Class notes
summary of conditions in GI
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Oesophagus GallbladderOesophagitis 1A Chronic cholecystitis 1B
Mallory-Weiss tear 1B Cholelithiasis 1B
Neoplasms 1B Acute cholecystitis 1B
Strictures 1B
Varices 1B Liver
Motor Disorders 2B Acute hepatitis 1B
Chronic hepatitis 1B
Stomach Cirrhosis 1B
Gastro-oesophageal reflux 1A Hepatic neoplasms 2B
disease
Gastritis 1A
Peptic ulcer disease 1A Pancreas
Gastric Neoplasms 1B Acute pancreatitis 1B
Pyloric stenosis 2B Chronic pancreatitis 2B
Pancreatic neoplasms 2B
Small Intestine/ Colon
Constipation/ faecal impaction 1A Hernia
Irritable bowel syndrome 1A Hiatus 1B
Infectious diarrhoea 1A Incisional 1B
Diverticular disease 1B Inguinal 1B
Appendicitis 1B Umbilical 1B
Intussusception 1B Ventral 1B
Ischaemic bowel disease 1B
Obstruction – small bowel 1B Other Gastro-Intestinal
obstruction Conditions
Obstruction – colonic 1B Peritonitis 1B
obstruction
Toxic megacolon 1B Gastro-intestinal perforation 1B
Inflammatory bowel disease 2B Gastro-intestinal 1B
haemmorrhage
Intra-abdominal abscess 2B
Rectum
Haemorrhoids 1A
Anal fissure 1B
Anorectal abscess/ fistula 1B
Pilonidal disease 1B
Polyps 1B
Rectal neoplasms 1B
, Oesophagitis (1A)
Definition Inflammation of inner lining of the oesophagus. Commonly caused by GORD.
Definition:
Pathophysiology:
Stomach content usually prevented from entering the oesophagus by lower oesophageal sphincter (LOS).
Weakness of LOS allows stomach contents to regurgitate into oesophagus.
Acid, pepsin (breaks down protein and damages cells) and bile can cause damage to the lining of oesophagus.
Eosinophilic oesophagitis: infiltration of eosinophils into the oesophagus – pathophysiology is unclear
Causes: Sphincter of oesophagus fails to prevent acid reflux Clinical features:
GORD Heartburn – sensation in chest,
Emesis Acid brash - taste in mouth - bitter
MWT (Mallory Weiss tear) Nausea and vomiting
Hiatus hernia Dysphagia
Achalasia Coughing at night
Wheezing
Risk Factors: Sore throat/ hoarseness
Weakened immune system (HIV, AIDs, Diabetes, Halitosis
lymphoma, leukaemia) Dyspepsia
GORD Burning – drinking at night
Hiatus hernia Feeling of lump in throat
Obesity – caused by intra-abdominal pressure
Medications: NSAIDS/ Bisphosphonates / Steroids
Smoking
Alcohol
Allergies and FHx
Immunosuppressants
Investigations:
ONLY ADVISED IF SYMPTOMS SEVERE OR DON’T
IMPROVE OR NOT TYPICAL OF GORD
Endoscopy (OGD)
FBC – anemia
Oesophageal pH test (stop antacids 7 days prior,
no food 3 hours before unless diabetic)
Barium swallow (hiatal hernia)
Management:
Change in lifestyle (NSAIDs. Smoking, certain foods,
food habits, posture, weight loss, drinking)
Antacids
PPI for 4 weeks
H2 receptor antagonists (Ranitidine) as second line treatment or adjunct PPI
Fundoplication
Complications:
Stricture
Barrett’s oesophagus (Replacement of the normal squamous epithelium lining the lower oesophagus with
columnar epithelium. This may progress to malignancy)
Cancer – adenocarcinoma
https://www.youtube.com/watch?v=ZpUgh4ktqSc
, Notes: Grades A to D
Mallory-Weiss tear (MWT) (1B)
Definition: Tear or laceration in oesophagus often near oesophageal junction or right border of junction.
Often self-limiting. Non-variceal upper GI bleeding. Common in males.
Pathophysiology: not completely understood
Sudden rise in abdominal pressure or transmural pressure gradient across gastro-oesophageal junction with
corresponding low intrathoracic pressure.
When forces high enough to cause distention in poorly distended area. Acute gastro-oesophageal tear/laceration.
Causes: Clinical features:
Coughing, retching, straining, conditions that induce emesis Haematemesis
Closed chest compression/ resuscitation Light-headedness/dizziness
Blunt abdominal trauma Postural/orthostatic hypotension
Iatrogenic: endoscopy Dysphagia
Odynophagia
Risk Factors: Pain
Condition predisposing to coughing, retching, straining Melaena
Chronic cough (conditions e.g. COPD) Haematochezia
Hiatal hernia Shock – secondary to rapid blood loss
Retching during endoscopy etc. Signs of anaemia
Alcohol use
Male
NSAIDs/ aspirin
Hiccups
Primal scream therapy
Investigations:
FBC
↑ Urea
LFT
PT/INR
PTT
CXR
OGD - oesophagogastroduodenoscopy
Cross-matching/ blood grouping
Creatinine kinase or creatinine kinase-MB
Troponin
ECG
Angiography
Management:
Differential Diagnosis:
Oesophagitis
Spontaneous oesophageal perforation
Oesophageal or gastric neoplasm
Complications:
, Rebleeding
Myocardial ischaemia or infraction
Gastric ischemia or infarct
Metabolic disturbance
Oesophageal perforation
Oesophagus Neoplasm (1B)
Definition: Carcinoma – aggressive tumour. Different types almost all are epithelial in origin. Majority are SCC
(squamous cell carcinoma) or adenocarcinoma (AC).
Pathophysiology: Changes in DNA of cells that line the oesophagus.
Causes: ALARMS
A = Anaemia
L = Loss of weight
Risk Factors: A = Anorexia
Smoker R = Recent onset of progressive symptoms
Alcohol M = Melaena/ Haematemesis/ mass
Barrett’s oesophagus (precursor of AC) S = Swallowing symptoms
Achalasia
Obesity Clinical features:
FHx of hiatal hernia Progressive dysphagia
GI bleeding
Investigation: Non-specific dyspeptic symptoms
Anyone with ALARM symptoms or >55 years with dysphagia = Anorexia
2 week wait for urgent endoscopy Weight loss
FBC, U and Es, LFT, glucose, CRP
Chest x-ray
CT/MRI or barium swallow
Management:
Primary treatment modalities: surgery/ chemotherapy or radiation therapy. Consider with dieticians
Endoscopic mucosal resection and submucosal dissection option for patients with early oesophageal cancer.
Other techniques employed with endoscopy to treat early cancers include lasers, electrocoagulation, argon
plasma coagulation (APC) and radiofrequency ablation.
Endoscopic resection: used for more advanced tumours when patient is unwilling or unfit to undergo more
invasive surgery.
Oesophagectomy: treatment of choice for most advanced cancers
Many patients will present late in the disease process with unresectable disease. For this group of patients, the
emphasis will be on palliation and symptom relief.
Radiotherapy, brachytherapy, chemotherapy, electrocautery or plasma/laser ablation may be of use (primarily in
reducing tumour bulk and bleeding). Photodynamic therapy may also be used for palliation in advanced disease.
Trastuzumab in combination with cisplatin/fluoropyrimidine should be considered for patients with HER2-
positive oesophago-gastric junctional AC.
Stenting is a first-line option to assist swallowing.
Nutritional status may be maintained by the use of liquid feeds, enteral nutrition or percutaneous endoscopic
gastrostomy (PEG) tubes.
Pain relief should be maintained at a level at which the patient experiences little, or no pain.
Differential Diagnosis: Complications:
Esophageal stricture Tracheo-esophageal fistulas
Compression of oesophagus from external source Anaemia
e.g bronchial carcinoma Weight Loss
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