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MBChB Finals > Gastroenterology: Upper GI > Flashcards

Gastroenterology: Upper GI Flashcards

1
Q

What 4 conditions present with a progressive dysphagia?

A

Oesophageal cancer (adenocarcinoma and SCC)
Achlasia
Pharyngeal pouch
Bulbar palsy

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2
Q

What is the main risk factor present in adenocarcinoma but not SCC

A

GORD/Barrett’s

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3
Q

What is the significance of a left supraclavicular node with regards to GI conditions

A

Virchow’s node: Suggests an intra-abdominal malignancy

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4
Q

How does adeno and Squamous carcinoma differ in their location in oesophageal cancer?

A

Adeno: Lower 1/3

Squamous: Upper 2/3

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5
Q

What is the first line investigation for suspected oesophageal malignancy?

A

1st line: Upper endoscopy

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6
Q

What is the treatment for oesophageal cancer?

A

Resection + adjuvant chemo if operable
Palliative chemoradiotherapy if not

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7
Q

What are the 2 conditions that present with non-progressive dysphagia

A

Benign stricture
Benign oesophageal spasm

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8
Q

How does a benign stricture present differently to oesophageal carcinoma?

A

Non-progressive

Longer standing GORD symptoms

No systemic symptoms

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9
Q

How does achalasia differ from oesophageal cancer given the fact they all have progressive dysphagia?

A

Achalasia can present with regurgitation of food rather than vomiting

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10
Q

How is achalasia treated?

A

Endoscopic balloon dilatation/Heller’s cardiotomy

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11
Q

How can the dysphagia in benign oesophageal spasm be distinguished from malignancy?

A

Tends to be episodic and non-progressive

Solids and liquids (motor issue instead of mechanical)

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12
Q

What investigation can confirm benign oesophageal spasm?

A

Contrast swallow/manometry will reveal abnormal contractions

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13
Q

How can a pharyngeal pouch be distinguished from other casues of dysphagia?

A

Regurgitation of food

Aspiration

Neck swelling that gurgles on palpation

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14
Q

How do you treat a pharyngeal pouch?

A

Surgical resection

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15
Q

What are the ALARMS symptoms in dyspepsia?

A

Anaemia

Loss of weight

Anorexia

Recent history of progressive symptoms

Masses

Swallowing difficulties

(or Vomiting, Bleeding/Anaemia, Anorexia/loss of weight, Dysphagia)

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16
Q

What are the indications for UGI endoscopy in dyspepsia?

A

All with dysphagia

All with suspected malignancy

>55 years with ALARMS symptoms

17
Q

What is the treatment pathway for a patient with GORD?

A

1 month trial high dose PPI

If response: commence low dose longer term

No response + Endoscopy +ve: double dose 1 month

No response + ES -ve: Trial H2RA or prokinetic

18
Q

What is the management of suspected peptic ulcer disease?

A

UGI endoscopy if dysphagia/>55 with ALARM symptoms

Lifestyle changes with OTC antacids for 1 month

Test for H.Pylori

+ve test: Commence PPI + Amoxicillin + metronidazole/clarithromycin

-ve test or eradicated: PPIs/H2RA for 1 month

If no improvement: low dose PPI 1 month and consider endoscopy

19
Q

If oesophageal endoscopy finds goblet cells and brush border in the columnar epithelium, what does this indicate?

A

Barrett’s Oesophagus

20
Q

How is barrett’s oesophagus managed?

A

Metaplastic: Surveillance every 3-5 years

Dysplastic: Resect/ablate

21
Q

How can you determine if a peptic ulcer is gastric or duodenal?

A

Duodenal: RELIEVED on eating

Gastric: WORSENED on eating

22
Q

Which two groups of people is gastric cancer more common in?

A

Over 75s

Males

23
Q

What are the features of gastric cancer?

A

Epigastric pain, vague

Weight loss and anorexia

Dysphagia

Nodes: Left supraclavicular (Virchow’s) and periumbilical (Sister Mary Joseph)

24
Q

What are the risk factors for developing gastric cancer?

A

think SHADO

Smoking

H. Pylori

Atrophic gastritis

Diet high in salt and nitrates (smoked food)

O blood group

25
Q

What 2 investigations confirm a diagnosis of gastric cancer?

A

Endoscopy with biopsy: signet ring cells (more rings = worse prognosis)

CT for staging

26
Q

How is gastric cancer managed?

A

Surgical resection or gastrectomy

Chemotherapy

27
Q

What are the 5 physical complications of a gastrectomy?

A

Abdominal fullness: Improves with time, consume small regular meals

Afferent loop syndrome: bilious vomiting after a meal, should improve with time

Diarrhoea: Give codeine phosphate

Gastric tumour: reduces acid production

Increased amylase: urgent surgery if abdo pain also present

28
Q

What are the 5 metabolic complications from a gastrectomy?

A

Dumping syndrome: Fainting and sweating from highly osmolar foods being dumped in the jejunum, causing hypovolaemia. Late dumping due to hypoglycaemia 1-3 hours after a meal

  • Eat less, consume guar gum + pectin

Weight loss: Often due to poor calorie intake

Bacterial overgrowth +/- malabsorption

Anaemia

Osteomalacia

29
Q

What are the 3 typical features of an upper GI bleed?

A

Vomiting fresh/’coffee ground’ blood

Melaena

Abdominal tenderness

30
Q

Outline the management of an upper GI bleed

A

Resuscitate via ABCDE

If variceal: Terlipressin + Prophylactic IV broad spec antibiotics

Endoscopy to investigate and treat

  • Immediate if severe bleed
  • Otherwise within 24 hours

Give PPIs post-endoscopy if needed

31
Q

How can you tell the difference between oesophageal varices and Mallory weiss tear?

A

Malaena: More common in OVs

Prior vomiting: More common in MW tears

32
Q

What 3 historical features are typical in an oesophageal varices patient?

A

Previous ulcers

Liver cirrhosis

Heavy alcohol use

33
Q

What artery may be at risk of rupture in a duodenal ulcer

A

Gastroduodenal artery

34
Q

A patient presents with haematemesis. They appear to have pigmented lesions on the face, lips, palms and soles. they mention a history of consitpation due to ‘blocked bowels’. What diagnosis do you have to bear in mind?

A

Peutz-Jegher’s syndrome

AD mutation of LKB1/STK1

Bleeding prone polyps in GI tract

Pigmented lesions on face, palms and soles

Conservative management

35
Q

What AV malformation causes UGI bleeding without prior symptoms?

A

Dieulafoy lesion

36
Q
A

MBChB Finals (31 decks)

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