Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Key Points > Upper GI > Flashcards

Upper GI Flashcards

1
Q

Vitamin deficiencies

A

A: xerophthalmia, night-blind, hyperkeratosis;
D: rickets, osteomalacia (normal density, poor minerlisation - soft)
E: haemolytic anaemia, ataxia
K: coagulation disorder

B1 (thiamine): beri-beri; wernicke-korsakoff
B2 (riboflavin): glossitis, stomatitis
B3 (niacin): pellagra (derma, dd, dementia)
B6 (pyridoxine): polyneuropathy
B7 (biotin): dermatitis, alopecia, paraesthesia
B9 (folate): anaemia
B12 (cobalamin): anaemia, neuropathy
C: scurvy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

vitamin excess:

A

A: liver damage, bone damage, terato
D: hypercalcaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

NGT

A

empty stomach: pre-op, obstruction, ileus, GOO, panc, aspiration risk
intra-op: deflate/inflate stomach, decompress bowel, test anastamoses
irreversible dysphagia e.g. MND
feeding: fine bore tube

SE: pain, electrolytes, oesophagitis, necrosis, perf, intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

undernutrition

A

increased requirement, increased losses, intake, treatment SE/D&V, NBM

immunity, healing, recovery, wasting/weakness, cardioresp function, psych/mood, fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

obesity

A 
overweight 25-30;
class I= 30-35; II= 35-40; III= >40 (surgery)

metabolic syndrome, liver, GORD, hernia, ventilation/OSA, OA, VV, cancer

Roux-en-Y (stomach bypass), banding (vert/adjust), bilio=panc diversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ALARM SYMPTOMS (?cancer - scope!)

A 
anaemia
loss of weight
anorexia and vomiting
recent onset
malaena/bleeding
swallowing issues

age >55yo
abdo mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Dyspepsia DDx

A

GORD: give PPI; risk of stricture, metaplasia
PUD: check H. pylori/CA; stop NSAIDs and smoking
Cancer: gastric, oesophageal
functional (non-ulcer) and non-erosive GORD
non-GI: heart, lungs, liver, GB, panc
drugs: NSAID, nitrates, CST, theo, Ca-agonist

scope +/- biopsy: accurate diagnosis
(normal = functional dyspepsia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

GORD presentation etc.

A

heartburn >2/w (retrosternal, positional, heat worse)
regurgitation (food and acid)
belching, acidbrash, waterbrash, odynophagia
worse asthma

RF: CREST, weight, diet, drugs (TCA, NSAID, CCB), H. Pylori, ZES

Tx if no red flags: life, antacid, alginates, PPI/anti-H
scope if ALARM, Tx fail, relapse, >4/52
Nissen Fundoplication: severe/refractory, young

complications: oesophagitis, ulcers, strictures, Barrett’s, AC/SqCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dysphagia DDx

A

oropharyngeal: higher; neuro; aspiration risk
lower oeso: localised; ‘stuck’ +/- regurg

mouth: tonsilitis, globus (functional)
neuromm: pharynx, bulbar palsy, MG/MS/CVA/PD
dysmotility: achalasia, SSc, spasm, DM
extrinsic: LA, goitre, AAA, L atrium, tumours
intrinsic: FB, stricture, webs (PWS), atresia, P-pouch
* PWS: IDA + webs + dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Dysphagia Hx + Ix

A

progressive (solids - liquids): Ca, stricture
solids + liquids: achalasia, neuro, pharyngeal
pain: Ca, ulcer, infection/inflam, spasm
intermittent = spasm; dry swallow = bulbar

Ix: bloods, CXR, scope + Bx,
oeso motility: manometry, barium swallow
orophary: videofluoroscopy + neuro testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

oeso cancer presentation

A

60-70yo; 30% lower (AC), 50% mid (SCC)
AC: metaplastic/stomach spread; earlier LN
SCC: drink/ciggs; later presentation, early LN

progressive persistent dysphagia
retrosternal pain, cough, aspiration,s anorexia/satiety

RF: ciggs/alc, diet, RDT, strictures, achalasia, Barrett’s/GORD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Oeso cancer treatment

A

staging: Barium, CXR, scope + Bx/EUS, CT/MRI

radical curative oesophagectomy: T1/2 (20-30%); transhiatal/3 stage open/ILO
neoadjuvant CTX (cisplatin + 5FU): morbidity risk
CTX + RDT if no operation
palliative: stent (risk of perf, bleed, stuck food bolus)

prognosis: poor but SCC better
<10% 5ys; mets in 25-30% at Dx (liver, lung, bone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

achalasia

A

tonic muscle contraction/peristaltic spasm
progressive megaoesophageus (prox dilatation)
RF for oeso CA

middle-aged, dysphagia, regurg, cramping, weight loss

OGD, barium swallow (rat’s tail), manometry (pressure)

Tx: small meals; balloon (recurs); cardiomyotomy; botulinum (last)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ZES

A

Gastrinoma: high fasting gastrin + secretin stimulation test
epigastric pain + diarrhoea
malabsorption
multiple duodenal ulcers

30% part of MEN1 (parathyroid, pit, panc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

!!(DELETE)

To-DO

A

antibodies: ANA/anti-SM = AIH; PBC = anti-mito

* PSC = IBD-assoc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

PUD

A

aetio: H. pylori (D > G), NSAIDs, cigg/alc, stress, ZES, acid/caff

burning epigastric pain, food-related (gastro worse, duo better)
nausea, anorexia/satiety, weight loss
haematemesis and melaena
?perf: severe, persistent, back pain

clinical Dx unless ALARM/>55 (scope)
test for H. pylori if refractory and no PMH
(ulcer PMH = assume infection)

Tx: antacids +/- anti-reflux +/- ABx (H. pylori)
comps: hge, perf, stenosis; (operate)

17
Q

PUD - Duo vs. gastric

A

duo: commoner, pain pre-meal + night, +/- back pain, melaena more likely, more complications
gastro: older (55-65yo), post-food worse, haematemesis more likely, cancer more likely if not lesser curve

18
Q

GI Hge DDx

A

PUD: 45-50% (PPI, ligate, adr, diathermy)
Mallory-Weiss tear:15%
gastroduo erosions: 10%
reflux oesophagitis: 10%
inflammation: gasto, duo, oeso (pain + vom)
varices: 7% (banding + BB/terlipressin)
gastric CA: usually small bleeds
post-PCI: 2% of PCI
Boerhaave’s: oeso rupture (pneumo-m’stinum)
rare: gastric AVM, portal HTN, GIST, angiodysplasia

19
Q

Glasgow-Blatchford score (pre-endo)

A

decide need/urgency of scope
0 low risk; higher = likely intervention; 6 = >50% need
*urgent scope: <4h if ?varices; 12-24h if shock/co-morbid

urea (2/3/4/6)
Hb (F = 1/6, M = 1/3/6)
SBP (1-3)
tachycardia (1)
melaena (1)
syncope/hepatic disease/heart failure (2)
20
Q

Rockall score (post-endo)

A

prognosis: rebleed and mortality

age
shock
comorbidity
diagnosis: Mallory vs. other vs. CA
recent hge signs on scoping

pre-endo 7 = 50% mortality
post-endo 7 = 27% mortality
post-endo 8 = 41.1%

21
Q

Lower GI Hge DDx (HAND CrAC)

A 
Haemorrhoids
Angiodysplasia
Neoplasm
Diverticular
Crohn's 
Anal fissure
Colitis (ischaemic, inflammatory, infective)
22
Q

GI Hge: Sx2

A

haematemesis, melaena, haematochezia (PR)
postural hypoTN/dizzy, syncope
abdo pain

shock (HR, BP), low JVP, cold and clammy
CLD stigmata, purpura
low UO, Urea (»Cr), lactate
jaundice (biliary colic + jaundice + melaena = ?haemobilia)

23
Q

GI Hge management

A

1) assess for shock
* not shocked: IV access, bloods, vitals, UO, ?transfuse (Hb >8)

2) protect airway + NBM
3) access + bloods (FBC, UE, LFT, BM, clotting, XM 6)
4) O2 + fluid resus (MAP 65) + monitor UO (>30/h)
5) correct clotting: vit K, FFP, plt (<50), terlipressin (varices)
6) monitor 15mins until stable (then hourly)
7) urgent scope (consult surgeons)
8) ?IV omeprazole (stabilise clot, prevent re-bleed)
9) ?anti-emetic (gastric emptying), transexamic acid

24
Q

Gastric Cancer Sx2

A

RF: male, H. pylori/gastritis, diet, ciggs/alc, group A, pernicious, polyps, FHx

epigastric pain (food better), N&V, dysphagia
anorexia, satiety, weight loss
anaemia, dyspepsia (>1/12 + >55yo UPO)

palpable mass (50%; late stage)
hepmeg, ascites, jaundice
Virchow’s node/ Troisier’s sign
acanthosis nigricans/dermatomyositis

25
Q

Gastric Cancer Mx (Ix + Tx)

<10% 5ys (20% if radical surgery)

A 
FBC, UE, LFT
gastroscope + biopsies
barium meal (filling defect, irregular rolled ulcer)
EUS + CT/MRI (staging)
staging laparoscopy if ?M0

partial/total gastrectomy (distal/proximal)
chemotherapy (advanced disease)
endoscopic mucosal resection (early disease)
palliation CTX/RDT: obstruction, pain, hge

26
Q

Gastrectomy complications

A

ulceration, gastric tumour
abdo fullness, loop obstruction
bilious vomiting, diarrhoea
dumping syndrome: osmosis - faint + sweat
weight loss, anaemia, malabsorption, osteomalacia

27
Q

Gastric Ca pathology

A

mostly antral and AC (90%)
local + lymph spread: malignant ascites, Krukenberg, umbilical nodule

intestinal TI: commonest; metaplasia; polyp/ulcer; well/mod-diff
intestinal TII: signet ring, linitus plastica, poor-diff

other CA: stromal, GIST, lymphoma, carcinoid, polyps

28
Q

Gastric Ca staging (Borrmann classification)

A

1: polypoid
2: excavating
3: ulcerated and raised
4: infiltrative
5: early - limited to mucosa/submucosa

early disease/Dx rare; usualyl late stage

29
Q

Acute Abdomen: Ix/Tx

A

FBC, UE, LFT, CRP, ABG/lactate, UA
MUST DO AMYLASE AND b-HCG
erect CXR; ECG if >50yo/PMH
USS, AXR, CT, ERCP/MRCP

laparoscopy
laparotomy: ruptured organ, peritonitis

*remember: AAA, panc, DKA, gynae, testicular, heart, lungs, haemo

Key Points (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions