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RCSI SURGERY > Upper GI > Flashcards

Upper GI Flashcards

1
Q

barretts esophagus

A

endoscopically visible columnar epithelium within the esophagus regardless of length , with interstitial metaplasia and histological examination
- IRREVERSIBLE

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2
Q

percentage of Barrets esophagus that goes to cancer

A

1%

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3
Q

causes of difficulty / painful swallowing

A

ANATOMICAL

  • FB, malignancy, web, pharyngeal pouch, strictures, schedlasia
  • EXTRENSIC lesions: LAD, retrosternal loiter, bronchial CA, left atrial enlargement due to MS
FUNCTIONAL 
NEURO 
- post CVD, MND, globus hystericus 
ESOPHAGEAL dysmotility 
- diffuse esophageal spasm 
- scleroderma
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4
Q

Plummer vinson syndrome

A

non b islet cell tumour secreting gastrin ass. w/ acid hyper secretion and severe PUD

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5
Q

ph study score

A

DeMESSTER score - composite that measures of reflux episodes and length of occasions that the PH is <4

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6
Q

CXR of achalasia

A

air fluid level in the mediastinal shadow with dilated esophagus

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7
Q

achalasia

A

characteristic increase pressure in LE and failure to relax due to a damage of ganglion in Auerbach’s plexus resulting in poor parastasis throughout the esophagus

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8
Q

investigation achalasia

A
  1. endoscopy
  2. barium swallow - bird beak
  3. manometry - absence parastasis
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9
Q

complicationachalasia

A

nocturnal aspiration
bronchiectasis
lung abscess
carcinoma - 3% - SCC

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10
Q

treatment achalasia

A
  1. ballon dilatation
  2. Heller’s cardiomyotomy
  3. injection of botulinum toxin - injection into LOS
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11
Q

diffuse esophageal spasm

A

retrosternal pain radiating to the jaw and inter capsular region and you get NUTCRACKER ESOPAHgus with high amplitude peristalsis

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12
Q

treatment diffuse esophageal spasm

A

nifdepine and reassurance

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13
Q

chagas disease

A

similar to achalechia due to trypanosome cruzi . also ass. w/ megacolon, CM, megaduodenum, megaureter

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14
Q

manometry findings in scleroderma

A

HYPOTENSIVE

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15
Q

what is the number one test for hiatus hernia

A

Barium swallow

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16
Q

GERD Definitionn

A

reflux of gastric contents into the esophagus, esophageal ph <4 for 4% over a 24 hour period on ph Monitoring

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17
Q

Cause of GERd

A
  1. esophageal clearance - relies on gravity, saliva flow, normal motility, fixation to efficient peristalsis
  2. LES competence
    - OCP, smoking, pregnancy lose LOS tone
  3. Gastric clearance
    - gastic outlet obstruction can reflux
    - obseity and pregnancy- causes low clearance b/c increase pressure in abdomen
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18
Q

What surgery for GERD

A

nissen fundoplication - wraps the funds of the stomach around the intra=abdominal esophagus to augment high pressure zones
INDICATIONS:
- persistent symptoms despite max medical treatment
- large reflux with aspiration pneumonia
- Complication of reflux - stricture and severe ulcerations

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19
Q

test for H.pylori

A

urease testing (from Bx on endoscopy)
Urea breath testing
stool antigen test
serology

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20
Q

failure of PU to heal with meds

A
  1. NSAID sbuse
  2. non compliant
  3. chrons
  4. gastric secreting tumour
  5. malignancy
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21
Q

treatment of haemorrhage in pUD

A
  • injection of adrenaline, thermo-coagulation , clipping, hawmostasis, nano powered spray

if these fail
- surgery - overseeing of the artery

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22
Q

treatment of perf PUD

A

ulcer overseen and secured with a plug of omentum

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23
Q

Gastric outlet obstruction how?

A

pylorus / pre pylori are areas of chronic ulcerations , healing with fibrosis leads to stricture formation and pyloric stenosis

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24
Q

Gastric outlet obstruction clinical

A

projectile vomitting unrelated to eating, episodic

SUCCUSSION SPLASH on abdo exam

HYPOCLOREMIC ALKALSIS

DILATED STOMACH

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25
Q

Gastric outlet obstruction Tx

A 
aggressive resuscitation 
gastric drainage 
gastro-enterostomy
 truncal vagotomy
prloroplasty 
rare: 
- partial gastrectomy
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26
Q

treatment adenocarcinoma in the esophagus

A

SRUGERY

CTX

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27
Q

treatment of SCC of esophagus

A

surgery

RTX

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28
Q

causes adenocarcinoma of esophagus

A 
GERD 
Baretts 
obesity 
high fat intake 
cigarettes 
high alcohol intake
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29
Q

causes SCCof esophagus

A 
high alcohol intake 
tobacco use 
nitrosamines 
vita and C
coeliac idsase 
strictures and webs 
achalasia 
PUD
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30
Q

staging of esophagus investigation

A

local: endoluminal Ultrasound
regional: CT scanning and laparoscopy (to asses peritoneal disease)
Disseminated: PET scanning may be use to exclude occult disseminated disease in patients otherwise consider potentially curative tx

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31
Q

surgical treatment for esophageal cancer

A

Ivor Leis procedure (abdomen - throat opened)

McKwoen three phase esophagectomy (ado-thorax- neck)

Transmittal resection (abdo- neck opened)

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32
Q

CTX treatment for esophageal cancer

A
  • adeno
  • patient is fit
  • curative
  • mets
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33
Q

RTX treatment for esophageal cancer

A
  • SCC
  • strictures
  • fistulas
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34
Q

palliative treatment for esophageal cancer

A
  1. incubation
  2. stent - SEMS - self expanding metal stenting
  3. laser treatment
    - good for intrinsic tutors
    - carries risk of perforation
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35
Q

R.F for gastric adenocarcinoma

A
  • diet rich in Nitrosamines (smoked fresh fish, pickled fruit)
  • chronic Atrophic gastritis
  • blood group A
  • chronic gastric ulceration related to H. pylori

NAAH

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36
Q

symptoms of gastric adenocarcinoma

A
  • DYSPEPSIA (indigestion)
  • N V WL Anorexia
    Anemia - Fe deficiency
    EARLY SAIETY
37
Q

signs gastric adenocarcinoma

A
  • WL
    palpable epigastric mass
    Supraclavicular nodes - VIRCHOWS and Troisers sign
38
Q

Dx gastric adenocarcinoma

A 
- gastroscopy and Bx 
Staging investigation 
- CT TAP 
- endoluminal US 
- laparoscopy
39
Q

treatment gastric adenocarcinoma - GOLD STANDARD

A
  1. SURGERY

- resection - GOLD STANDARD

40
Q

Treatment gastric adenocarcinoma

A

surgery - number 1
if advanced disease - not surgical candidates
total or partial gastrectomy
chemotherapy
palliation (with limited radiation therapy (palliative gastrojejunostomy to control symptoms

41
Q

dumping syndrome

A

late complication post gastrectomy
- general weakness, faint and sweating
Early: rapid transit of hyperosmolar solutions
late: hypoglycaemia due to increase insulin secretion

42
Q

epidemiology gastric adenocarcinoma

A

Men > 50

43
Q

acute complication of gastrectomy

A 
ACUTE PANCREATITIS 
others: 
- haemorrhage 
anastomotic leak 
duodenal stump disribution 
respiratory compromised
44
Q

how long before OGD do you have to go without food and water

A

6 hours fasting

2 hours water

45
Q

what medication do you have to stop prior to OGD

A

PPI for 2 weeks before OGD

tell patient to warn doctor if they are on warfarin aspirin or plavix

46
Q

prehaptic causes of Jaundice

A

H.A
Congenital hyperbilirubinemia
transfusion reactions
Drug toxicity

47
Q

intraheptatic causes of Jaundice

A

UCB:

  • CN (absence UGT uridine glucoronyl transferase)
  • Gilbert syndrome ( defect in the bilirubin canicular transport
CB
- viral hepatits 
alcoholic liver disease 
toxic drug jaundice 
mets
48
Q

post hepatic obstructive jaundice cause

A

Intramural - cholidocolithaisis
Mural - biliary stricture , PBC
Extrinsic - pancreatitis , pancreas carcinoma
enlarged LN , Mirizzi syndrome

-

49
Q

Mirizzi syndrome

A

external biliary compression from stone impacted in the neck of the gallbladder

50
Q

medications that cause Jaundice

A

Chlorpromazine

51
Q

Spider Navei pathological

A

> 3 in the Superior Vena Cava distribution

52
Q

Ascites in abdomen

A

Hypoproteninaemia

intra abdo malignancy - pancreas , stomach, ovary, colon

53
Q

Caput medusae

A

Portal hypertension ass. w/ CLD

54
Q

large tender smooth live

A

Hepatitis

55
Q

Large irregular liver

A

mets

56
Q

Courvoisor’s Law

A

non tender palpable gallbladder in the presence of jaundice is UNLIKELY to be gallstones and duet malignant obstruction of the gland

57
Q

LFT of hemolysis

A

RISED UCB

NORMAL Alk P, GGT, transaminase, lactate dehydrogenase

58
Q

LFT in hepatocellular

A

RAISED AST and ALT
less raised GGT, lactate dehydrogenase
NORMAL alk phospate
RASIED UCB

59
Q

OBSTRUCtive LFT

A

VERY RAISED ALK P, GGT
Transaminase normal
lactate dehydrogenase - Normal
UCB - normal

60
Q

what autoantibodies do you test in liver disease

A

anti-microsomal (PBC)
anti-nuclear
anti-smooth muscle

61
Q

US findings in gallstones

A

dilated cystic duct
thickened gallbladder wall
gallstone

62
Q

General treatment of Liver disease

A

correct dehydration
monitor urine output
clotting factors (vit K if PT is prolonged)
Diet - enternal feeding, dietician
ERCP: sphincterotomy, stent insertion , percutaneous transhepatic cholangiogram , surgical drainage

63
Q

hemolytic jaundice treatment

A

steroids for autoimmune cases

splenectomy

64
Q

hepatic failure

A

transplantation

65
Q

head of pancreas tumour tx

A

whipples prancreATICOduodeneCTOMY

66
Q

definition acute pancreatitis

A

is an inflammatory process of the pancreas , resulting in release of inflammatory cytokines and pancreatic enzyme (lipase, trypsin) initiated by pancreatic injury

67
Q

acute pseudocyst

A

collection of pancreatic juice surrounded by a wall of fibrous tissue that occurs 6-8 weeks after acute pancreatitis

68
Q

pancreatic abscess

A

circumscibred intra-abdominal collection of pus arising close primximity to the pancreas but containing LITTLE TO NO pancreatic necrosis which arises as a consequence of acute pancreatitis

69
Q

medications that can cause acute pancreatitis

A

Metronidazole tetracycline
azathioprine mercaptopurine
H2 blockers

70
Q

metabolic causes of acute pancreatitis

A

hyperglycaemia
jhypercalcaemia
hypertriglyceridemia

71
Q

acute pseudocyst treatment

A

percutansou ultrasound guided drainage

72
Q

clinical pancreatitis necrosis

A

SWINING PYREXIA

73
Q

late complication of acute pancreatitis

A

DM

Malabsorption (due to loss of secretion of pancreatic digestive enzymes

74
Q

within first 2 weeks complication of acute pancreatitis

A

multiple organ failure
- cardiovascular collapse from fluid shifts
- pulmonary failure
- pneumonia
- ARD
- renal failure from hypotension.
Pancreatic necrosis and peri-pancreatic necrosis

75
Q

after 2 weeks complication of acute pancreatitis

A

pancreatic psudeocyst

pancreatic abscess

76
Q

chronic pancreatitis

A

characterized by recurrent or persistent abdominal pain and pancreatitis , often ass. with either exocrine or endocrine pancreatic insufficiency

77
Q

chronic inflammation in chronic pancreatitis cases

A
  • glandular atrophy
  • ductal ectasia
  • micro calcification
  • intraductal stone formation
  • ## cystic changes secondary to duct formation
78
Q

Causes chronic pancreatitis

A

1/ recurrent episodes of acute pancreatitis usually alcohol induced

2/ secondly to pancreatic duct obstruction

  • pancreatic head tumours and cyst
  • pancreatic duct stricture
  • congenital pancreatic abnormality
  • cystic fibrosis

3/ autoimmune - PBC, PSC

79
Q

clinical chronic pancreatitis

A

Recurrent abdo pain
STEATORRHEA
- WL and anorexia
-INSULin dependant DM

80
Q

how do you differentiate chronic pancreatitis from tumour

A

endoscopic US combined with aspiration cytology / biopsies

81
Q

how do you test exocrine function in chronic pancreatitis

A

fecal elastase

82
Q

Treatment of chronic pancreatitis

A

Treat cause - stop alcohol, cholecystectomy , treat A.I disease

Diet change
CREON 
PPI 
INSULIN - if DM 
ANALGESIA 
CONSIDER if not responding 
   - extracorporeal shock wave lithotripsy 
   - celiac nerve block 
   - denervation surgery 
SRUGERY 
- only if not responding to medical treatment with obstructed pancreatic duct 
- Whipples 
- partial or distal pancreatectomy 
pancreaticojejunostomy
83
Q

R.F for pancreatic cancer

A

smoking
alcoholism
Dm
chronic pancreatitis

84
Q

type of pancreatic cancer

A

ductal adenocarcinoma
Cystic neoplasm (7%)
3% islet cell tumours

85
Q

tumour marker for pancreatic Ca

A

CA 19-9

86
Q

images for pancreatic Ca

A

US abdomen - to investigate obstructive jaundice - gallstone

CT - to see pancreatic mass, local invasion, mets

endoscopic US - detecting SMALL CA and peripancreatic node involvement

US or CT guided FNA cytology

ERCP

PET

LAPrascopy - for staging (outule peritoneal disease)

87
Q

most common endocrine pancreatic tumour

A

INSULINOMA - whipple’s triad
Symptoms due to hypoglycemia especially after fasting or heavy exercise
A low plasma glucose with symptoms
Relief of symptoms when the glucose is raised to normal

88
Q

endocrine pancreatic tumour investigation

A

abdominal CT scanning and selective pancreatic arteriography

RCSI SURGERY (7 decks)

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