Disorders of the upper GI tract

Question 1

What investigations would you immediately do if someone presents acutely unwell with abdominal pain?

Answer 1

Chest XRay,
Abdominal CT/XR,
pH assessment,
bloods (LFT, renal etc.)

Question 2

What lifestyle factors can decrease pH in the body?

Answer 2

NSAIDs,
smoking,
alcohol

Question 3

Why would you not do manometry straight away?

Answer 3

Long waiting lists NHS

Question 4

How would you see signs of a perforation in a CXR?

Answer 4

Subdiaphragmatic air

Question 5

Which area of the body is most at risk of perforation?

Answer 5

Duodenum

Question 6

How would you initially manage a patient with perforation?

Answer 6

PPI,
Nil by Mouth,
IV Fluids,
Broad range antibiotics (amoxicillin, clarithromycin, pantoprazole)

Question 7

How do you surgically correct a perforation?

Answer 7

Drain abdomen, keyhole repair (suturing + laparoscopic omental patch - from omentum)

Question 8

When would you be certain of a diagnosis of pancreatitis?

Answer 8

When amylase is greater than 3x the limit

Question 9

What is the normal range of amylase?

Answer 9

40-140 ish

Question 10

How do you manage pancreatitis?

Answer 10

IV fluid, antibiotics, low fat diet, analgesia

Question 11

What is the first investigation for pancreatitis?

Answer 11

Ultrasound Scan
Testing for gallstones

Question 12

How can you usually tell the presence of gall stones in initial investigations?

Answer 12

Abnormal liver function tests (particularly bilirubin)

Question 13

What would be the next investigation after USS?

Answer 13

MRCP - Magnetic Resonance Cholangiopancreography
uses powerful magnetic field to image the abdominal organs

Question 14

Why would you not do an ERCP in this stage?

Answer 14

ERCP is invasive and has risk of complications (including making pancreatitis worse, perforations, mortality)

Question 15

What is ERCP

Answer 15

Endoscopic retrograde cholangiopancreatography
combines endoscopy and x rays to image biliary and pancreatic duct