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FINALS - GI > oesophagus > Flashcards

oesophagus Flashcards

1
Q

what is achalasia

A

failure of oesophageal peristalsis and relaxation of LOS

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2
Q

what ganglia degenerates in achalasia

A

Auerbach’s plexus

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3
Q

what dysphagia is present in achalasia

A

of both liquids and solids

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4
Q

what are the 3 main investigations for achalasia and what is most important

A

oesophageal manometry (first line) // Ba swallow (birds beak) // CXR (wide mediastinum)

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5
Q

what surgical treatment options are available for achalasia (3), what is first line

A

pneumatic balloon dilation (first line) // heller cardiomytomy // botulinum toxin injection

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6
Q

where does a pharyngeal pouch form

A

between thyropharyngeus and cricophargygeus muscles

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7
Q

what are features of pharyngeal pouch

A

elderly men // dysphagia// regurgitation // neck swelling that gurgles on palpation // bad breath

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8
Q

investigation for pharyngeal pouch

A

ba swallow and video fluoroscopy

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9
Q

how do you manage pharyngeal pouch

A

surgically

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10
Q

what does corkscrew appearance on CXR/ ba swallow indicate

A

diffuse oesophageal spasm

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11
Q

what is oesophagitis

A

heartburn, odnophagia but systemically well

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12
Q

what must be done with new onset dysphagia

A

urgent endoscopy regardless of age/ other symptoms

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13
Q

what are risk factors for gord

A

pregnancy, obese, smoking, TCA, anticholinergics, nitrates

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14
Q

what are the common features of GORD

A

heartburn worse lying down // water/ acid brash, (regurg) / odnophagia

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15
Q

what features/ symptoms of GORD would warrant an OGD

A

> 55 weeks // symptoms last >4 weeks despite symptoms // dysphagia // unresponsive // weight loss

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16
Q

if an endoscopy is negative for GORD what invx can be considered

A

24 hour oesophageal pH monitoring (gold standard)

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17
Q

what treatment is offered for GORD w/o endoscopy

A
  1. review meds and lifestyle 2. full dose PPI one month OR H.pylori treatment
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18
Q

what treatment is offered for GORD positive endoscopy

A

full dose PPI 1-2 months –> double if not working, half if it is

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19
Q

what treatment is offered for GORD negative endoscopy

A

full dose PPI 1 month –> H2 receptor blocker eg cimetidine, raniditine

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20
Q

what is a haitus hernia

A

herniation of stomach above the point of diaphragm

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21
Q

what is a sliding hiatus hernia

A

gastroesophageal junction moves above diaphragm// (stomach slides up the oesophagus) // 95%

22
Q

what is a rolling hiatus hernia

A

gastroesophageal junction remains below diaphragm but part of stomach herniates through to sit next to oesophagus

23
Q

what are risk factors for hiatus hernia

A

obese, raised intra pressure eg ascites, multiparity

24
Q

what investigations are done for hiatus hernia and what is most sensitive

A

Ba most sensitive // usually OGD –> for dyspepsia

25
Q

what lifestyle, pharmacological, and surgical options are available for hiatus hernias

A

weight loss // PPI // surgical only in paraesophageal

26
Q

what is barrett’s oesophagus

A

squamous –> columnar cells from repeated GORD

27
Q

what cells can be found on biopsy of barrett’s

A

epithelium with goblet cells and brush border

28
Q

how + when can you manage barrett’s surgically

A

if signs of DYSplasia –> ablation if low grade // mucosal resection

29
Q

how often should barrett’s patients get endoscopy

A

3-5 years if metaplasia but not dysplasia

30
Q

what are the 2 common cancers and which is gord a risk factor for

A

adenocarcinoma, lower 1/3 (GORD) // SSC, upper 2/3 (smoking)

31
Q

how is oesophageal cancer diagnosed

A

(FBC) OGD + biopsy

32
Q

how is oesophageal cancer staged

A

CT usually first line –> USS for local

33
Q

how is oesophageal cancer managed surgically + what adjuvant

A

oesophagectomy + chemo

34
Q

what is a mallory weiss tear

A

haemetemesis from repeated vomitting

35
Q

what is Boerhaave’s syndrome

A

rupture of oesophagus from repeat vomiting (left distal side) + chest pain

36
Q

what is seen on the chest wall of Boerhaave’s syndrome

A

seubcut empysema

37
Q

invx for Boerhaave’s syndrome

A

CT contrast swallow

38
Q

mx Boerhaave’s syndrome

A

thoracotomy + lavage if <12 hours // if 12+ create fistula

39
Q

how does sepsis occur from Boerhaave’s syndrome

A

mediastinitis (severe sepsis)

40
Q

what is plummer vinson syndrome a triad of

A

dysphagia from oesophageal webs// glossitis// iron deficiency anaemia

41
Q

what is the biggest risk factor for variceal bleeds

A

portal hypertension from liver disease

42
Q

what is the first management in variceal bleeds

A

ABCDE // consider platelets, FFP and vit K

43
Q

what is the order of treatment in variceal bleeds

A

1 terlipressin (vasoactive) 2. IV abx usually quinolones 3. endoscopy

44
Q

OGD treatment of variceal bleeds best –> worst (4)

A

band ligation > sclerotherapy > SB tube (balloon) (IF UNCONTROLLED HAEMORRHAGE) > TIPSS

45
Q

what is the most common side effect of TIPPS

A

hepatic encephalopathy

46
Q

what prophylaxis is given for variceal heamorrhage (2)

A

propranolol or variceal band ligation (give 2 week PPI cover)

47
Q

what assessment can be done pre or post endoscopy to manage patients

A

blatchford before –> rockall after

48
Q

what usually causes gastroparesis

A

autonomic (diabetes!) or illness

49
Q

what are features of gastroparesis

A

early satiety, abdo pain, vomitting undigested foods, (erratic glucose in diabetics)

50
Q

invx gastroparesis

A

gastric emptying studies / T99

51
Q

what prokinetics are given for gastroparesis and when are they to be avoided

A

domperidone, metoclopramide // small bowel obstruction

52
Q

what is a side effect of metoclopramide

A

extrapyramidal (D2 antagonist)

FINALS - GI (18 decks)

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