19 - upper GI pathology

Question 1

What is dysphagia?

Answer 1

Swallowing difficulties

Question 2

What neuromuscular causes of dysphagia?

Answer 2

myathenia graves

achalasia

muscular dystrophy

Sroke

parkinsons

CN IX, X XII lessions

Question 3

Occulsion causes of dysphagia?

Answer 3

Throat cancer

esophageal cancer

GORD

Pharyngeal pouch

Question 4

What does a progressive dysphagia for solids suggest?

Answer 4

Mechanical obstruction or stricture

Question 5

Features which surgest malignancy is dysphgia?

Answer 5

Progressive

retrosternal pain

Regurgitation

weight loss

Question 6

What is pulmmer Vinson syndrome?

Answer 6

Triad of:

Dysphagia

Iron deficiency aneamia

Glossitis

Question 7

Patient has aggressive vomiting which then results vomiting in blood, What is the likely diagnosis?

Answer 7

Mallory-Weiss syndrome

Question 8

What is Boerhave syndrome?

Answer 8

Severe vomiting resulting in oesophageal rupture.

Question 9

Questions to ask duringa history of dysphagia?

Answer 9

Weightloss - intentional and timescale

Vomiting - blood, coffee granuels, contineuos or single heamatesis?

Bowel habit - malaena

Pain

anaemia symptoms

Question 10

What to ask if you suspect Peptic ulcer?

Answer 10

Previous ulcers

OGD

NSAIDS

Drinking and smoking

Question 11

What is barrettes oesophagus?

Answer 11

Metaplasias of squamous to columnar epithilium.

Pre-cancerous

Question 12

Criteria for OGD?

Answer 12

GORD for > 5 years, 2 times a week

+ 3 of : > 50 years, male, white, obese, smoker

Question 13

How often is surverillande for barrettes oesphagus?

Answer 13

OGD every 3-5 years

Question 14

How is adenocarcinoma of the oesophagus treated?

Answer 14

PET and CT
oesopahgealectomy if appropriate

Question 15

What is the most common cause of peptic uclers?

Answer 15

H. pylori in LEDC

NSAISD in MEDC

Question 16

What is Zollinger-Ellison syndrome?

Answer 16

a gastrin releasing tumour, can lead to peptic ulceration

Question 17

How to treat H. pylori?

Answer 17

7 days oral PPI

Amoxycillin + clarthromycin/ matronidazole

Question 18

How is NSAID peptic ulcer treated?

Answer 18

Stop NSIADS

offer 8 weeks PPI or H₂RA

H. pylori test if appropriate

Question 19

What medication can cause upper GI bleed/ gastritis/ peptic ulcer?

Answer 19

anti-platelets

SSRIs

corticosteroids

NSIADS
Anticoagulants

Nicorandil - K channel activator leading to vasodilation

Question 20

What is the Glasgow batchford score used for?

Answer 20

GI bleeding risk, indicates who can be managed as an outpatient. Doesn’t require endoscopic evaluation.

Question 21

What does the Rockall score indicate?

Answer 21

Risk of upper GI risk (score > 3) after endoscopic evaluation.

Question 22

What questions to ask about an upper GI bleed?

Answer 22

1 - Quantity of blood

2 - Is it still bleeding

3 - Where is it comming from

Question 23

Where does a bleed stop being an upper GI bleed and become a lower GI bleed?

Answer 23

Ligament of Triatz - this is where OGD evaluation stops

Question 24

What deos streaks and clots during heamatemesis surgest?

Answer 24

smaller bleed

Question 25

Why is urea raised in GI bleeds?

Answer 25

blood is broken down and reabsorbed as urea

Question 26

Management of variceal bleed?

Answer 26

Telipressin Omeprazole IV Band ligation - temporarily Prophylatic antibiotics

Question 27

What should be done before the addministation of tellipressin?

Answer 27

ECG to exclude ischaemia

Question 28

At what platelet count has a big risk of a major bleed?

Answer 28

\< 30

Question 29

What is transjugular intrahepatic portal system shunt?

Answer 29

Radiological intervention resulting in a shunt being produced from the hepatic portal vein to the hepatic vein leading to reduction of hepatic portal vein hypotensions and therefore helping to reduce variceal bleed.

Question 30

Relook over case on medlea

Question 31

What is the difference between regurgitation and vomiting?

Answer 31

Vomiting has mechanical propulsion and regugitation does not require any effort from the patient.

Question 32

What are the symptoms of salivary gland lumps?

Answer 32

Pain associated with meals Persistant or rapid growth Diagnosis by needle biopsy

Question 33

What are the deferentials for bilarteral hylar markings?

Answer 33

Disseminanted malignancy lymphoma Sarcoid TB - \> immunosupressed patients Glandular fever

Question 34

What histological cell character indicates Hodgkins lymphoma?

Answer 34

**Reid sternberg cells**

Question 35

What do Reid sternberg cells look like?

Answer 35

muiltinucleated, bi-lobed cells

Question 36

What is the cure rate for Hodgkins lymphoma?

Answer 36

80%

Question 37

After treatment for Hodkins lymphoma, how many years does it take where there is no relapse until the risk of the cancer re-occuring is the same as normal?

Answer 37

5 years - at this point the patient is discharged from clinic.

Question 38

What is Ann arbour staging?

Answer 38

A way of staging Hodgkins and non-Hodgkins lymphoma by the spread of the cancer.

Question 39

What imaging is needed for Ann Arbour staging?

Answer 39

Contrast CT, ofter CT-PET is also used

Question 40

On imaging there are enlarged lymph nodes in the axillary and the inguinal nodes. They are shown to be non/Hodgkins lymphoma. What stage is this?

Answer 40

3 - lymphadenopathy is found both below and above the diaphragm

Question 41

What is neutropenic spesis?

Answer 41

Low neutrophil count resulting in sepsis. Often due to chemotherapy. Most commonly presents 10 days post chemotherapy.

Question 42

How is neutropenic sepsis diagnosed?

Answer 42

Antibiotics (as per local guilines) given within 1 hour

Question 43

What age is Hodgkins lymphoma most common at?

Answer 43

15-40 the +70 years

Question 44

What median age does non-Hodgkins occur?

Answer 44

median age of 55

Question 45

What are the features of T cell Non-hodgkins lymphoma?

Answer 45

Aggresive Responsive to treatment however poor prognosis and is considered incurable

Question 46

What are the features of B cell Non-hodgkins lymphoma

Answer 46

Common (95% of lymphoma) Good prognosis Can be treated with Rituximab

Question 47

What are the features of indolent B cell Non-hodgkins lymphoma?

Answer 47

incurable slow growing responds to treatmetn median survival of 10 years Follicular lympoma is the most common

Question 48

What are the features of aggressive B cell Non-hodgkins lymphoma?

Answer 48

Grows quicjkly symptomatic good prognosis examples: Birkitts and diffuse large B cell lymphoma

Question 49

What is Eccymosis?

Answer 49

Dyscolouration under the skin from bleeding \> 1 cm

Question 50

What is Pupura?

Answer 50

Discolouration under the skin due to blood which is \< 1 cm

Question 51

Differential for Eccchymosis and pupura

Answer 51

TTP HUS meningococcal septiceamia Haematological malignancies

Question 52

Anaemia + hypercalcaemia with persistant back pain should raise suspiscion for what?

Answer 52

muiltiple myeloma

Question 53

What is the most common lymphoma?

Answer 53

Diffuse B cell non-Hodgkins lymphoma?

Question 54

What is the 2nd most common lymphoma?

Answer 54

Follicular non-Hodgkins lymphoma is 2nd most common. It is incurable however responds well to treatement.

Question 55

What are side effect are there from haematological malignancies?

Answer 55

Infertility Heart failure arrythmias etc. 2nd malignancies Alopecia Neurtopenic sepsis

Question 56

A paitent undergoes a core biopsy where pressure cannot be appplied afterwards in case of bleeding. How many days sould clopidogrel/ aspirin be stopped for before carring out the investigation.

Answer 56

5 days

Question 57

A T2 DM undergoes a contrast CT. How much time does metformin need to eb stopped for before giving contrast?

Answer 57

48 hours Interaction can result in reduced renal function

Question 58

What viral causes for axillary + inguinal lymphadenopathy?

Answer 58

mononucleosis CMV HIV Hep B/C

Question 59

What can cause lymphadenopathy in the axillary and inguinal regions?

Answer 59

Mets infection - viral + bacterial Autoimmune Sarcoidosis Drug reactions

Question 60

What treatment should be done for lymphadenopathy in the axillary and inguinal lymph nodes?

Answer 60

Viral screen - exclude some infective causes Biopsy CT contrast + PET

Question 61

What is Rituximab?

Answer 61

CD20 antibodies immuno therapy For the treatment of non-Hodgkins B cell lymphoma and other autoimmuno causes. Targets B cells

Question 62

What is Bendamustine?

Answer 62

An alkylolytic agent give with Rituximab. Used for CLL, MM and non-Hodgkins lymphoma