GI SHARIAR EXCEL WEEL DONE-2 Flashcards
What are common symptoms of GERD in adults?
Nighttime heartburn, bloating followed by GERD.
What are common symptoms of GERD in children?
Milk flows freely from the mouth.
What are the initial tests for diagnosing GERD?
Barium swallow, 24-hour pH monitoring.
What is a red flag that requires direct endoscopy in GERD?
Anemia to rule out malignancy.
What condition is GERD associated with?
Asthma.
What is Barrett’s esophagus?
Columnar epithelium replaces squamous epithelium.
What are the lifestyle management strategies for GERD?
Weight loss.
What is the medical management for GERD?
Proton Pump Inhibitors (PPIs).
How is asthma related to GERD managed?
Double dose of PPIs.
How is hiatus hernia managed if it doesn’t respond to PPI?
Surgery.
What are the characteristics of achalasia?
No heartburn (late sign), tight lower esophageal sphincter (LES), mostly congenital, dysphagia to liquids first, then solids.
What is the initial test for diagnosing achalasia?
Barium swallow (bird’s beak appearance).
What is the confirmatory test for diagnosing achalasia?
Manometry.
What are the conservative treatments for achalasia?
Nitrates and dilation (balloon or pneumatic).
What is the best treatment for achalasia if conservative treatment fails?
Cardio -Myotomy.
What are the types of peptic ulcers?
Duodenal ulcer and gastric ulcer.
What are the pain characteristics of duodenal ulcers?
Pain with hunger, relieved by eating.
What are the pain characteristics of gastric ulcers?
Pain with eating.
What is the investigation of choice for peptic ulcer disease?
Endoscopy.
What are common causes of peptic ulcer disease?
NSAIDs, steroids, H. pylori.
What test is used for diagnosing H. pylori?
Urea breath test.
What is the initial treatment for peptic ulcer disease?
Triple therapy.
What should be considered if triple therapy for peptic ulcer disease is not working?
Resistance to metronidazole and clarithromycin; consider alternatives like tetracycline and amoxicillin.
How is a bleeding peptic ulcer managed?
Injection of adrenaline, IV omeprazole (80mg).
What are the characteristics of esophageal cancer?
Dysphagia to solids first, then liquids, weight loss, progressive dysphagia, can be silent and invasive.
What is the best diagnostic test for esophageal cancer?
Endoscopy with biopsy.
What are the staging investigations for esophageal cancer?
Endoscopic ultrasound, CT for local spread, bronchoscopy for asymptomatic spread to bronchi.
What is the treatment for metastatic esophageal cancer?
5-fluorouracil plus radiation.
What are the characteristics of scleroderma affecting the esophagus?
Dysphagia plus GI reflux, LES immobile tube.
What is the most accurate test for scleroderma affecting the esophagus?
Motility studies.
What are the characteristics of diffuse esophageal spasm?
Mimics heart attack (intermittent chest pain).
What is the initial test for diagnosing diffuse esophageal spasm?
Barium swallow.
What is the most accurate test for diagnosing diffuse esophageal spasm?
Manometry.
What are the treatments for diffuse esophageal spasm?
Nitrates, balloon dilation, avoid extreme hot or cold foods.
What are the types of esophageal cancer?
Squamous cell carcinoma and adenocarcinoma.
Where is squamous cell carcinoma commonly located?
Upper third of esophagus.
Where is adenocarcinoma commonly located and what is it associated with?
More common in Australia, associated with Barrett’s esophagus.
What is the diagnosis INVESTIGATION for Boerhaave syndrome?
Best: Lateral chest X-ray, then CT scan.
What is the management for Boerhaave syndrome?
IV fluids, antibiotics, NPO, ICU admission, surgical repair required.
What are the characteristics of Mallory-Weiss syndrome?
Location: Gastroesophageal junction, cause: severe vomiting, retching, severity: less severe, tear depth: mucous membrane tear, bleeding: possible, not primary feature.
What is the pathophysiology of Zollinger-Ellison syndrome?
Gastrin increases motility and acid production, causing multiple ulcers and diarrhea.
What is the treatment for Zollinger-Ellison syndrome
Gastrinoma ?
Chemotherapy plus PPI.
The treatment of Zollinger-Ellison syndrome (ZES) according to RACGP and other guidelines involves two main approaches: managing the gastrin-secreting tumors and controlling the excessive gastric acid production.
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Controlling Acid Production:
- Proton Pump Inhibitors (PPIs): High doses of PPIs are the first line of treatment to control the hypersecretion of gastric acid. Commonly used PPIs include omeprazole, lansoprazole, pantoprazole, rabeprazole, and esomeprazole. These medications help in reducing acid levels and healing ulcers caused by excessive acid production oai_citation:1,RACGP - Deprescribing proton pump inhibitors oai_citation:2,Zollinger-Ellison syndrome - Diagnosis and treatment - Mayo Clinic.
- Octreotide: This somatostatin analog can be used to counteract the effects of gastrin in some patients, reducing acid secretion and controlling symptoms oai_citation:3,Zollinger-Ellison syndrome - Diagnosis and treatment - Mayo Clinic.
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Managing the Tumors:
- Surgical Removal: If the tumors are localized and can be identified, surgical removal is recommended. However, surgery might not be feasible if the tumors are numerous or have metastasized, especially to the liver oai_citation:4,Zollinger-Ellison syndrome - Diagnosis and treatment - Mayo Clinic oai_citation:5,Current Management of Zollinger-Ellison Syndrome | Drugs.
- Other Treatments: In cases where surgery is not possible, other treatments may include embolization (cutting off blood supply to the tumor), radiofrequency ablation (using heat to destroy cancer cells), chemotherapy, and sometimes liver transplantation for extensive liver involvement oai_citation:6,Zollinger-Ellison syndrome - Diagnosis and treatment - Mayo Clinic oai_citation:7,Current Management of Zollinger-Ellison Syndrome | Drugs.
These treatments aim to control both the tumor growth and the excessive acid production, improving the patient’s quality of life and preventing complications. Regular follow-ups and monitoring are essential for managing this chronic condition.
What are the clinical features of eosinophilic esophagitis?
Dysphagia, gastro-esophageal reflux, acute food bolus obstruction, associated with allergic disorders such as hay fever, cow’s milk allergy, asthma.
What is the diagnosis for eosinophilic esophagitis?
Endoscopy with biopsy showing eosinophilic infiltrates.
What is the management for eosinophilic esophagitis?
Acute Elimination diet, IM buscopan, swallowed topical corticosteroids fluticasone.
not diagnosed =PPI
Diagnosed =Budesonide
What are the clinical features of stomach cancer?
Male to female ratio = 3:1, often asymptomatic early, consider in patients over 40 with upper GIT symptoms, especially weight loss, dyspepsia unresponsive to treatment, weight loss, anemia.dysphagia is a late sign.
