GI

Question 1

Gastric cancer
Rf, sx, ix, mx

Answer 1

Rf:
- smoking
- pernicious anaemia
- h.pylori
- >6 units alcohol
- dietary nitrosamines
- atrophic gastritis
- blood group a
- adenomatous polyps
- achlorhydria

Sx:
• Anaemia (iron deficient)
• Weight loss
• Anorexia (early satiety)
• Recent onset/progression of symptoms
• Melaena/haematemesis
• Swallowing difficulty (dysphagia)
• Lymphadenopathy - may suggest early spread
• Left supraclavicular lymph node (Virchow’s node)
• Periumbilical nodule (Sister Mary Joseph’s node)

Ix:
- endoscopy
- biopsy
- CT
- MRI

Mx:
- gastrectomy
- chemo

Question 2

Hiatus hernia
Def, types, sx, ix, mx

Answer 2

Abdominal contents protrude through an enlarged oesophageal hiatus in the diaphragm

Sx:
- heartburn
- dysphagia
- regurgitation
- odynophagia
- SOB
- chronic cough
- chest pain

Ix:
- barium swallow
- endoscopy
- oesophageal manometry

Mx:
- weight loss
- elevate bed head
- avoid large meals 3-4 hours before bed
- avoid alcohol and acidic foods
- smoking cessations
- PPIs
- Nissens fundoplication

Question 3

Gallstone disease
Causes, types, rf, sx, ix, mx

Answer 3

Causes:
- super saturation of bile with cholesterol
- gallbladder dysmotility leading to stasis
- excessive bilirubin excretion

Types:
- pigment (haemolysis, stasis and infection)
- cholesterol (female, age and obesity)
- mixed

Risk factors:
- 4Fs: female, fat, 40 and fertile
- diabetes
- FHx
- crohns
- bariatric surgery
- sickle cell anaemia

Sx:
• Biliary colic: Colicky right upper quadrant pain, worse after eating, no fever, negative Murphy’s sign.
• Acute cholecystitis: Right upper quadrant/epigastric pain (radiating to right shoulder tip if the diaphragm is irritated), fever, nausea and vomiting, right upper quadrant tenderness, positive Murphy’s sign.
• Ascending cholangitis: Right upper quadrant pain, fever, jaundice, hypotension, and confusion if sepsis is severe.
• Mirizzi’s syndrome: Chronic right upper quadrant pain, intermittent jaundice due to extrinsic compression of the common hepatic duct by an impacted stone in the cystic duct or gallbladder neck.
• Chronic cholecystitis: Flatulent dyspepsia, vague abdominal pain, nausea, bloating, symptoms worsening after a fatty meal, occasional colicky pain.
• Gallstone ileus: Signs of small bowel obstruction due to gallstone migration.
• Cholangiocarcinoma: Abdominal pain, jaundice, anorexia, weight loss, possible right upper quadrant mass.

Ix:
- bloods (LFTs, CRP
- US as first line imaging
- CT (better for stones)
- MRCP
- ERCP

Mx:
- IV fluids, antibiotics and critical care
- biliary drainage via ERCP
- cholecystectomy