Gastro

Question 1

Mallory Weiss tear def/pres/treatment

Answer 1

• Haematemesis from tear in oesophageal mucosa
• Haematemesis, melaena (black tarry stools from upper GI bleeding), symptoms of hypovolaemia shock
• TERLIPRESSIN + urgent endoscopy
• Rockall score + inpatient observation
• Banding/clipping, adrenaline, thermocoag

Question 2

Oesophageal varices diagnosis/treatment

Answer 2

• Urgent endoscopy
• FBC
• CXR
• Bleeding varices - terlipressin + prophylactic antibiotics (ciprofloxacin), balloon tamponade, banding
• Bleed prevention - B-blockers, endoscopic banding

Question 3

Barrett’s oesophagus def/diagnosis/treatment

Answer 3

• Metaplasia of lower oesophageal mucosa (stratified squamous to columnar epithelium with goblet cells)
• Oesophago-gastro-duodenoscopy (OGD) + biopsy
• Endoscopic surveillance with biopsies
• High dose PPI

Question 4

Oesophageal cancer investigation/treatment

Answer 4

• Upper GI endoscopy + biopsy
• CT scan or endoscopic ultrasound for staging
• Operable disease - surgical resection + adjuvant chemo
• Palliation - relief of symptoms

Question 5

Gastro-oesophageal reflux disease (GORD) def/investigation/treatment

Answer 5

• Lower oesophageal sphincter leading to reflux of gastric contents to symptoms of oesphagitis
• Endoscopy
• Conservative - smoking, alcohol, diet, sleeping position
• Medical - PPI - OMEPRAZOLE, H2 receptor agonist
• Surgical - Nissen fundoplication - creates sphincter at bottom of oesophagus

Question 6

Peptic ulcer causes/investigation/management

Answer 6

• H.pylori, NSAIDs, ZE syndrome
• H.pylori test (urease breath test)
• Endoscopy
• Treat cause - stop NSAIDs, and/or eradicate H.pylori - PPI, clarithromycin, amoxicillin

Question 7

Gastric vs duodenal ulcers

Answer 7

Both epigastric pain

• Gastric worse on eating relieved by antacids - weight loss
• Duodenal before meals and at night relieved by eating or milk - weight gain

Question 8

Diverticulitis pres/investigation/management

Answer 8

• Left iliac fossa pain with tenderness
• Palpable LIF mass
• Constipation
• Bloods - raised WCC, ESR & CRP
• Imaging - erect CXR, AXR (abdo xray) and CT
• Oral/IV antibiotics - CIPROFLOXACIN, METRONIDAZOLE

Question 9

Diverticular disease pres/investigation/treatment

Answer 9

• Altered bowel habit, abdo pain, BLEEDING per rectum
• CT (acute)
• Colonoscopy
• High fibre diet and fluids
• Surgery

Question 10

Gastric cancer presentation/investigation

Answer 10

• Often late presentation
• Anorexia, nausea, weight loss, anaemia, dysphagia, vomiting
• Epigastric pain - better with antacids
• Gastroscopy - 8-10 biopsies
• Endoscopic US for depth of invasion
• CT/MRI/PET

Question 11

Colon cancer diagnosis

Answer 11

• FAECAL OCCULT BLOOD TEST
• Colonoscopy + biopsy
• Flexible sigmoidoscopy/barium enema/CT colonoscopy