Upper GI

Question 1

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

Answer 1

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

Question 2

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

Answer 2

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

Question 3

Options for unresectable oesophageal disease?

Answer 3

local ablative procedures, palliative chemotherapy or stent insertion.

Question 4

What is the rockall score for?

Answer 4

severity UGI bleed

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

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

Question 5

What are the components of the rockall score?

Answer 5

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

Question 6

Causes of oesophageal bleed?

Answer 6

oesophagitis
cancer
mallory weiss tear
varices

Question 7

Causes of gastric bleeding?

Answer 7

gastric cancer
Dieulafoy Lesion
Diffuse erosive gastritis
Gastric ulcer

Question 8

Most common cause of haemorrhage in GI?

Answer 8

Posteriorly sited duodenal ulcer

Question 9

Management of UGI bleed?

Answer 9

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

Question 10

Indications for surgery with UGI bleed?

Answer 10

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

Question 11

Which score predicts need for admission?

Answer 11

Blatchford

Question 12

most common cause of biliary disease in patients with HIV?

Answer 12

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

Question 13

What is not well absorbed following gastrectomy?

Answer 13

vit b12 and folic acid as no intrinsic factor produced

Question 14

What is post gastrectomy syndrome?

Answer 14

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

Question 15

Which hormones delay gastric emptying?

Answer 15

gastric inhibitory peptide
Cholecystokinin
Enteroglucagon

Question 16

which hormones increase gastric emptying?

Answer 16

gastrin

Question 17

What may occur following gastrectomy?(syndromes)

Answer 17

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

Question 18

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

Answer 18

ductal cells
(ductular epithelium)

Question 19

Clinical features of pancreatic cancer?

Answer 19

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

Question 20

Investigations for pancreatic cancer?

Answer 20

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

Question 21

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

Answer 21

azygous vein

Question 22

What is the zollinger Ellison syndrome triad?

Answer 22

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

Question 23

Where are gastronomas most commonly located?

Answer 23

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