Upper GI

Question 1

Risk factors for Oesophageal cancer

Answer 1

smoking
alcohol
GORD
Barrett's oesophagus - adeno
achalasia - squam
Plummer-Vinson syndrome
squamous cell carcinoma is also linked to diets rich in nitrosamines
rare: coeliac disease, scleroderma

Question 2

Diagnosis of oesopahgeal cancer

Answer 2

Upper endoscopy
Contrast swallow
Staging with CT (chest, abdo, pelvis)

Question 3

Mx of oesophageal cancer

Answer 3

Surgery (oesophagectoy) and adjuvant chemotherapy

Question 4

Acalculous cholecystitis

Answer 4

Have intercurrent illness, systemically unwell gallbladder inflammation in absence of stones
High fever

Question 5

Gallstone Illeus

Answer 5

Hx of cholecystitis and known gallstones - small bowel obstruction

Question 6

Gallbladder abcess

Answer 6

Prodromal illness
RUQ pain 
Swinging pyrexia 
Systemically unwell
no generalised peritonism

Question 7

Chronic pancreatitis

Answer 7

Inflammatory condition which can effect both exocrine and endocrine functions of pancreas
- 80% due to alcohol and 20% unexplained

Features:

• pain worse 15-30 mins post meal
• steatorrhoea (5-25 years post pain onset)
• Diabetes mellitus

Ix: Abdo Xray (calcification)
CT
Functional tests: faecal elastase

Mx: Pancreatic enzyme supplements, analgesa, antioxidants

Question 8

Consequences of pancreatitis

Answer 8

perpancreatic fluid collections
Pseudocysts
Pancreatic necrosis
Pancreatic abcess
Haemorrhage

Question 9

Pancreatic pseudocyst

Answer 9

• peripancreatic fluid collections (can communicate with ductal systems)
• post retrogastric
• 75% associated with raised amylase
• occur typically 4 weeks post
• 50% resolve - therefore rv for 12 weeks
• Mx with endoscopic or surgical cystogastrostomy or aspiration

Question 10

Pancreatic necrosis

Answer 10

Can involve pancreatic parenchyma and surround fat

Question 11

Dukes Classification

Answer 11

A - mucosa
B - Invading bowel wall
C - lymph node mets
D- distant mets