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General - Upper GI Flashcards

1
Q

What is Barrett’s oesophagus?

A

Metaplastic columnar epithelium replacement of the squamous epithelium in the oesophagus.

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2
Q

What is the most common cause of Barrett’s oesophagus?

A

Chronic GORD

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3
Q

Which area of the oesophagus is most commonly affected in Barrett’s oesophagus?

A

Distal oesophagus

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4
Q

Risk factors for Barrett’s oesophagus?

A

Caucasian ethnicity
Male gender
>50yrs
Smoking
Obesity
Hiatus hernia

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5
Q

What investigation is diagnostic for Barrett’s oesophagus?

A

Upper GI endoscopy with biopsy

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6
Q

Management for Barrett’s oesophagus?

A

PPI
Stop NSAIDs
Reduce alcohol intake
Weight loss
Regular surveillance endoscopy

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7
Q

What cancer are people with Barrett’s oesophagus at risk of?

A

Adenocarcinoma of the oesophagus

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8
Q

How often would a patient with Barrett’s oesophagus with no evidence of dysplasia require endoscopy?

A

Every 2-5 years

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9
Q

How often would a patient with Barrett’s oesophagus with low grade dysplasia require endoscopy?

A

Every 6 months

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10
Q

How often would a patient with Barrett’s oesophagus with high grade dysplasia require endoscopy?

A

Every 3 months

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11
Q

How should high grade dysplasia in Barrett’s oesophagus be managed?

A

Endoscopic mucosal resection
Endoscopic submucosal resection

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12
Q

What are the 2 main types of oesophageal cancer?

A

Adenocarcinoma
Squamous cell carcinoma

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13
Q

Which subtype of oesophageal cancer is more common in the developing world?

A

Squamous cell carcinoma

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14
Q

Which subtype of oesophageal cancer is more common in the developed world?

A

Adenocarcinoma

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15
Q

Which areas of the oesophagus does squamous cell carcinoma usually occur?

A

Middle and upper thirds of the oesophagus

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16
Q

Which area of the oesophagus does adenocarcinoma usually occur?

A

Lower third of the oesophagus

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17
Q

What are the risk factors for squamous cell carcinoma of the oesophagus?

A

Smoking
Excessive alcohol consumption
Chronic achalasia
Low vitamin A

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18
Q

What are the risk factors for adenocarcinoma of the oesophagus?

A

Barrett’s oesophagus
GORD
Obesity
High fat intake

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19
Q

What are the presenting features of oesophageal cancer?

A

Dysphagia
Weight loss
Odynophagia
Hoarseness
Supraclavicular lymphadenopathy

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20
Q

What are the red flag criteria for upper GI endoscopy for suspected oesophageal malignancy?

A

Any patient with dysphagia
Any patient >55yrs with weight loss and upper abdo pain, dyspepsia or reflux

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21
Q

How would you investigate suspected oesophageal cancer?

A

Urgent upper GI endoscopy +/- biopsy
CT CAP
Endoscopic US
Staging laparoscopy

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22
Q

Curative management of oesophageal cancer?

A

Chemo-radiotherapy
Oesophageal resection (adenocarcinoma)

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23
Q

Palliative management of oesophageal cancer?

A

Oesophageal stent
Chemotherapy
Radiotherapy
Thickened fluid/nutritional supplements
Gastrostomy

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24
Q

What is achalasia?

A

Failure of relaxation of the lower oesophageal sphincter and the absence of peristalsis along the oesophageal body

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25
Clinical features of achalasia?
Progressive dysphagia Regurgitation of food Chest pain Dyspepsia Weight loss
26
What is the gold standard investigation for oesophageal motility disorders?
Oesophageal manometry
27
Management of achalasia?
Sleeping with multiple pillows Advice to eat slowly Take plenty of fluids with meals CCBs (Nifedipine) Botox injections to lower oesophageal sphincter Laparoscopic Heller Myotomy Per Oral Endoscopic Myotomy Endoscopic balloon dilatation
28
Clinical features of diffuse oesophageal spasm?
Severe dysphagia Central chest pain, exacerbated by food Pain responsive to nitrates
29
Management of diffuse oesophageal spasm?
CCBs Pneumatic dilatation Heller myotomy
30
What are the main two subtypes of oesophageal tear?
Mallory-Weiss tear Full thickness ruptures
31
What is another name for spontaneous full thickness rupture of the oesophagus?
Boerhaave's syndrome
32
What is the most common cause of Boerhaave's syndrome?
Severe forceful vomiting
33
What are the clinical features of Boerhaave's syndrome?
Severe, sudden-onset retrosternal chest pain Respiratory distress Subcutaneous emphysema
34
How do you investigate Boerhaave's syndrome?
Routine bloods (incl. group and save) CT CAP with IV and oral contrast
35
What are the management principles for Boerhaave's syndrome?
Control oesophageal leak Eradication of mediastinal and pleural contamination Decompress the oesophagus (NG tube) Nutritional support
36
Presenting features of Mallory-Weiss tears?
Short periods of haematemesis
37
Management of Mallory-Weiss tears?
Usually conservative as self-limiting
38
What is a hiatus hernia?
Protrusion of an organ (usually stomach) from the abdominal cavity into the thorax through the oesophageal hiatus.
39
What are the 2 subtypes of hiatus hernia?
Sliding and Para-oesophageal (rolling)
40
What is a sliding hiatus hernia?
The gastro-oesophageal junction, abdominal section of the oesophagus & cardia of the stomach slide upwards through the diaphragmatic hiatus into the thorax
41
What is a para-oesophageal (rolling) hernia?
Gastric fundus moves up whilst the gastro-oesophageal junction remains normally placed. Creates a stomach 'bubble' in the thorax.
42
Risk factors for developing a hiatus hernia?
Increasing age Pregnancy Obesity Ascites
43
Clinical features of hiatus hernia?
Usually asymptomatic Burning epigastric pain, worse on lying Vomiting Weight loss Hiccups
44
What is the gold standard investigation for hiatus hernia?
Oesophagogastroduodenoscopy
45
Management of hiatus hernia?
PPI (omeprazole) Weight loss Smaller meals Smoking cessation Reduce alcohol intake Cruroplasty Fundoplication
46
What are the indications for surgical management of a hiatus hernia?
Remaining symptomatic despite maximal medical therapy Increased risk of strangulation/volvulus Nutritional failure
47
Potential complications of hiatus hernia?
Incarceration Strangulation Gastric volvulus
48
What is Borchardt's triad of gastric volvulus?
Severe epigastric pain Retching without vomiting Inability to pass NG tube
49
What is the most common location of a gastric ulcer?
Lesser curvature of the stomach
50
Risk factors for developing peptic ulcers?
H. pylori infection Prolonged NSAID use Previous gastric bypass surgery Physiological stress Zollinger-Ellison syndrome
51
Clinical features of peptic ulcer disease?
Often asymptomatic Epigastric/retrosternal pain Nausea Bloating Post-prandial discomfort
52
Differentials of peptic ulcer disease?
Acute coronary syndrome GORD Gallstone disease Gastric malignancy Pancreatitis
53
What is Zollinger-Ellison syndrome
Severe peptic ulcer disease Gastric acid hypersecretion Gastrinoma
54
What disorder is associated with Zollinger-Ellison syndrome?
Multiple endocrine neoplasia type 1
55
How would you investigate peptic ulcer disease?
H. pylori testing (carbon 13 urea breath test) OGD Ulcer biopsy
56
Management of peptic ulcer disease?
Smoking cessation Weight loss Reduced alcohol consumption PPI for 4-8 weeks H. pylori eradication (PPI + amoxicillin/clarithromycin/metronidazole)
57
Potential complications of peptic ulcer disease?
Perforation Haemorrhage Pyloric stenosis
58
What is the most common subtype of gastric cancer?
Adenocarcinoma
59
Risk factors for gastric cancer?
Male gender Far Eastern ethnicity H. pylori infection Increasing age Smoking Alcohol consumption High salt diet
60
Clinical features of gastric cancer?
Dyspepsia Dysphagia Early satiety Vomiting Melena
61
Examination findings of a patient with gastric cancer?
Epigastric mass Troisier sign (palpable left supraclavicular node)
62
How would you investigate suspected gastric cancer?
Upper GI endoscopy Biopsy for histology, CLO testing CT CAP Staging laparoscopy
63
Management of gastric cancer?
MDT involvement Nutrition status assessment Peri-operative chemotherapy Total gastrectomy (proximal cancers) Subtotal gastrectomy (Distal cancers) Endoscopic mucosal resection (T1a) Stenting
64
Potential complications of gastric cancer?
Gastric outlet obstruction Iron deficiency anaemia Perforation Anaemia

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