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Y4 GI / Surgery > Oesophagus & Stomach > Flashcards

Oesophagus & Stomach Flashcards

1
Q

Define dysphagia and odynophagia

A

Difficulty swallowing

Painful swallowing

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2
Q

Dysphagia to liquids and then solids suggests what cause?

A

Neurological eg myasthenia, MND

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3
Q

Dysphagia to solids then liquids suggests what cause?

A

Benign or malignant stricture

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4
Q

Dysphagia to both solids and liquids from the start suggests what cause?

A

Motility disorder eg spasm, achalasia

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5
Q

Oesophageal candidiasis is a known cause of odynophagia, true or false

A

True

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6
Q

Pharyngeal pouch

  • what age group commonest in?
  • what gender commonest in?
  • associated with nausea?
  • associated with weight loss?
  • symptoms consistent or intermittent?
A

Elderly males
No nausea or weight loss
Symptoms consistent when eating + drinking

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7
Q

What investigation diagnoses a pharnygeal pouch?

A

Barium swallow

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8
Q

What is the management of pharyngeal pouch?

A

Surgical treatment

However usually elderly population so reassure isn’t progressive for malignant

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9
Q

A female with dysphagia and iron deficiency anaemia due to a post cricoid oesophageal web describes what disorder?

A

Patterson Kelly brown

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10
Q

What features of the history should alert you to a malignant cause of odynophagia / dysphagia?

A

Progressive symptoms + weight loss

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11
Q

Corkscrew appearance on barium swallow is diagnostic of what cause of odynophagia?

A

Diffuse oesophageal spasm

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12
Q

Are diffuse oesophageal spasm symptoms consistent or intermittent? Does odynophagia or dysphagia predominate?

A

Intermittent severe pain when swallowing

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13
Q

GORD and radiotherapy are both risk factors for what cause of dysphagia?

A

Benign oesophageal stricture

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14
Q

Failure of the LOS to relax + failure of peristalsis describes what disorder?

A

Achalasia

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15
Q

Pathology in Zenker’s diverticulum is associated with what cause of dysphagia?

A

Pharyngeal pouch

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16
Q

Pathology in Auerbach’s plexus is associated with what cause of dysphagia?

A

Achalasia

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17
Q

What test is diagnostic of achalasia?

A

Barium swallow bird beak appearance

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18
Q

What is the management of achalasia?

A

1st line try CCB / GTN to relax sphincter

Last line surgical / botox

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19
Q

What is the 1st line investigation for most cases of dysphagia? If this comes back as normal what investigation is usually done next?

A

1st OGD

2nd barium swallow

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20
Q

Delayed gastric emptying is the description of what disorder?

A

Gastroparesis

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21
Q

What investigation diagnoses gastroparesis?

A

Gastric emptying study

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22
Q

What is the aetiology of gastroparesis?

A

Idiopathic or diabetic neuropathy

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23
Q

N&V on eating, early satiety and epigastric pain is the presentation of what disorder?

A

Gastroparesis

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24
Q

Why is pregnancy and obesity a risk factor for reflux?

A

Raised intra abdominal pressure

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25
Q

What are the two types of hiatus hernia?

A

Sliding or paraesophageal

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26
Q

Can hiatus hernia be seen on OGD?

A

Yes, can also be seen on barium swallow

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27
Q

What is the first line management of hiatus hernia?

A

Conservative weight reduction + PPI

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28
Q

What is the first line investigation and management of reflux/dyspepsia?

A

If 1st presentation no Ix; give PPIs should respond in 4-6wk

If no response arrange OGD to assess severity and look for Barrett’s

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29
Q

What time should PPIs be taken in relation to eating?

A

30 minutes before eating

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30
Q

Cimetidine and ranitidine are in what class of drugs?

A

H2 antagonists - used in the management of reflux

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31
Q

Salmon coloured mucosa in the distal third of the oesophagus suggests what?

A

Barrett’s oesophagus

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32
Q

What is Barretts oesophagus? What is the risk?

A

Premalignant metaplasia squeamish to columnar epithelium

Risk of oesophageal adenocarcinoma

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33
Q

Where in the oesophagus are oesophageal adenocarcinoma and squamous carcinoma found?

A

Adenocarcinoma distal 1/3

Squamous carcinoma proximal 2/3

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34
Q

What is the management of Barretts oesophagus?

A

Surveillance/ oesophageal resection/ radio frequency ablation/ mucosectomy

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35
Q

What is the management of oesophageal adenocarcinoma?

A

Surgery / palliative

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36
Q

What is the management of oesophageal squamous carcinoma?

A

Chemo / radio

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37
Q

What are the criteria for referral for suspected oesophageal adenocarcinoma?

A 
2wk wait OGD if:
dysphagia OR >55yr
\+ 
weight loss 
\+ 
any of (upper abdo pain, reflux, dyspepsia)
38
Q

Haematemesis is defined as vomiting of blood from the upper GI tract. Red blood suggests what? Coffee grounds suggest what?

A

Bright red = active bleeding

Coffee grounds = bleeding ceased

39
Q

What is “black tarry offensive odour stool” What is it caused by?

A

Melena
Upper GI haemorrhage
(black appearance caused by oxidation of iron in haemoglobin as it passes through ileum/colon)

40
Q

Is a Mallory-Weiss tear a longitudinal or transverse tear? What is it caused by?

A

Longitudinal tear at gastroesophageal junction
Repetitive/strenuous vomiting
(bleeding stops spontaneously for most)

41
Q

What is the clinical significance of the ligament of Treitz?

A

Above/below = upper v lower GI bleeding

its in duodenum

42
Q

What is a Blatchford score?

A

Need for intervention pre-OGD in upper GI bleeding

43
Q

What is a Rockall score?

A

Mortality in upper GI bleeding

44
Q

What is Boerhaave syndrome?

A

Oesophageal rupture

45
Q

What are the indications for fresh frozen plasma transfusion in upper GI bleeding?

A

If actively bleeding + prothrombin time greater than 1.5X normal

46
Q

What are the indications for platelet transfusion in upper GI bleeding?

A

If actively bleeding + platelet count <50

47
Q

When should OGD be offered in upper GI bleeding?

A

Immediately after resuscitation if severe bleeding, otherwise within 24 hours

48
Q

Subcutaneous chest wall emphysema is associated with what cause of upper GI bleeding?

A

Boerhaave syndrome

49
Q

What is the management of a Mallory-Weiss tear?

A

Bleeding stops spontaneously for most

If acutely unwell (HR) admit for IV fluids + IV PPI infusion

50
Q

Aorto-duodenal fistula can cause upper GI bleeding, what surgical procedure is it a complication application off?

A

AAA

51
Q

How is upper GI bleeding classified in terms of aetiology?

A

Variceal and non-variceal

52
Q

When is RBC transfusion offered an upper GI bleeding?

A

If Hb <70

53
Q

What is the management of non-variceal upper GI bleeding?

A 
ABCDE
IV fluid resuscitation
Transfuse it Hb<70
Bladder catheterisation
Correct clotting
Everyone gets an OGD
IV PPI after OGD (80mg bolus followed by 8mg/hr infusion)
54
Q

How does cirrhosis cause varices?

A

Cirrhosis > portal HTN > collaterals between systemic / portal circulations > varices

55
Q

What effect does portal hypertension have on the spleen?

A

Hypersplenism splenomegaly due to blockage of blood backflow - as a result can get thrombocytopenia

56
Q

What is the management of variceal bleeding?

A

IV fluids + IV terlipressin at 2mg every 6hr + prophylactic IV antibiotics - then OGD - during OGD do band ligation of esophageal varices
(Terlipressin is a vasopressor)

57
Q

In the management of variceal bleeding if variceal band ligation isn’t successful at controlling bleeding, what can be done next?

A

TIPS

58
Q

What is the role of the urea breath test in h pylori infection?

A

Test of h pylori eradication

- don’t think done as a diagnostic test but double check this

59
Q

How can you clinically differentiate a gastric v duodenal ulcer?

A

Gastric exacerbated by eating

Duodenal relieved by food (pain before eating + at night)

60
Q

Why do you need a follow up OGD after a gastric ulcer?

A

Risk of malignant transformation so need to make sure eradicated

61
Q

“Gram negative urease producing bacteria, faecal oral spread” describes what

A

H pylori

62
Q

What is the treatment of h pylori infection?

A

omeprazole + amoxicillin + clarithromycin triple therapy

metronidazole if penicillin allergic

63
Q

What type of cancer is associated with h pylori infection?

A

Gastric MALT lymphoma and gastric adenocarinoma

64
Q

How is h pylori infection diagnosed?

A

IDK

Biopsy CLO urease test

65
Q

What is the management of a bleeding peptic ulcer?

A

OGD - IJ adrenaline / clips

66
Q

What common drug class aggravates / causes gastritis ?

A

NSAIDs incl aspirin

67
Q

In a patient with gastritis/PUD, if NSAIDs have to be used what can you do to prevent more harm?

A

Co-prescribe a PPI

Use selective COX-2 inhibitors like Coxib

68
Q

What is the definition of diarrhea?

A

> 3 unformed stools/day

69
Q

What is the commonest infectious agent in gastroenteritis?

A

Campylobacter

70
Q

Which infectious agent in gastroenteritis is associated with the O-antigen?

A

Salmonella

71
Q

Which infectious agent in gastroenteritis is associated with the VTEC toxin?

A

E coli 0157

72
Q

Which infectious agent in gastroenteritis is associated with GBS?

A

Campylobacter

73
Q

Which infectious agent in gastroenteritis is associated with reheated rice?

A

Bacillus cerus

74
Q

Which infectious agent in gastroenteritis is associated with unpasteurized milk and is harmful in pregnancy?

A

Listeria

75
Q

Which infectious agent in gastroenteritis is associated with cruise ships?

A

Norovirus

76
Q

Which infectious agent in gastroenteritis is associated with outbreaks in daycare?

A

Rotavirus

77
Q

Which infectious agent in gastroenteritis is associated with HUS?

A

E coli 0157

78
Q

Which infectious agent in gastroenteritis is associated with BBQs?

A

Think e coli ???

79
Q

Can campylobacter cause bloody diarrhea?

A

Yes

80
Q

Can bacillus cereus cause bloody diarrhea?

A

No

81
Q

Can e coli 0157 cause bloody diarrhea?

A

Yes

82
Q

Can rotavirus cause bloody diarrhea?

A

No

83
Q

Can norovirus cause bloody diarrhea?

A

No

84
Q

Can c diff cause bloody diarrhea?

A

Yes

85
Q

Which infectious agent in gastroenteritis is associated with pseudomembranous colitis?

A

C diff

86
Q

What organisms are tested for in a standard stool sample?

A 
Salmonella
Shigella
Campylobacter
E coli 0157
Cryptosporidium
C diff (if >4y.o)
(Other tests you have to request)
87
Q

What is the most important aspect of management in norovirus & rotavirus infection?

A

Hydration

88
Q

How is c diff diagnosed?

A

Stool toxin

89
Q

What is the management of c diff infection?

A

Less severe PO metron

Severe PO vancomycin

90
Q

Which infectious agent in gastroenteritis is associated with recent antibiotic use / hospital acquired?

A

C diff

Y4 GI / Surgery (11 decks)

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