Upper GI Flashcards
in patients with lower third oesophageal cancer which procedure is usually done?
an Ivor - Lewis type procedure is most commonly performed. Very distal tumours may be suitable to a transhiatal procedure
in patients with oesophageal cancer higher than the lower third which procedure is usually done?
total oesphagectomy (Mckeown type) with anastomosis to the cervical oesophagus.
Options for unresectable oesophageal disease?
local ablative procedures, palliative chemotherapy or stent insertion.
What is the rockall score for?
severity UGI bleed
Score <3 = Good prognosis (mortality approx. 2%)
Score >8= High mortality (Mortality approx. 40%)
What are the components of the rockall score?
ABCDE
A: Age
B: Blood pressure drop (Shock)
C: Co-morbidity
D: Diagnosis
E: Evidence of bleeding
Causes of oesophageal bleed?
oesophagitis
cancer
mallory weiss tear
varices
Causes of gastric bleeding?
gastric cancer
Dieulafoy Lesion
Diffuse erosive gastritis
Gastric ulcer
Most common cause of haemorrhage in GI?
Posteriorly sited duodenal ulcer
Management of UGI bleed?
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
Indications for surgery with UGI bleed?
Patients > 60 years
Continued bleeding despite endoscopic intervention
Recurrent bleeding
Known cardiovascular disease with poor response to hypotension
Which score predicts need for admission?
Blatchford
most common cause of biliary disease in patients with HIV?
sclerosing cholangitis due to infections such as CMV, Cryptosporidium and Microsporidia
What is not well absorbed following gastrectomy?
vit b12 and folic acid as no intrinsic factor produced
What is post gastrectomy syndrome?
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
Which hormones delay gastric emptying?
gastric inhibitory peptide
Cholecystokinin
Enteroglucagon
which hormones increase gastric emptying?
gastrin
What may occur following gastrectomy?(syndromes)
Small capacity (early satiety)
Dumping syndrome
Bile gastritis
Afferent loop syndrome
Efferent loop syndrome
Anaemia (B12 deficiency)
Metabolic bone disease
The cell of origin in virtually all pancreatic carcinomas is which of the following?
ductal cells
(ductular epithelium)
Clinical features of pancreatic cancer?
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
Investigations for pancreatic cancer?
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
During an Ivor Lewis Oesophagectomy for carcinoma of the lower third of the oesophagus which structure is divided to allow mobilisation of the oesophagus
azygous vein
What is the zollinger Ellison syndrome triad?
- Non beta islet cell tumours of the pancreas
- Hypergastrinaemia
- Severe ulcer disease
Where are gastronomas most commonly located?
duodenum (in up to 50% patients), then the pancreas (approximately 20%). Other ectopic areas include stomach, spleen, gallbladder and ovary
