Upper Gi

Front 1

What is dysphagia, and what are common causes?

Back 1

Dysphagia = difficulty swallowing (Odynophagia is painful swallowing).

Causes:

• If young --> GORD
  
• If old w/ progressive dysphagia + weight loss = Oesophageal cancer

Front 2

Difference between mechanical and dysmotility

Back 2

Mechanical is most often an oesophageal problem characterised by gradual worsening and more difficulty passing solids than liquids.

Dysmotility is most often an oropharyngeal problem characterised by difficulty passing solids AND liquids. Also, it may be acute

Front 3

Anatomy of the Stomach

Where is and what (if any) cell types are associated with:

1. Cardia
2. Fundus
3. Body
4. Antrum
5. Pylorus

Back 3

1. Cardia - Found at the most superior part of the stomach. Associated with mucus cells
2. Funds - Found left lateral, associated with parietal cells (acid) and chief cells (pepsin)
3. Body - Found most inferior.
4. Antrum - Most distal part of stomach, associated with Mucus cells and G cells (gastrin)
5. Pylorus - Where the stomach meets the duodenum

Front 4

What do the following cells secrete?

1. Mucus cells
2. Chief cells
3. Parietal cells
4. G cells

Back 4

1) Mucus

2) Pepsin

3) Acids

4) Gastrin

Front 5

What type of cell is the stomach lined with?

Back 5

Columnar epithelium

Front 6

What is GORD, and what are its risk factors?

Back 6

GORD is the reflux of gastric contents into the oesophagus causing symptoms that interfere with daily life.

Risk Factors: Obesity, Smoking, EtOH, Caffeine, Spicy foods, Excessive juice (orange/grapefruit)

Front 7

What are the symptoms that GORD presents with?

Back 7

The symptoms of GORD can be divided into two categories: Typical and Atypical

Typical

• Heartburn
• Acidbrash (acid-taste in mouth)
• Waterbrash (excess saliva)
• +/- belching

Atypical

• Hoarseness (caution: also w/ cancers)
• Recurrent cough/chest infections
• Asthma

Front 8

What percentage of the population does Peptic Ulcer Disease (PUD) affect, and what are the risk factors involved?

Back 8

PUD affects 10-20%

Risk Factors: Smoking, EtOH, Stress, Obesity, Medications, H. pylori infection

Medications: NSAIDS, NSA, Bisphosphonates, Steroids

NSA = None-sedating antihistamine

Bisphosphonates = osteoporosis

Front 9

What are the signs of PUD?

Back 9

Signs

• epigastric or RUQ tenderness
• Guarding
• Rebound tenderness
• Signs of anaemia (blood loss)
• Haemetemesis (vomit blood)
• Meleana (blood in stools)

Front 10

What are the symptoms of PUD

Back 10

Symptoms

• Dyspepsia
• Epigastric Pain
• Back pain
• Symptoms of anaemia

Front 11

Gastritis Alphabet, what is it?

Back 11

A: Alcohol, Atrophic (older F>M, Pernicious anaemia)

B: Bacteria (H pylori)

C: Chemical (Aspirin, NSAIDS, EtOH)

D: Duodeno-gastric reflux (Bile, post cholecystecomy)

Front 12

What are investigations used for UPPER GI?

Back 12

1. OGD
2. Gastric Biopsy + Rapid urease testing
3. Urea breath test
4. H. pylori serology
5. pH probe / oesophageal manometry
6. Barium swallow +/- CT thorax
7. Video fluoroscopy
8. EUS (Endoscopic Ultrasound)

Front 13

What may be seen on an OGD?

Back 13

1) Schatzki ring

2) Reflux oesophagitis

3) Hiatus hernia

Front 14

What is the urea breath test used for and how does it work?

Back 14

Urea breath test is used to investigate H. pylori infections and the basis of the test is adding urea tagged with Carbon-13. The bacteria has a high urease activity, and will liberate the C-13 which will be exhaled and can be recorded.

Front 15

What is Achalasia?

Back 15

A rare disease where the oesophagus is unable to relax.

Front 16

What is a pH probe/Manometry used for?

Back 16

To evaluate reflux and motility of the oesophagus

Front 17

What is an endoscopic ultrasound used for?

Back 17

1. Stage oesophageal cancers
2. Evaluate and Biopsy lymph nodes
3. Evaluate the Pancreas
4. Evaluate biliary disorders
5. Evaluate lesions on ampulla of Vater

Front 18

How is GORD/PUD managed?

Back 18

Lifestyle modifications

• Smoking cessation
• EtOH education
• Weight loss
• Discontinue aggravating meds and foods
• Raise head of bed at night

H. pylori eradication

• Triple Therapy (1 mo.): 2 antibiotics (Amoxicillin + Clarithromycin) & PPI (esomeprizole)

Other medical treatment:

• Antacid, Mucosal protective agents, anti-secretory medications, H+/K+ ATPase inhibs.

Front 19

What is the difference between antacids and PPIs or H2 antagonists?

Back 19

Antacids neutralise acid, the others block acid release

Front 20

Why might a Peptic Ulcer fail to heal?

Back 20

1. Non-compliance
2. Taking PPI with/after meal (instead of before)
3. Failure to modify lifestyle
4. Nicotine, Caffeine, EtOH use
5. NSAID use/abuse
6. Crohn's disease
7. Gastrin recreating tumour
8. Malignancy
9. Eosinophilic oesophagitis

Front 21

What Surgical options are there to treat PUD and when is surgery indicated?

Back 21

Endoscopy to inject, clip, or heat/laser coagulate

Indicated if:

• Intractable haemorrhage
• Perforation
• Gastric outlet obstruction
• Zollinger-Ellison syndrome
• Failure of medical treatment

Essentially anything medications can't fix