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General Surgery > GI conditions > Flashcards

GI conditions Flashcards

1
Q

What is the most common upper gastrointestinal disorder in the Western World?

A

Gastro Oesophageal Reflux Disease (GERD) is the most common upper gastrointestinal disorder in the Western World.

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2
Q

What are some associated factors with GERD?

A

It is associated with hiatus hernia in 80% of cases, as well as factors like incompetent lower oesophageal sphincter (LOS), increasing age, male gender, and obesity.

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3
Q

What are the typical symptoms of GERD? Can it have atypical presentations?

A

Typical symptoms include heartburn, regurgitation, and dysphagia. Atypical presentations can include cough, wheezing, and chest pain.

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4
Q

What is the gold standard for diagnosing GERD?

A

Ambulatory pH monitoring, which measures the episodes and duration of pH<4 in the distal oesophagus, is the gold standard for diagnosing GERD.

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5
Q

What is Barrett’s Oesophagus, and why is it significant?

A

Barrett’s Oesophagus is a premalignant condition characterized by columnar metaplasia in the oesophagus. It requires endoscopic surveillance due to its potential to progress to oesophageal cancer.

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6
Q

What are the three main approaches for managing GERD, and in what circumstances is surgery like Nissen fundoplication indicated?

A

1) lifestyle changes
2) Medications: PPI (omeprazole), H2 antagonists (cimetidine), antacids (calcium carbonate)
3) Surgery - if above doesnt work, and can help Barrett’s oesophagus

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7
Q

What are the common causes of peptic ulcers?

A

Peptic ulcers can result from the corrosive action of acid gastric juice on vulnerable epithelium. Common causes include H. pylori infection, NSAID use, smoking, and rare cases of acid hypersecretion (Zollinger-Ellison syndrome).

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8
Q

What is the cardinal symptom of peptic ulcer disease?

A

epigastric pain.

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9
Q

How does pain presentation differ between duodenal and gastric ulcers?

A

In duodenal ulcers, pain typically occurs between meals and is relieved by food. In gastric ulcers, pain worsens after meals.

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10
Q

What are the potential complications of peptic ulcer disease?

A

Complications include bleeding, perforation, stenosis causing gastric outlet obstruction, and rare fistulation.

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11
Q

What lifestyle factors should be avoided in peptic ulcer disease management?

A

Patients should avoid smoking, alcohol, and other irritants. e.g. spicy food

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12
Q

What is the recommended medical treatment for peptic ulcer disease?

A
  • Acid suppression therapy with proton pump inhibitors (e.g., omeprazole)
  • H. pylori eradication (using a combination of antibiotics like amoxycillin, clarithromycin, and omeprazole)
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13
Q

In what situations might surgery be considered for peptic ulcer disease?

A

Surgery may be considered if medical therapy is not effective, or in emergency situations such as uncontrolled bleeding or perforation.

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14
Q

What is the prevalence of gallstones in females aged 70 and over?

A

> 30%, fat female fifty fair

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15
Q

What are the two main types of gallstones and their respective percentages?

A

Cholesterol stones make up 80% of gallstones, while pigment stones make up 20%.

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16
Q

CHOLELITHIASIS

A

presence of gallstones in the gallbladder.

Usually asymptomatic

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17
Q

What will labs reveal in cholelithiasis?

A

WBC, LFTs and lipase all normal

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18
Q

What is ‘biliary colic’?

A

Transient pain, caused by a transient impaction of gallstone in the cystic duct

NON-INFECTIOUS

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19
Q

Describe the clinical presentation of biliary pain.

A

Biliary pain is a constant, poorly localized visceral pain in the upper abdomen, can radiate to back, R) shoulder, scapula.

Can induce vomiting/nausea.

It is exacerbated by fatty food.
Can last several hours.

20
Q

Management of acute biliary colic?

A

1x without systemic symptoms/peritonism –> analgesia, antiemetics

Recurrent –> elective laparoscopic cholecystectomy

21
Q

What complications can occur depending on where a gallstone lodges in the biliary tree?

A

Depending on the location, complications can include more localized right upper quadrant (RUQ) pain and tenderness, systemic signs of inflammation (fever, increased white blood cells) - CHOLECYSTITIS, obstructive jaundice, ascending cholangitis, and/or pancreatitis.

22
Q

CHOLECYSTITIS

A

inflammation of the gallbladder due to sustained impaction of a gallstone in cystic duct or Hartmann’s pouch

Compared to biliary colic - transient impacting

Cholelithiasis - just in the gall bladder

23
Q

CHOLEDOCHOLITHIASIS

A

presence of gallstone in common bile duct

24
Q

CHOLANGITIS

A

blocked common bile duct –> biliary stasis, infection, sepsis

25
Q

How is acute cholecystitis treated?

A

Acute cholecystitis is treated with analgesia, anti-emetics, IV antibiotics. If it is early in the course, cholecystectomy may be performed.

26
Q

How are gallstones in the common bile duct typically extracted?

A

ERCP

27
Q

What is the main enzyme responsible for inflammation in pancreatitis?

A

Trypsinogen is activated to trypsin, leading to inflammation of the pancreas.

28
Q

What are the three main causes of pancreatitis?

A

1) gallstones
2) alcohol
3) other: trauma, obstruction, drugs, infection

29
Q

Describe the clinical presentation of acute pancreatitis.

A

Acute pancreatitis may range from mild to severe. It is characterized by rapid onset epigastric pain radiating to the middle of the back, and may include vomiting. History of alcohol consumption and gallstones is particularly important. Epigastric tenderness and signs of peritonism may be present in severe cases.

30
Q

How is acute pancreatitis diagnosed through laboratory tests?

A

Raised serum amylase is diagnostic, but it has a short half-life. For symptoms of longer duration, serum lipase increases sensitivity for diagnosis.

31
Q

What is the initial management approach for pancreatitis?

A

Initial management of pancreatitis is supportive. Severe cases may require large volumes of IV fluid replacement and cardiovascular support. Enteral feeding is beneficial. There is no role for antibiotics in uncomplicated pancreatitis.

32
Q

What complications can arise from pancreatitis that may require surgical management?

A

Complications of pancreatitis can include necrosis, infection, pseudocysts, gut ischemia, or pseudoaneurysms, which may necessitate surgical intervention.

33
Q

How should the underlying cause of pancreatitis be addressed?

A

The cause of pancreatitis should be addressed. For gallstones in the common bile duct, ERCP is performed followed by cholecystectomy once pancreatic inflammation has settled. Patients are advised to avoid alcohol, and drugs are carefully reviewed and withheld if possible.

34
Q

What are the major upper gastrointestinal (GI) malignancies that upper GI surgeons encounter?

A

The major upper GI malignancies include oesophageal, gastric, liver, biliary tree, and pancreatic cancers.

35
Q

What are the two main types of oesophageal cancer, and what are their risk factors?

A

Oesophageal cancer can be squamous cell carcinoma (top 2/3) or adenocarcinoma (bottom 1/3).

Risk factors for squamous cell carcinoma include smoking, and alcohol, HPV, poor diet, nitrates, fungi

Adenocarcinoma is associated with Barrett’s oesophagus (though note it is uncommon) and is increasing in Western countries. M:F 7:1.

36
Q

What is the common clinical presentation of oesophageal cancer?

A

Oesophageal cancer often presents with dysphagia, weight loss, regurgitation of food and saliva, hoarse voice, and foul breath. Anemia, especially unexplained iron-deficiency anemia, may also occur.

37
Q

How is oesophageal cancer treated, both curatively and palliatively?

A

Curative treatment includes neoadjuvant chemoradiotherapy followed by oesophagectomy or oesophagogastrectomy.

Palliative treatment may involve radiotherapy or endoscopic stenting.

38
Q

What is the main type of gastric cancer, and what are its risk factors?

A

Gastric cancer is predominantly adenocarcinoma. Risk factors include dietary nitrates, Helicobacter pylori infection, and certain genetic syndromes.

FAP, E-cadherin gene, Lynch syndrome

39
Q

What are the clinical presentations of gastric cancer?

A

Gastric cancer may present with anorexia, weight loss, dysphagia, nausea, vomiting, and even hematemesis. Unexplained iron-deficiency anemia can also be a sign.

40
Q

How is gastric cancer treated, both curatively and palliatively?

A

Curative treatment involves neoadjuvant chemotherapy followed by gastrectomy. Palliative treatment options include radiotherapy, stenting, or bypass of the tumor.

41
Q

What are the risk factors and clinical presentation of pancreatic cancer?

A

Risk factors for pancreatic cancer include smoking, family history, and genetic syndromes.

Clinical presentation includes central abdominal pain, weight loss, and obstructive jaundice.

42
Q

How is pancreatic cancer treated, both curatively and palliatively?

A

Curative treatment involves pancreaticoduodenectomy (Whipple’s resection).

Palliative treatment includes ERCP and stenting to relieve obstructive jaundice and associated symptoms.

43
Q

Name a drug which can cause pancreatitis

A

Mesalazine

44
Q

main risk factor for cholangiocarcinoma

A

Primary sclerosing cholangitis

45
Q

A 2% strength liquid medicine means that…

A

2g of the drug are dissolved in 100ml

46
Q
A

General Surgery (7 decks)

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