8. Upper GI

Question 1

What is achalasia?

Answer 1

Failure of the LOS to relax as well as aperistalsis. Caused by degeneration of myenteric plexus.
Can be secondary to chagas disease (trypanosoma cruzi)

Question 2

How does achalasia present?

Answer 2

Dysphagia of both solids and liquids
Regurgitation due to trapped food
Gradual weight loss due to lack of food ingestion

Question 3

Investigations in achalasia?

Answer 3

Gold-standard - high-resolution oesophageal manometry to demonstrate relaxation
Other - upper GI endoscopy (often first line to rule out cancer) and barium swallow (birds beak appearance)

Question 4

What is GORD?

Answer 4

Complication or symptoms of gastric contents into the oesophagus.
Can be caused by a hernia, obesity, LOS hypotension, pregnancy etc.

Question 5

How does GORD present?

Answer 5

Heartburn, pain retrosternally
Acid regurg leaving bitter taste in mouth
Waterbrash (increase salivation)
Odynophagia if ulceration or oesophagitis
Chronic cough or nocturnal asthma.

Question 6

Investigations and treatment for GORD?

Answer 6

Resolution of symptoms after 8 weeks of PPI.

Treat with PPI and lifestyle modification, consider adding histamine blocker and antacids. Nissen fundoplication to increase LOS

Question 7

What is peptic ulcer disease?

Answer 7

A break in the lining of the stomach with obvious depth through the submucosa.

Question 8

Risk factors for PUD?

Answer 8

H.Pylori
NSAIDs
Smoking
Increased/decreased gastric emptying

Question 9

Zollinger-ellison syndrome?

Answer 9

Multiple gastric ulcers due to increase bicarbonate and acid levels from high gastrin. Associated with MEN.

Question 10

PUD presentation?

Answer 10

Epigastric pain directly after meals - duodenal is a few hours later.

Sometimes N&V and weight loss

Question 11

PUD investigations?

Answer 11

Gold - upper GI endoscopy (biopsy too)

H.Pylori tests
Serum fastin gastrin for zollinger ellison

Question 12

How to manage PUD?

Answer 12

Reduce smoking and alcohol intake.
If H.pylori then triple therapy of PPI and 2 abx
If not then stop drug causing ulcer and offer 4-8 weeks of PPI therapy.

Question 13

What is gastritis?

Answer 13

Inflammation of stomach mucosa, do all stuff for ulcers with same risk factors.

Question 14

What is a hiatus hernia?

Answer 14

A protrusion of abdo contents into thorax, usually stomach
Two types, sliding (mostly) and rarely rolling .

Risk factors are obesity and anything that increases intra-abdo pressure

Question 15

How do hiatus hernias present?

Answer 15

Often GORD, asymptomatic.
Maybe GORD is worse lying down.
Palpitations or hiccups.

Question 16

Investigations for hiatus hernia?

Answer 16

Gold - upper GI endoscopy

CXR isn’t as specific but is done.

Question 17

Treatment of hiatus hernia?

Answer 17

Weight loss and PPI to treat GORD.

Fundoplication can be surgical if unresolving.

Question 18

What is barrett’s?

Answer 18

Metaplasia of normal stratified squamous epithelium to columnar epithelium.
GORD biggest risk factor and presents with this.

Question 19

Investigations and treatment for barrett’s?

Answer 19

Upper GI endoscopy with biopsy is gold and first line.

Treatment -
Non-dysplastic/low grade dysplasia relies on PPI and surveillance
Radiofrequency ablation or endoscopic resection if dysplastic

Question 20

Oesophageal cancer types and risk factors?

Answer 20

Squamous is upper 2/3rd - alcohol, smoking, strictures, achalasia, nitrosamines
Adenocarcinoma is lower 1/3rd - GORD, barretts, obesity, achalasia

Question 21

Presentation of oesophageal cancer?

Answer 21

First solids and then liquid dysphagia
Rapid weight loss from lack of intake and cancer
Hoarseness if recurrent laryngeal pressed on (upper so squamous only)

Question 22

Investigations for oesophageal cancer?

Answer 22

CT/MRI for staging

Upper GI endoscopy with biopsy is gold

Question 23

What is gastric cancer?

Answer 23

Neoplasm of stomach, mainly adenocarcinoma.
Intestinal type - h.pylori associated
Diffuse - e-cadherin mutation associated

Pernicious anaemia, h.pyori, nitrosamines, smoking, high salt and low vit c and blood type a are risk factors

Question 24

How does gastric cancer present?

Answer 24

Epigastric pain
Weight loss
Lymphadenopathy!!! (remember this!!!)
Offer to do lymph exam when doing  abdo.
Causing virchow's node and sister mary joseph nodule.

Question 25

Gastric cancer investigation?

Answer 25

Upper GI endoscopy with biopsy to see signet ring cells.

MRI and CT for staging.
something else.

Question 26

What is a mallory-weiss tear?

Answer 26

Longitudinal laceration to mucosa and submucosa near GOS. Usually self-limiting and resolves spontaneously.

Risks - persistent coughing, retching, vomiting or straining (alcoholics and bulimics)

Question 27

How does mallory-weiss tear present?

Answer 27

Haematemesis is common
Lightheaded/dizziness
Postural hypotension
Malaena

Question 28

Mallory-weiss tear investigations?

Answer 28

Upper GI endoscopy to see tears (gold)
FBC for anaemia
Urea elevation may indicate GI bleed
CXR to rule out perforation

Question 29

How do we manage a mallory-weiss tear?

Answer 29

Usually self-resolves
Endoscopy inject adrenaline or band ligation
Give PPIs before endoscopy to stop re-bleed or give anti-emetics

Second line - sengstaken-blakemore tube.