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UL Final Year OSCE's & Short Cases > RCSI: UPPER GI > Flashcards

RCSI: UPPER GI Flashcards

1
Q

What is the definition of Gastro-Oesophageal Reflux Disease (GORD)?

A

A condition describing excessive reflux of gastric contents (acid, bile, and pancreatic enzymes) into the oesophagus, through a defective lower oesophageal sphincter (LOS), causing symptoms and/or oesophageal mucosal injury.

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2
Q

What can be observed at endoscopy in GORD?

A

Erosive and non-erosive disease.

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3
Q

What confirms the diagnosis of GORD?

A

An abnormal DeMeester score on pH monitoring.

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4
Q

What is the epidemiology of GORD?

A
  • Most frequently diagnosed upper GI disorder
  • Most commonly found in middle-aged adults
  • About 25–40% of healthy adult Americans experience symptomatic GORD.
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5
Q

What are the risk factors for GORD?

A
  • Family history of GORD
  • Elevated BMI
  • Heavy alcohol use
  • Smoking
  • Pregnancy
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6
Q

What are the pathophysiological mechanisms involved in GORD?

A
  • Poor/inefficient oesophageal motility
  • Reduced LOS tone
  • Increased intragastric pressure and delayed gastric emptying.
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7
Q

What are common clinical features of GORD?

A
  • Retrosternal discomfort or heartburn
  • Acid reflux into pharynx
  • Commonly worse at night and after large meals
  • Dysphagia may occur if there is associated ulceration or a stricture
  • Globus: Feeling of a lump in throat
  • Pulmonary aspiration (nocturnal coughing; hoarse voice)
  • Commonly associated with hiatus hernia.
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8
Q

What investigations are used to confirm GORD?

A
  • Routine laboratory investigations
  • 24 hours continuous pH monitoring
  • Oesophageal manometry
  • Oesophago-gastro-duodenoscopy (OGD) for patients over 45.
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9
Q

What lifestyle modifications can help manage GORD?

A
  • Smaller meals at frequent intervals
  • Avoid late-night food intake
  • Avoid gastric irritants like coffee, chocolate, and spicy food
  • Smoking cessation and moderation in alcohol intake.
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10
Q

What medical treatments are used for GORD?

A
  • Proton pump inhibitors (PPIs)
  • Antacids (e.g., Gaviscon).
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11
Q

What are the types of fundoplication surgeries for GORD?

A
  • Nissen’s fundoplication
  • Dor fundoplication
  • Toupet fundoplication.
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12
Q

What are some complications of GORD?

A
  • Oesophagitis and ulceration
  • Peptic stricture
  • Barrett’s oesophagus
  • Increased risk of oesophageal adenocarcinoma.
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13
Q

What is Barrett’s Oesophagus?

A

The metaplastic change of stratified squamous epithelium of the distal oesophagus to columnar epithelium.

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14
Q

What are the classifications of Barrett’s Oesophagus?

A
  • Long segment (>3 cm)
  • Short segment (<3 cm).
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15
Q

What are the management strategies for Barrett’s Oesophagus?

A
  • Lifestyle modifications
  • Anti-reflux medications
  • Eradication therapy for Helicobacter pylori
  • Radiofrequency ablation and OGD surveillance
  • Mucosal endoscopic resection
  • Oesophagectomy.
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16
Q

What is the definition of a hiatus hernia?

A

The prolapse of the gastro-oesophageal junction (GOJ) and part or all of the stomach into the thoracic cavity through the oesophageal diaphragmatic hiatus.

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17
Q

What are the types of hiatus hernias?

A
  • Type I: Sliding
  • Type II: Paraoesophageal
  • Type III: Combined
  • Type IV: Complex.
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18
Q

What are common investigations for hiatus hernia?

A
  • CXR
  • Barium swallow
  • OGD
  • CT scan.
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19
Q

What are the management options for hiatus hernia?

A
  • Conservative/medical: Reduce acid production, counteract acid secretion
  • Surgical: Laparoscopic/robotic reduction of the hernia, excision of the sac, and gastric fixation (gastropexy).
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20
Q

What are complications associated with hiatus hernia?

A
  • Oesophageal inflammation
  • Ulceration
  • Bleeding
  • Iron deficiency anaemia
  • Gastric volvulus.
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21
Q

What is the definition of Peptic Ulcer Disease?

A

Injury leading to the breakdown of the mucosal layer of the lower oesophagus, stomach, or duodenum, mainly occurring secondary to excessive acid production or damaged barrier mechanisms.

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22
Q

What are the key facts about Peptic Ulcer Disease?

A
  • Lifetime prevalence: 11–14% in men, 8–11% in women
  • Most common sites: First part of the duodenum, gastric antrum, lesser curve of the stomach
  • H. pylori accounts for 90% of duodenal ulcers and 70–80% of gastric ulcers.
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23
Q

What are the clinical features of Peptic Ulcer Disease?

A
  • Nonspecific symptoms: dyspepsia, nausea, epigastric pain
  • Heartburn and acute chest pain
  • Hematemesis/melaena for bleeding ulcers
  • Symptoms of anaemia
  • Duodenal ulcers: hunger pains, nocturnal pain, relieved by food.
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24
Q

What investigations are used for Peptic Ulcer Disease?

A
  • Urease test for H. pylori
  • Urea breath test
  • Stool antigen testing
  • Serology
  • Fasting serum gastrin levels
  • OGD.
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25
Q

What is the management for Peptic Ulcer Disease?

A
  • Eliminate H. pylori infection with triple therapy
  • Diminish irritant effects of acid-pepsin
  • Use mucosal protective agents
  • Reduction of acid secretion with PPIs and H2 receptor-blocking drugs.
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26
Q

What are the complications of Peptic Ulcer Disease?

A
  • Bleeding
  • Perforation and sepsis
  • Gastric outlet obstruction.
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27
Q

What is the definition of upper gastrointestinal bleeding?

A

Bleeding from the oesophagus, stomach, or duodenum (above the ligament of Treitz).

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28
Q

What are the key facts about upper gastrointestinal bleeding?

A
  • Hematemesis indicates vomiting of blood
  • Melaena refers to black ‘tarry’ stools
  • PUD is the most common cause.
29
Q

What are the clinical presentations of upper gastrointestinal bleeding?

A
  • Haematemesis and melaena
  • Abdominal pain
  • Heartburn, reflux, dyspepsia
  • Symptoms of chronic liver disease
  • Features of anaemia.
30
Q

What symptoms suggest oesophagitis or ulceration?

A

Burn, reflux, dyspepsia

These symptoms may indicate inflammation or ulceration of the esophagus.

31
Q

What are the features of chronic liver disease?

A

Jaundice, ascites, spider naevi, gynecomastia, caput medusae, hepatomegaly

These features may indicate the presence of liver dysfunction or cirrhosis.

32
Q

What are common medications associated with upper gastrointestinal bleeding?

A

Aspirin/Plavix, warfarin/NOAC, NSAIDs, steroids

These medications can increase the risk of bleeding due to their anticoagulant or irritant properties.

33
Q

What vital signs indicate instability in a patient with upper GI bleeding?

A

Tachycardia, hypotension, tachypnoea, reduced urine output

These signs suggest significant blood loss and potential shock.

34
Q

What is the differential diagnosis of upper gastrointestinal bleeding?

A
  • Oesophageal Varices
  • Malignancy
  • Ulcer
  • Oesophagitis
  • Mallory-Weiss tear
  • Gastric Varices
  • Gastritis
  • Dieulafoy lesion
  • Duodenal Ulcer
  • Vascular malformation (such as aorto-enteric fistula)

Each of these conditions can lead to bleeding in the upper gastrointestinal tract.

35
Q

What blood tests are essential in the investigation of upper GI bleed?

A
  • FBC
  • U&E
  • Coagulation screen
  • LFTs
  • Group and crossmatch
  • ABG

These tests help assess blood loss, kidney function, liver function, and bleeding risk.

36
Q

What is the purpose of IV PPI infusion in the management of upper GI bleeding?

A

To reduce gastric acid secretion

This helps prevent further erosion of the gastric mucosa and promotes healing.

37
Q

What is the Rockall Score used for?

A

To estimate the risk of rebleeding or death in an upper GI bleed

It helps guide management decisions based on the patient’s risk profile.

38
Q

Define dysphagia.

A

Difficulty swallowing

This can be a symptom of various underlying conditions affecting the esophagus.

39
Q

What are the causes of odynophagia?

A
  • Trauma
  • Foreign body
  • GORD
  • Infective causes
  • Neoplasia
  • Motility-related issues
  • Other (e.g., scleroderma)

Odynophagia is painful swallowing, which can arise from various etiologies.

40
Q

What is achalasia?

A

A condition characterized by a loss of esophageal peristalsis and failure of the lower esophageal sphincter to relax

This leads to swallowing difficulties and can result in food accumulation in the esophagus.

41
Q

What is the primary investigation for dysphagia?

A

Upper GI Endoscopy

This allows direct visualization and potential biopsy of the esophagus.

42
Q

What is the characteristic appearance of achalasia on barium swallow?

A

Bird’s beak appearance

This appearance is due to the narrowed esophago-gastric junction and dilated esophagus.

43
Q

What are the key complications of achalasia?

A
  • Nocturnal aspiration
  • Bronchiectasis
  • Lung abscess
  • Carcinoma (3% risk)

These complications arise from chronic obstruction and stasis in the esophagus.

44
Q

What is the most common histological type of esophageal cancer?

A

Squamous Cell Carcinoma (SCC)

SCC is prevalent in specific regions, while adenocarcinoma is more common in Western countries.

45
Q

What are the risk factors for adenocarcinoma of the esophagus?

A
  • Barrett’s esophagus
  • GORD
  • Obesity
  • High fat intake
  • Cigarette smoking
  • High alcohol intake

These factors contribute to the development of metaplasia leading to cancer.

46
Q

What is the management strategy for esophageal cancer?

A
  • Chemotherapy
  • Radiotherapy
  • Surgery

Multidisciplinary approaches are essential for effective treatment.

47
Q

What are some risk factors for oesophageal cancer?

A

Cigarette smoking, high alcohol intake, nitrosamines in diet, vitamin A and C deficiency, coeliac disease, strictures and webs, achalasia, peptic ulcer disease.

48
Q

What clinical features indicate the need for urgent referral for endoscopy in patients over 45?

A

Any new symptoms of dysphagia, especially with weight loss.

49
Q

What is the significance of high-grade dysplasia in Barrett’s metaplasia?

A

It is associated with occult adenocarcinoma in 30%.

50
Q

List symptoms of disseminated oesophageal cancer.

A
  • Cervical lymphadenopathy (including Virchow’s node)
  • Hepatomegaly due to metastases
  • Epigastric mass due to para-aortic lymphadenopathy.
51
Q

What are symptoms of local invasion in oesophageal cancer?

A
  • Hoarseness in recurrent laryngeal nerve palsy
  • Cough and haemoptysis in tracheal invasion
  • Neck swelling in superior vena cava (SVC) obstruction
  • Horner’s syndrome if sympathetic chain invasion.
52
Q

What investigations are used for local staging of oesophageal cancer?

A

Endoluminal ultrasound scan to assess depth of invasion and paraesophageal lymph nodes.

53
Q

Which imaging technique is used to evaluate local invasion and locoregional lymphadenopathy in oesophageal cancer?

A

CT Thorax Abdomen Pelvis (TAP).

54
Q

What is the role of PET scan in the management of oesophageal cancer?

A

It is used to exclude metastases.

55
Q

What is the management approach for early-stage oesophageal cancer without nodal involvement?

A

Surgery can be a single modality treatment.

56
Q

What is the Ivor Lewis procedure?

A

A 2-stage oesophagectomy performed for distal tumours.

57
Q

What type of cancer is classified through the Siewert classification?

A

OGJ (oesophagogastric junction) tumours.

58
Q

What are the key facts about gastric cancer?

A
  • Sixth most common cancer
  • Third most common cause of cancer-related deaths
  • Most patients present with advanced disease
  • 5-year survival is 31%.
59
Q

What are common subtypes of gastric cancer?

A
  • Gastric adenocarcinoma
  • Adenocarcinoma of the GOJ
  • Gastrointestinal stromal tumours (GISTs)
  • Neuroendocrine tumours (carcinoid tumours)
  • Lymphoma (associated with H. pylori).
60
Q

What are the risk factors for gastric adenocarcinoma?

A
  • Chronic gastric ulceration related to H. pylori
  • Diet rich in nitrosamines
  • Epstein-Barr virus (EBV)
  • Family history of gastric cancer
  • Blood type A.
61
Q

What are the common symptoms of gastric cancer?

A
  • Dyspepsia
  • Weight loss, anorexia, lethargy
  • Hematemesis, melena
  • Dysphagia
  • Gastric outlet obstruction and projectile vomiting.
62
Q

What are some signs of gastric cancer?

A
  • Anaemia
  • Palpable epigastric mass
  • Palpable supraclavicular lymph node (Troisier’s sign)
  • Malignant pleural effusion and ascites
  • Hepatomegaly and jaundice.
63
Q

What is the first step in the diagnosis of gastric cancer?

A

Gastroscopy and biopsy.

64
Q

What is the purpose of neoadjuvant chemotherapy in gastric cancer?

A

To improve surgical outcomes in locally advanced disease.

65
Q

List early complications of partial or total gastrectomy.

A
  • Haemorrhage
  • Acute pancreatitis
  • Anastomotic leak
  • Duodenal stump disruption
  • Respiratory compromise.
66
Q

What are late complications of gastrectomy?

A
  • Dumping syndrome
  • Bile reflux and vomiting
  • Diarrhoea
  • Recurrent stomal ulceration
  • Metabolic abnormalities.
67
Q

What is the overall prognosis for gastric cancer?

A

Overall prognosis remains poor with a five-year survival of 66% for stage I disease and 10% for stage III disease.

68
Q

What should patients be informed about before oesophago-gastro-duodenoscopy?

A

The procedure involves inspection of the upper GI tract with a flexible endoscope, and they can choose sedation or local anaesthetic.

69
Q

What are the risks associated with oesophago-gastro-duodenoscopy?

A
  • Perforation
  • Bleeding
  • Damage to teeth
  • Risks associated with sedation
  • Aspiration.

UL Final Year OSCE's & Short Cases (107 decks)

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