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