GI conditions: gastric/ oesophageal Flashcards
Differentials for
- difficulty swallowing solids vs
- difficulty swallowing both solids and liquids
Difficulty with solids only: strictures
Difficulty with both: achalasia (LES not relaxing)/ neuro problem eg Myasthenia Gravis
How long must someone be off PPIs before undergoing an H Pylori test
2 weeks
What would make you suspect an oesophageal stricture is malignant
Abrupt,
Asymmetrical,
Irregular nodular mucosa
(benign would taper smoothly)
2ww criteria for upper GI cancer
- Dysphagia
- Upper abdo mass consistent with cancer
- > 55 + weight loss + dyspepsia/ reflux/ upper abdo pain
What test is used to check if H pylori eradication therapy worked
Urea breath test
What type of oesophageal cancer is associated with
- Barrett’s oesophagus
- Achalasia
- Barrett’s oesophagus: adenocarcinoma
- Achalasia: squamous cell cancer
What is the best long term feeding option for someone with an unsafe swallow
PEG tube
Likely cause of odynophagia in immunocompromised patient (HIV/ Hep C) with diarrhoea and weight loss
Oesophageal candidiasis
Risk factors for oesophageal strictures
Hiatus hernia
Management of oesophageal strictures (benign, malignant, palliative)
Oesophageal strictures
Benign: balloon dilation
Malignant: treat underlying cause
Palliative: stent, internal radiation
Imaging/ special test investigations (and findings) for achalasia
Which one is diagnostic
(DIAGNOSTIC) Manometry: failures of LES relaxation
Barium swallow: birds beak oesophageal (dilation then tapering)
Biopsy: absent nerve cells in myenteric plexus
Medical/ interventional/ surgical treatment of achalasia
Medical: CCB, GTN (reduce LES pressure)
Botox: paralyse muscles than hold LES shut
Balloon dilation
Surgery: Hellers cardiomyotomy
Risk factors for oesophageal cancer: squamous cell cancer vs adenocarcinoma
OESOPHAGEAL CANCER
squamous cell cancer: achalasia
adenocarcinoma: GORD, Barret’ts
Management of pharyngeal pouch
Only fixed by surgery
What do the following signs/symptoms suggest
Reflux
Chronic cough
Difficult intubation
Halitosis
Pharyngeal pouch
What do the following signs/symptoms suggest
Central crushing chest pain
Weight loss
Trouble swallowing both solids and liquids
Achalasia
What’s the Rockall score used for? What are the components
Risk of adverse outcome after acute upper GI bleed
Age BP fall Co-morbidities Diagnosis after endoscopy Evidence of bleeding
What is used as prophylaxis against oesophageal varices bleeding
- Propanolol
- Variceal band ligation
What is used to treat oesophageal varices bleeding
- Terlipressin
- Pipercillin/tazobactam for 3 days
- Variceal band ligation
- TIPPS
Why should PPI not be given to patients with upper GI bleed before endoscopy
PPI would mask the site of bleeding
