PUD, Zolinger Ellison, UGIB, Oesophageal d/o

Question 1

Mx of non variceall bleed

Answer 1

Scope within 24 hours
Supportive mx
PPI post scope

Question 2

Variceal bleeding - acute mx

Answer 2

1. Octreotide and terlipressin
2. Stat Cef –> PO Norflox
3. Scope within 12 hours
4. Consider TIPS or SB tube

Question 3

Octreotide MOA

Answer 3

Like somatostatin, octreotide decreases the release of growth stimulating hormones, decreases blood flow to the GI tract

Question 4

Terlipressin MOA

Answer 4

Splanchnic and extrarenal vasoconstriction by stimulation of V1 receptors –> reduces splanchnic blood flow and portal pressure

Question 5

Capsule endoscopy

Answer 5

good for small intestine tumours/bleeds/Chron’s disease/polyps etc, esp for mild disease or bleeding that cant be seen by other imaging modalities

Question 6

CT colonography

Answer 6

ow dose CT post bowel prep with faecal tagging. Looks at rectum + colon. Good for patients who are at risk of colon ca or polyps but cant have scopes due to risk of perforation etc

Question 7

CTA -

Answer 7

good for acute active bleeding esp when bleeding +++ and wont be able to see the source with a scope or when patient hasn’t had bowel prep in the emergency setting

Question 8

Red cell scan

Answer 8

• slow or intermittent bleeding but can have difficulty locating exact source
• Ovarian and uterine activity in the young woman can be mistaken for bleed

Question 9

PUD - CF

Answer 9

Abdo pain : ‘classic’ duodenal ulcer pain – occurs 2-5 hours post prandial when acid is secreted in the absence of a food buffer and at night when circadian pattern of acid secretion is maximal

○ Associated symptoms – bloating, abdominal fullness, nausea and early satiety that may be provoked by eating. Reflux

Question 10

Gastric ulcers a/w -

Duodenal ulcers a/w

Answer 10

Gastric ulcers a/w - malignancy

Duodenal ulcers a/w - H pylori

Question 11

Risk factors PUD

Answer 11

Smoking
ETOH
NSAID including aspirin

Question 12

Testing for H Pylori

Answer 12

Negative biopsy results DOES NOT EXCLUDE H.Pylori and another test (ideally a urea breath test or stool antigen test for H.pylori) should be performed to confirm a negative result.

Question 13

Mx H Pylori

Answer 13

○ Triple therapy – PPI + clarithromycin + amoxicillin/metronidazole for 7 days.

○ After confirmed eradication – long term PPI no longer needed unless for other indications

• Increasing metronidazole resistance
• 95% clarithromycin resistance

Question 14

Zollinger-Ellison syndrome

Answer 14

Excessive levels of gastrin, usually from a gastrin secreting tumour usually of the duodenum or pancreas.

Around 30% occur as part of MEN type I syndrome

Question 15

Zollinger-Ellison syndrome Dx

Answer 15

1. fasting gastrin levels: the single best screen test

2. secretin stimulation test

Question 16

Eosinophilic Oesophagitis

clinical presentation
Ix

Answer 16

young males, dysphagia, food impaction
a/w asthma, atopy
scope: exudates, rings and furrows, tearing on dilatation
bx: eosinophils ++

Question 17

Achalasia

Answer 17

Incomplete relaxation of LOS

Dysphagia– Solids and liquids– Progressive, may be associated with weight loss
Regurgitation– Esp postural (night)– Saliva, old food (not acid)

Mx - Myotomy

Question 18

Barrett’s Oesophagus

Patho
Mx
RF
Cx

Answer 18

Metaplasia of variable distance
Mx - mucosal ablation + high dose acid suppression

risk of oesophageal ca
RF: male, Caucasian, older, smoking, obesity, GORD