

Back 28

ulceration
stricture (fibosis & scarring = narrowing)
Barret's oesophagus

Front 29

what's the cell change (metaplasia) in Barret's oesophagus

Back 29

stratified squamous --> COLUMNAR epithelium
BENIGN...but...

(increase risk developing dysplasia & carcinoma)

Front 30

what's allergic oesophagitis characterised by and what does the oesophagus look like on endoscopy

Back 30

EOSINOPHILIA
corrugated, ridges
assoc with asthma, young, M

Front 31

3 drugs for treatment of allergic oesophagitis

Back 31

steroids, cromoglycate, ,montelukast

Front 32

what is the main type of benign oesophageal tumour
what virus is it related with

Back 32

squamous PAPILLOMA (wart-like growth)---HPV

Front 33

2 main types MALIGNANT oesophageal tumours

Back 33

SCC (epithelial layers)
ADENOCARDINOMA (glandular)

Front 34

aetiology (causes) of SCC in oesophagus

Back 34

vit A/ zinc def
tannic acid/ strong tea
smoking, alcohol
HPV
oesophagitis (GORD)
genetic

Front 35

epidemiology of oesophageal adenocarcinoma
aetiology - main BIG risk/ predisposition
pathogenesis

Back 35

caucasians, M, obese
lower 1/3 oesophagus
BARRET's --> dysplasia --> adenocarcinoma

Front 36

3 mechanisms of cancer metastises

Back 36

local - direct invasion
lymphatic
systemic - vascular- blood

Front 37

symptoms of oesophgeal tumour/ cancer

Back 37

DYSPHAGIA, retrosternal chest pain
regurgitation
anaemia, weight loss, fatigue, lymphadenopathy

Front 38

what's the treatment of choice for oral cancers

Back 38

surgery +/- adjuvant therapy

Front 39

symptoms of oesophagitis GORD

Back 39

heart burn/ acid reflux/ chest pain
belching
water brash (excessive salivation)
odynophagia (painful swallow)
weight loss
hoarseness/ cough (upper 1/3)

Front 40

risk factors for oesophagitis (GORD)

Back 40

ageing, obese, FH, smoking, alcohol, hiatus hernia, preg, big meals

Front 41

when does GORD/ oesophagitis require Ix

Back 41

ALARM symp's:
- gastroscopy OGD & biopsy
- Ba swallow (hiatus hernia?)

Front 42

management of oesophagitis (GORD)

Back 42

LIFESTYLE (weight loss, reg meals, raise bed, stop smoking, avoid fatty, hot drinks, alochol, eating late...)

DRUGS: antacids, PPIs

Front 43

Gastropariesis can cause GORD or be a complication of it, what is it
causes
symps

Back 43

DELAYED gastric EMPTYING (no physical obstruction:

DM, cannabis, meds, systemic disease

- early satiety, nausea, vomiting, epigastric pain

Front 44

Ix & management of gastropariesis

Back 44

IX: endoscopy & Ba swallow (exclude other causes)
gastric emptying studies

Rx: remove precipitating factors, soft diet, low fat

Front 45

4 ALARM features of oesophageal and gastric cancer
ALARM age to suspect it

Back 45

weight loss/ anorexia
HAEMATEMESIS
DYSPHAGIA
MASS
>55yrs

Front 46

aetiology / important cause of gastric cancer

Back 46

H.pylori infection

Front 47

Ix's for oesophageal cancers

Back 47

endoscopy + biopsy
bronchoscopy ?invasion

imaging: Ba swallow, CT

FITTNESS study--> potential surgery

Front 48

4 types treatment for oesophageal cancer

prognosis

Back 48

SURGERY
RADIOtherapy
INTUBATE/ stent
RECANALISATION

majority die <1yr

Front 49

symptoms specific to gastric cancer

Back 49

dyspepsia
early satiety
upper GI bleed
abdo mas- ALARM

general: weight loss, anaemia, >55yrs, fatigue

Front 50

Ix's gastric ca

Back 50

gastroscopy + biopsy

imaging: Ba meal, CT

Front 51

3 options for gastric cancer treatment

5 yr survival

Back 51

SURGERY
CHEMO
INTUBATION

15% 5-yr survival

Front 52

6 main causes upper GI bleed "haematemesis"

Back 52

peptic ulcer
GASTRIC EROSIONS
duodenal ulcer
varices
Mallory-Weiss tear
Oesophagitis

Front 53

presentation upper GI bleed

Back 53

haematemesis (bright or coffee-ground)
malena (dark, dig upper GI blood)
↑HR , ↓BP
dyspnoea
collapse

Front 54

what does the rockall score measure/ predict
what factors does it consider

Back 54

predict REBLEED & DEATH , triage- who to discharge...
- age
- shock
- cormobidity
- Dx
- sings of haemorrhage

Front 55

which score to use to assess need for endoscopy / intervention

Back 55

BLATCHFORD score or Rockall

Front 56

initial management of upper GI bleed

Back 56

ABCDE & RESUSCITATION
O2
IV fluids!
?blood transfusion >30% loss

asap endoscopy necessary?

Front 57

management (after initial resuscitation) of non-variceal upper GI bleeding
- endoscopic
- pharmacological

Back 57

1) ENDOSCOPIC therapy to ACTIVELY bleeding lesions/ visible vessels/ ulcers with adherent clot
- adrenaline, thermal , mechanical

2) DRUGS:
- H.pylori eradication (if applicable- e.g. omeprazole+amox+met )
- IV PPI

Front 58

clinical clues (S&Ss) to suspect VARICEAL upper GI bleed (as oppose to non-variceal bleed)

Back 58

portal HTN: ascites, caput medusa
CHRONIC LIVER DISEASE: palmar erythema, spider naevi, jaundice
confused

Front 59

management (after initial resuscitation) of VARICEAL bleed
- endoscopic
- pharmacological
- specifically for Chronic liver disease pt's

Back 59

TERLIPRESSIN (vasoactive)
BAND LIGATION

CLD= Abx's

Front 60

management of variceal re-bleed (2)

Back 60

TIPS (transjugular intrahepatic portosystemic shunt)- treats portal HTN

BALLOON TAMPONADE/ Sengstaken-Blakemore tube (temp)

Front 61

causes of peptic ulcers (4)

Back 61

bacterial/ viral infections
H.pylori!
IBS
GB/ liver disease
functional

Front 62

6 causes of dyspepsia

Back 62

peptic ULCER
oesophagitis/ duodenitis/ gastritis
gastric MALIGNANCY
GORD

Front 63

S&Ss peptic ulcer

Back 63

DYSPEPSIA
epigastric pain (assoc with food, nocturnal)
bloating/ early satiety
heartburn
weight loss
FH

Front 64

structures which can cause epigastric pain

Back 64

heart (eg MI)
oesophagus, stomach, duodenum
pancreas, liver, GB, CBD

Front 65

pharmacological therapy for peptic ulcers (2)

H.pyroli specific eradication

Back 65

PPIs: omeprazole
H2-antagonists: ranitidine

H.pylori= abxs: omeprazole+amox+met/ claryth

STOP NSAIDs

Front 66

what's produced by H.pylori to aid its survival

Back 66

UREASE
ammonium bicarb NEUTRALISES stomach pH

Front 67

tests/ Ix's for dx of H pylori

Back 67

★UREA BREATH TEST★
or
culture biopsy
serology

Front 68

how does H.pylori cause increased acidd (HCl) production

Back 68

H.pylori reduces somatostatin release from D cells
G cells → gastrin → parietal cells → HCl

Front 69

when H.pylori colonises stomach, what disease ensues

Back 69

chronic gastritis

Front 70

how does chronic gastritis predispose to gastric cancer

Back 70

ATROPHY of mucosa
↓parietal = ↓acid
H.pylori grows
dysplasia --> gastric cancer

Front 71

treatment for H.pylori (triple therapy)

Back 71

omeprazole + amox + metramidazole or clarythromycin

Front 72

if dyspepsia is H.pylori -ve, how to manage?

Back 72

PPI: omeprazole
or
H2-antagonist: ranitidine

Front 73

4 causes of ACUTE gastritis

Back 73

head injury
severe injury
shock
severe burns

Front 74

4 causes of CHRONIC gastritis (ABCR)

Back 74

AUTOIMMUNE (atrophic)

BACTERIAL: H.PYLORI

CHEMICAL: reflux, NSAIDs, alcohol

RARE: lymphocytic, eosinophilic, granulomatous

Front 75

3 chemical causes of chronic gastritis

Back 75

reflux bile
NSAIDs
alcohol

Front 76

what do lamina propria cells produce in response to infection with H.pylori

Back 76

anti-H.pylori IgA antibodies

Front 77

which type of peptic ulcer most common- pathogenesis

Back 77

DUODENAL
50% ↑acid secretion = gastric metaplasia, inflammation, epithlial damage

Front 78

morphology of peptic ulcers

Back 78

clear edges "punched out"
2-10cm diam or microscopic layered
floor of nectrotic fibropurulent debris
base granulation tissue
deep fibrotic scar
neutrophils & exudate

Front 79

3 complications of peptic ulcers

Back 79

perforation
haemorrhage
stenosis

Front 80

2 types of benign gastric tumours

Back 80

HYPERPLASTIC polyps
CYSTIC GLAND polyps

Front 81

3 types MALIGNANT gastric tumours

Back 81

ADENOCARCINOMA (epithlial cells)- most common!

lymphoma

GI Stromas Tumours (GISTs)

Front 82

aetiology & asoociation of gastric adenocarcinomas

Back 82

H.pylori- chronic gastritis
atrophic gastritis (autoimmune)
deprived
SMOKING
adenomatous POLYPS (e.g. genetic- FAP)
HNPCC/ Lynch syndrome

Front 83

2 subtypes of gastric adenocarcinomas

what's the difference:
- loc
- formation
- prognosis

Back 83

1) INTESTINAL- exterior, gland formation, better prognosis

2) DIFFUSE (pic) - stomach wall, thickening & fibrosis, worse prognosis
- linitis plastica, sclerosis, SIGNENT RING type

Front 84

which type of malignant gastric tumour is derived from mucosal lymphoid tissue, shows clonal B-cell proliferation & lymphoid cells fill the stroma of stomach wall

Back 84

gastric lymphoma (MALToma)

Front 85

dysphagia (difficulty swallowing) can be due to what 2 broad categories of problems

Back 85

MECHANICAL BLOCK
MOTILITY disorder

other: inflam

Front 86

important Q-s to ask about dysphagia- why

Back 86

ONSET- gradual (mechanical- stricture), sudden (motility d.)
CONSTANT/ EPISODIC - stricture/ spasm
DURATION- ca over long period
PAIN- ca, inflam, spasm
ASSOC SYMPs
DYSPEPSIA

Front 87

6 Common Ix's for dysphagia

Back 87

FBC (anaemia)
U&Es (hydration)
CXR (mediatinum fluid, gastric bubble, aspiration)

★OGD +/- biopsy ★
Ba swallow ---normal?---> manometry

Front 88

MECHANICAL causes of dysphagia

Back 88

food bolus
Schatzki ring (benign fibrous narrowing lower oesophagus)
diverticulum
extrinsic pressure (lung ca, LA enlargement, mediastinal nodes, AAA)

Front 89

MOTILITY causes of dysphagia

Back 89

achalasia (LOS fails to relax)
diffuse spasm
Bulber palsy
Motor neurone disease
Cerebrovascular disease

Front 90

4 pathogens causing oesophageal infection

Back 90

candida
Herpes
CMV
EBV

Front 91

what's the ROME III criteria for IBS

Back 91

1) RECURRENT abdo pain for 3+ days/ month, for 3months
2) + 2 of:
- better with defaecation
- change stool freq
- change stool consistency

Front 92

age and sex presentation for IBS

Back 92

20-40yrs F>M

Front 93

S&Ss IBS

Back 93

abdo pain (central/lower)- better with defaecation
abdo bloating
altered bowel habit & freq
tenesmus
mucus PR
CHRONIC- exacerbated with stress, menstruation, fibre, drugs

Front 94

pathophysiological feature of IBS

Back 94

VISCERAL hypersensitivity

Front 95

IBS ALARM features!

Back 95

>50 - ?colorectal ca
short duration
woken at night- ?IBD
BLOOD PR- ?IBD/ ca
↓weight- ?IBD/Ca
anaemia
FH colorectal ca-----> scope!
recent abxs

Front 96

Dx of IBS by Ix

Back 96

Dx of EXCLUSION
FBC, U&Es, LFTs, ESR, CRP, coeliac serology
urinalysis
Stool if ?infection
Colonoscopy- if FH colorectal ca/ >50yrs

Front 97

treatment/ management of IBS

Back 97

Diet (reg, ↓fibre, ↓caffiene, hydrated)
Lifestyle (exercise, ↓stress)

DRUGS:
- laxatives- constipation
- antimotility (loperamide)- diarrhoea
- anti-spasmodics (mebeverine)- colic/bloating
- anti-depressants (amitryptiline)

PSYCHOLOGICAL therapies

Front 98

main Ddx's for IBS (5)

Back 98

IBD
colorectal ca
coeliac disease
malabsorption
gastroenteritis