Upper GI Flashcards

1
Q

in patients with lower third oesophageal cancer which procedure is usually done?

A

an Ivor - Lewis type procedure is most commonly performed. Very distal tumours may be suitable to a transhiatal procedure

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2
Q

in patients with oesophageal cancer higher than the lower third which procedure is usually done?

A

total oesphagectomy (Mckeown type) with anastomosis to the cervical oesophagus.

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3
Q

Options for unresectable oesophageal disease?

A

local ablative procedures, palliative chemotherapy or stent insertion.

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4
Q

What is the rockall score for?

A

severity UGI bleed

Score <3 = Good prognosis (mortality approx. 2%)

Score >8= High mortality (Mortality approx. 40%)

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5
Q

What are the components of the rockall score?

A

ABCDE
A: Age
B: Blood pressure drop (Shock)
C: Co-morbidity
D: Diagnosis
E: Evidence of bleeding

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6
Q

Causes of oesophageal bleed?

A

oesophagitis
cancer
mallory weiss tear
varices

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7
Q

Causes of gastric bleeding?

A

gastric cancer
Dieulafoy Lesion
Diffuse erosive gastritis
Gastric ulcer

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8
Q

Most common cause of haemorrhage in GI?

A

Posteriorly sited duodenal ulcer

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9
Q

Management of UGI bleed?

A

Cross match blood, check FBC, LFTs, U+E and Clotting (as a minimum)
Patients with on-going bleeding and haemodynamic instability are likely to require O negative blood pending cross matched blood
Varices -> terlipressn
UGI endoscopy <24h

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10
Q

Indications for surgery with UGI bleed?

A

Patients > 60 years
Continued bleeding despite endoscopic intervention
Recurrent bleeding
Known cardiovascular disease with poor response to hypotension

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11
Q

Which score predicts need for admission?

A

Blatchford

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12
Q

most common cause of biliary disease in patients with HIV?

A

sclerosing cholangitis due to infections such as CMV, Cryptosporidium and Microsporidia

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13
Q

What is not well absorbed following gastrectomy?

A

vit b12 and folic acid as no intrinsic factor produced

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14
Q

What is post gastrectomy syndrome?

A

Rapid emptying of food from stomach into the duodenum: diarrhoea, abdominal pain, hypoglycaemia
Complications: Vitamin B12 and iron malabsorption, osteoporosis
Treatment: High protein, low carbohydrate diet. Replace B12/Fe/Ca

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15
Q

Which hormones delay gastric emptying?

A

gastric inhibitory peptide
Cholecystokinin
Enteroglucagon

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16
Q

which hormones increase gastric emptying?

A

gastrin

17
Q

What may occur following gastrectomy?(syndromes)

A

Small capacity (early satiety)
Dumping syndrome
Bile gastritis
Afferent loop syndrome
Efferent loop syndrome
Anaemia (B12 deficiency)
Metabolic bone disease

18
Q

The cell of origin in virtually all pancreatic carcinomas is which of the following?

A

ductal cells
(ductular epithelium)

19
Q

Clinical features of pancreatic cancer?

A

Weight loss
Painless jaundice
Epigastric discomfort (pain usually due to invasion of the coeliac plexus is a late feature)
Pancreatitis
Trousseau’s sign: migratory superficial thrombophlebitis

20
Q

Investigations for pancreatic cancer?

A

USS: May miss small lesions
CT Scanning (pancreatic protocol). If unresectable on CT then no further staging needed
PET/CT for those with operable disease on CT alone
ERCP/ MRI for bile duct assessment
Staging laparoscopy to exclude peritoneal disease

21
Q

During an Ivor Lewis Oesophagectomy for carcinoma of the lower third of the oesophagus which structure is divided to allow mobilisation of the oesophagus

A

azygous vein

22
Q

What is the zollinger Ellison syndrome triad?

A
  1. Non beta islet cell tumours of the pancreas
  2. Hypergastrinaemia
  3. Severe ulcer disease
23
Q

Where are gastronomas most commonly located?

A

duodenum (in up to 50% patients), then the pancreas (approximately 20%). Other ectopic areas include stomach, spleen, gallbladder and ovary