Abdo/ GI

Question 1

GORD

Epidemiology

Answer 1

1in4 adults experience heartburn

Men > women

Question 2

GORD

Causes

Answer 2

Lifestyle: Alcohol, smoking, obesity, stress, coffee, chocolate
Organic: Increased abdo pressure (pregnancy)
Decreased gastric emptying
Inadequate cardiac sphincter (Nitrates, Ca channel blockers, tricyclics)

Question 3

GORD

Symptoms

Answer 3

Heartburn - worse after meals and lying down
Cough
Retrosternal discomfort
Bad breath
Tooth decay
Chest pain

Question 4

GORD

Investigations

Answer 4

Endoscopy
pH monitoring (see if acidic pH in oesophagus matches symptoms)
Barium swallow - Hiatus hernia

Question 5

GORD

Management

Answer 5

Lifestyle: Weight loss, upright bed, smoking cessation, smaller meals, less alcohol

PPI
H2 receptor antagonist for quick onset or persistent symptoms

Question 6

GORD

Red Flags

Answer 6

Late onset dyspepsia
Dyspepsia with jaundice, pernicious anaemia or mass
Weight loss, anaemia, vomiting

Question 7

Peptic Ulcer

Epidemiology

Answer 7

1in10 people get one in a lifetime
Men > women
More common in voer 60s
Duodenal ulcer more common than gastric

Question 8

Peptic ulcer

Causes

Answer 8

NSAIDs
H. pylori
Other: smoking, stress, alcohol, steroids, genetics

Question 9

Peptic ulcer

Risk Factors

Answer 9

Smoking
Stress
Alcohol
Genetics - type O blood

Question 10

Peptic ulcer

Symptoms

Answer 10

Gnawing epigastric pain, relieved by eating and can wake in night
Indigestion
Lack of appetite
Oral flatulence
Bloating

Question 11

Peptic Ulcer

Red flags

Answer 11

Melena
Haemetemesis
Coffee ground stool
Acute abdomen

Question 12

Peptic ulcer

ALARMS

Answer 12

Anaemia
Loss of weight
Anorexia
Recent symptoms
Melena/ haemetemesis
Swallowing difficulty

Question 13

Peptic ulcer

Investigations

Answer 13

Endoscopy if ALARMS
H. pylori test - urea breath or stool antigen
Biopsy if not NSAID or H. pylori

Question 14

Peptic ulcer

Management

Answer 14

H. pylori - PPI, Antibiotics (amoxicillin, clarythromycin, metronidazole) then test eradication
NSAID - Stop NSAID, PPI
Check bleeding with Rockall or Glasgow-Blatchford score
Stop smoking and taking NSAIDs

Question 15

Upper GI Bleed

Epidemiology

Answer 15

100/100,000 per year

10% mortality

Question 16

Upper GI bleed

Common causes

Answer 16

Peptic ulcer
Mallory-Weiss tear
Gastritis
Oesophageal varices
Malignancy
Oesophagitis

Question 17

Upper GI bleed

Rare causes

Answer 17

Pancreatic pseudocyst
Ehler’s Danlos
Haemobilia

Question 18

Upper GI bleed

Risk factors for rebleeding

Answer 18

Shock on admission
60+
Coagulopathy
Cardiovascular disease

Question 19

Upper GI Bleed

Symptoms

Answer 19

Melena
Coffee ground stool
Haemetemesis
(Fresh PR bleeding indicates massive bleed)
Dizziness

Question 20

Upper GI Bleed

Signs

Answer 20

Shock
Anaemic
Hypotensive
Dehydration

Question 21

What is Boerhaave’s syndrome?

Answer 21

Oesophageal tear due to vomiting

Question 22

Upper GI bleed

Investigations

Answer 22

Urea: creatinine ratio (30+ means increased risk)
CT - Pancreatitis, cholecystitis, liver disease
PR and abdo exam
Cross Match blood for transfusion

Question 23

Upper GI bleed

Management

Answer 23

Manage fluid loss
Varices - band
Non-variceal - mechanical/ thermal coagulation
O2 face mask