Upper GI Flashcards
Patient presents with flushed appearance, weight loss and raised serotonin levels
Carcinoid
Sudden onset chest, neck and upper abdo pain. Hypotensive and tachycardia. Surgical emphysema present in suprasternal notch and CXRRR shows pneumomdeiastinum
Oesophageal perforation
What is Mirizzi syndrome?
common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder
Which artery is most likely causing haemorrhage in first part of duodenum?
Gastroduodenal artery
CXR shows rertrocardiac gas filled viscus with a double air-fluid level
Gastric volvulus
Preferred treatment for patient with oesophageal carcinoma in middle to lower third of oesophagus?
Ivor-lewis procedurer
What tumour is the most common in the appendix and terminal ileum and what is it?
Carcinoid
A neuroendocrine tumour producing serotonin.
Which tumour commonly occurs in the ileum and how are they treated?
Lymphoma
Primary are resected and secondary lymphomas are treated with chemo.
What causes ongoing epigastric abdo pain and raised amylase in chronic pancreatitis?
pseudocyst
Collection of amylase rich fluid enclosed within fibrous or granulation tissue.
What is a highly selective vagotomy procedure?
Aims to remove only the vagal stimulation to the parietal cell mass in the body of the stomach to reduce acid secretion but preserve gastric emptying
What is Billrorth I procedure?
Removal of pylorus, and the distal stomach is anastomosed directly to the duodenum which results in better protein and fat digestion compared to a Billroth II procedure; however results in higher level of gastric outlet obstruction
What is Roux-en-Y procedurer?
commonly used in weight loss surgery.
Creation of small stomach pouch ensures that large amount of food cannot be consumed and bypassing the duodenum means that fat absorption is greatly reduced
What is truncal vagotomy?
eliminating the vagal stimulation to the stomach which reduces acid secretion but leads to gastric paralysis which requirers a further prqccedurrer such as pyloroplasty or gastrojejunostomy to be performed to ensurer adequate stomach drainage
What is Billroth II?
anastomosis of the greater curvature of the stomach to the first part of the jejunum following resection of the lower end of the stomach. indicated in refractory peptide ulcer disease and gastric adenocarcinoma
Presentation of adenocarcinoma in the oesophagus?
lower third of oesophagus
Associated with:
- smoking
- alcohol
- obesity
- Barrrett’s oesophagus
- GORD
- neostigmine ingestion
Presentation of squamous cell carcinoma in the oesophagus?
upper two thirds of oseophagus
Associated with:
- smoking
- alcohol
- achalasia
- coeliac disease
- Plummer-vinson syndrome
What is achalasia?
Oesophageal motility disorder where there is failure of lower oesophageal sphincter relaxation and loss of oseophageal peristalsis
Bird’s beak appearance in barium swallow
Most common complication following a splenectomy?
Thrombocytosis
Features of hyposplenism?
Howelll-Jolly bodies and pappenheimer bodies
Features of hypersplenism?
Anaemia
Thromboccytopenia
Leucopenia
What are the causes of cholangitis
Gallstones
Head of pancreas malignancy
Primary sclerosing cholangitis
Cholangiocarcinoma
Bile duct stricture
What are the potential complications of obstructive jaundice?
AKI
Sepsis
Encephalopathy
Coagulopathy
Hepatic failure
Renal failure
Malabsorption
What are gallstones made from?
Cholesterol and bile
Describe the metabolism of billirubin
Bilirubin is a byproduct of red blood cell metabolism
it travels bound to albumin to the liver where it is conjugated to glucuronic acid
Then it is excreted through bile into the bowel where it is further metabolised into urobilinogen and stercobilinog.
What is barretts oesophagus
affects the lower this of the oesophagus and is characterised by metaplasia of the stratified squamous epithelium to simple columnar epithelium
Causes of peptic ulcer disease
H. Pylori
Ischaemia
Burns
Stress
Alcohol
Smoking
Differences between gastric and duodenal ulcers
Gastric ulcer
50yr
Pain on eating
not-cyclic
pain relieved by vomiting
Duodenal Ulcer
25-30yr
Pain relieved by eating
cyclic
no vomiting
Management of peptic ulcer disease
Stop smoking
Reduce alcohol
Avoid NSAIDs
PPI
Define Troisier’s sign and what does this indicate?
Enlarged hard left supraclavicular lymph node which indicates a metastatic abdominal malignancy
Predisposing factors to gastric carcinoma
H.pylori
Blood group A
Low vit C
Hypergammaglobinaemia
Gastric polyp
Penicious anaemia
Types of hiatus hernias
Sliding
Roling
Presentations of different types of hiatus hernias
Sliding: dyspepsia and vomiting
Rolling: dyspepsia, odynophagia, dyspnoea on eating, dyspnoea on bending down
Complications of hiatus hernia
Incarceration
Strangulation
Gastric volvulus
Most common primary liver tumour and tumour marker
Hepatocellular carcinoma
Alpha-fetoprotein (AFP)
Surgical treatment options for pancreatic tumour?
Whipple’s procedure
Pancreaticodudenoectomy
