Gastro - Foregut Flashcards
Dysphagia factors concerning for malignancy?
Older patient
Solids > liquids
Constant/ progressive
Alarm Sx
Shorter duration
Appearance of eosinophilic oesophagi’s on G’scope?
longitudinal furrows
Basic pathophys of achelasia
myenteric plexus inflammation
Presumed viral infection sets of auto-immune process
Therapeutic options for achelasia?
CCBs
PerOral-Endoscopic Myotomy (POEM)
Oesophagectomy
Baloon dilatation
Botox
ISDN
Surgical myotomy
Presentation of eosinophilic oesophagitis
Dysphagia (solids > liquids)
Young patients
GORD unresponsive to PPIs
Food boluses
Treatments for eosinophilic oesopagitis
PPIs
Topical steroids (swallowed fluticasone/ viscous budesonide)
Elimination diet/ elemental diet
Dilatation
Food most commonly -> eosinophilic oesophagitis
gluten, milk (50%)
soy, egg, nut, seafood
Treatment options to prevent Barret’s oesophagus -> adenocarinoma
PPI
PPI + aspirin
Surgery (no better than the above)
Treatment for Low Grade Dysplasia (LGD) Barrett’s oesophagus
If there for 6 months radio frequency abalation
Treatment for High Grade Dysplasia (HGD) Barrett’s oesophagus
Oesophagectomy vs endoscopic resection
Then radiofrequence ablation to the rest of the Barret’s oesophagus
Benefit of PPI prior to G’scope in UGIB
may decrease need for intervention
No real evidence of mortality benefit/ need for surgery etc
Benefit of PPI after G’scope in UGIB
Improved mortality, rebreeding, surgery etc (quite good)
(IV and PO somewhat similar)
Treatment for H. Pylori
In absence of local Abe resistance quadruple therapy (amoxicillin, clarithro, PPI, metro) for 14 days
Post H. Pylori eradication testing
test everyone - 4 weeks after completion of therapy
- urease breath test
OR
- fecal antigen test
(Hold PPI 14 days before)
Anti-platelets in high risk (for MI) GI bleeding patients
COntinue aspirin, hold clopidogrel, re-start clopidogrel once bleeding controlled
