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Surgery Revision > Upper GI > Flashcards

Upper GI Flashcards

1
Q

Common causes of upper GIT bleeding

A

Oesoph

  • varices
  • Mallory Weiss

Stomach

  • ulcer
  • erosive hemorrhagic gastritis

Duodenum

  • ulcer
  • erosive duodenitis
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2
Q

Uncommon causes of upper GI bleeding

A
  • tumours
  • stomal/anastomotic ulcers
  • vascular malformations
  • oesophagitis
  • oesophageal ulcers
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3
Q

Most common causes of major GI bleeding

A
  • PUD

- oesophageal varices

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4
Q

Clinical findings in major haemorrhage

A
  • hypotension
  • pallor
  • weak and rapid pulse
  • poor peripheral perfusion
  • cool extremities
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5
Q

NB things to think of if a patient with upper GI bleeding has liver failure

A
  • avoid Na-containing fluids
  • give 5% dextrose
  • octreotide to lower portal pressure
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6
Q

NB diagnostic investigations for upper GI

A
  • endoscopy

- angiography

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7
Q

Forrest classification

A 
1A = spurting blood
1B = oozing blood
2A = non-bleeding visible vessel
2B = adherent clot
2C = pigmented spot
3 = clean ulcer base
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8
Q

Risk stratificaiton score for upper GI rebleed

A

Roackall Risk score

  • age
  • haemodynamic status
  • co-morbidities
  • endoscopic Dx
  • stigmata of recent Hg
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9
Q

Patients at risk of rebleeding

A
  • age >60 yrs
  • shock on admission
  • endoscopic stigmata of recent bleed
  • large ulcers (>2cm)
  • lesser curvature gastric and post-duodenal bulb ulcer
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10
Q

Indications for surgery for upper GI bleeding

A
  • exsanguinating Hg
  • associated perforation
  • failed endoscopy of active bleeding in shocked patient
  • recurrent bleeding after endoscopic therapy
  • patients at risk of rebleeding where endoscopy not avail.
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11
Q

Management of high risk upper GI patient

A
  • resus
  • admit to highcare
  • endoscopic therapy
  • commence IV PPIs
  • oral intake of clear fluids 6 hrs after endoscopic haemostasis
  • transition to oral PPIs
  • test for HP and eradicate
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12
Q

Symptoms of duodenal ulcers

A
  • upper abdo pain releived by food
  • nocturnal pain
  • heart burn, anorexia, vomiting and weight loss related to gastric outlet obstruction
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13
Q

Medical management of PUD

A
  • PPI

- amoxicillin and metronidazole

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14
Q

When is surgery indicated for PUD

A

To fix complications

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15
Q

Complications of PUD

A
  • haemorrhage
  • perforation
  • duodenal stenosis
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16
Q

Investigations for perforated peptic ulcer

A
  • erect chest and abdo XRAY
  • raised serum amylase
  • gastrografin swallow if doubtful

NO ENDOSCOPY

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17
Q

Surgical management of perforated peptic ulcer

A

primary closure with omental patch

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18
Q

2 types of pathology of duodenal stenosis as a result of PUD

A
  • large penetrating ulcers with inflammation and oedema
  • healed ulcer with fibrosis

Compensatory muscular hypertrophy

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19
Q

Metabolic end results of duodenal stenosis

A
  • severe dehydration
  • raised urea and heamatocrit
  • low serum Cl, Na, K
  • serum alkalosis and intra-cellular acidosis
  • decreased ionised calcium (tetany)
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20
Q

Clinical features of duodenal stenosis

A
  • long history of dyspepsia and LOW
  • anorexia, nausea and vomiting (undigested food)
  • metabolic and nutritional derangements
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21
Q

Examination findings of duodenal stenosis

A
  • dehydration
  • upper abdo distension
  • visible peristalsis
  • succussion splash
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22
Q

Investigations of duodenal stenosis

A
  • abdo XRAY
  • barium meal
  • endoscopy to exclude carcinoma
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23
Q

Treatment of duodenal stenosis

A
  • rehydration and electrolyte correction
  • enteral feeds
  • stomach washouts
  • ulcer therapy
  • endoscopic dilatation
  • often, surgery is necessary
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24
Q

3 types of gastric ulcers

A
  • prepyloric
  • combo duodenal and gastric
  • > 2cm from the pylorus on the lesser curve
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25
Q

Symptoms of gastric ulcer

A
  • pain precipitated by meals

- LOW

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26
Q

Complications of gastric ulcers

A
  • bleeding
  • perforation
  • penetration into pancreas
  • gastric outlet obstruction
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27
Q

4 layers of the small intestine

A
  • mucosa
  • submucosa
  • muscularis
  • serosa
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28
Q

Hormones produced by the small intestine

A
  • gastrin
  • cholecystokinin
  • secretin
  • motilin
  • vasoactive intestinal polypeptide
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29
Q

Most common causes of small bowel obstruction

A
  • adhesions

- hernias

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30
Q

Symptoms of small bowel obstruction

A
  • abdo discomfort/pain
  • abdo distension
  • N + V (bile-stained)
  • obstipation
31
Q

Causes of small bowel perforation

A
  • TB
  • typhoid
  • CMV
  • malignancy
  • Crohn’s disease
  • steroids
  • radiotherapy
32
Q

Describe short bowel syndrome

A
  • diarrhoea, steatorrhoea, malnutrition
  • 100cm or less
  • most need life-long TPN
33
Q

Causes of small intestinal haemorrhage (excl. ulcers)

A
  • vascular abnormalities
  • Crohn’s
  • Meckel’s
34
Q

Mets that go to the small bowel

A
  • melanoma
  • renal
  • breast
35
Q

Risk factors for chronic atrophic gastritis

A
  • autoimmune disorders
  • chronic bile reflux
  • H. pylori
  • alcohol
  • smoking
  • poor nutrition
36
Q

Describe Correa’s hypothesis

A
  • nutritional defects cause gastritis
  • cell damage leads to defective acid production and bacterial prolif
  • bacteria produce nitrate reductase
  • reduces dietary nitrate to nitrites which combine with amines
  • nitrosamines are carcinogenic
37
Q

Risk factors for gastric cancer

A
  • H. pylori
  • EBV
  • gastric surgery
  • abdominal radiation
  • blood group A
  • family history
  • hereditary diffuse gastric cancer
  • gastric polyps
  • hypertrophic gastropathy (Menetiers)
  • gastric ulcer
  • pernicious anaemia
38
Q

2 types of gastric cancer

A
  • intestinal

- diffuse

39
Q

Difference between intestinal and diffuse gastric adenocarcinomas

A

Intestinal

  • ulceration
  • acinar formation
  • antrum

Diffuse

  • constricting linitis plastica
  • no acini
  • fundus
  • worse prognosis
40
Q

Presentation of gastric carcinoma

A
  • dyspepsia
  • local complications
  • insidious onset
  • dysphagia (prox stomach)
  • paraneoplastic manifestations
41
Q

Differential diagnoses of dyspepsia

A
  • functional dyspepsia
  • PUD and gastritis
  • GORD
  • oesophagitis
  • Drug SE
  • biliary disease
  • gastric Ca
42
Q

Causes of gastric outlet obstruction

A
  • Gastric carcinoma
  • PUD
  • pancreatic pathology
  • corrosive stricture
  • rarities (volvulus, bezoars)
43
Q

Surgical decision making steps for gastric cancer

A
  • confirm with endoscopic biopsy
  • metastatic screen
  • assess extent
  • assess fitness for surgery
44
Q

Operation for localised disease of gastric cancer

A

Billroth 2 (distal gastrectomy)

45
Q

What are GI stromal tumours?

A
  • sub-epithelial neoplasms found usually in the stomach

- symptoms only really occur when large

46
Q

Mutation found in GIST

A

CD 117Ag (part of tyrosine kinase receptor)

  • responsive to Imatinib (blocks tyrosine kinase receptor)
47
Q

What type of lymphoma is gastric lymphoma usually?

A
  • non-Hodgkin

- most are aggressive and treated with CHOP chemo

48
Q

Benign disease of the pharynx/oesophagus

A
  • GORD
  • Para-oesoph hernia
  • motility disorders
  • achalasia
  • diverticula
  • oesoph perforation
  • dysphagia
49
Q

Possible investigations for benign oesophageal diseases

A
  • chest and abdo XRAY
  • barium swallow and meal
  • endoscopy
  • CT
  • endoscopic US
  • manometric studies
  • 24 hr pH monitoring
50
Q

What is the pathology in GORD?

A

Incomplete/inappropriate relaxation of the LOS

- many have sliding hiatus hernia

51
Q

Symptoms of GORD

A
  • burning substernal/epigastric distree
  • acid regurg after meals or when lying down
  • associated aspiration, asthma and hoarseness
52
Q

Complications of GORD

A
  • oesophagitis
  • ulceration (stenosis and bleeding)
  • Barrett’s oesophagus
53
Q

Complications of para-oesophageal hernia

A
  • gastric volvulus
  • obstruction
  • incarceration
  • strangulation
  • pulmonary complications
54
Q

Types of achalasia

A
  • hypofunctional

- hyperfunctional

55
Q

What causes hypofunctional achalasia

A
  • destruction of Auerbach’s nerve plexus
  • oesoph gradually dilates
  • test with manometry
56
Q

Management of hypofunctional achalasia

A

Heller’s myotomy

57
Q

Causes of hyperfunctional achalsia

A
  • diffuse oesophageal spasm

- nutcracker oesophagus

58
Q

3 types of oesophageal diverticulae

A
  • pharyngo-oesophaegeal (Zenkers)
  • Traction diverticula
  • Epiphrenic diverticula
59
Q

Types of oesophageal perforation

A
  • instrumental

- non-instrumental

60
Q

Causes of non-instrumental perforation

A
  • post-emetic
  • foreign body
  • penetrating injury
  • anastomotic leak
61
Q

Severe result of oesophageal perforation

A

Virulent necrotising mediastinitis

62
Q

Benign causes of dysphagia

A
  • GORD
  • caustic
  • Webs
  • Schatzki ring
  • motility disorders
  • drug-induced
  • post-Nissen
  • eosinophilic oesophagitis
63
Q

Malignant causes of dysphagia

A
  • squamous carcinoma
  • adenocarcinoma
  • metastases
64
Q

Causes of odynophagia

A
  • hypermobility disorders
  • candidiasis
  • herpes simplex
  • drugs
65
Q

Two types of oesophageal cancer

A
  • squamous cell (upper)

- adenocarcinoma (glandular cells at junction)

66
Q

Risk factors for oesophageal cancer

A
  • race
  • sex (M)
  • age
  • smoking
  • alcohol
  • GORD
  • other (HPV, PlummeriVinson, tylosis, achalasia)
67
Q

What is Plummer- Vinson

A

association of postcricoid dysphagia, upper esophageal webs, and iron deficiency anemia

68
Q

What is tylosis?

A

A genetic disorder characterized by thickening (hyperkeratosis) of the palms and soles, white patches in the mouth (oral leukoplakia), and a very high risk of esophageal cancer

69
Q

Local symptoms of oesophageal cancer

A
  • dysphagia
  • cough and regurg
  • odynophagia
  • weight loss
  • upper GI bleeding
70
Q

Symptoms of oesophageal cancer caused by surrounding invasion

A
  • resp fistula
  • hoarseness
  • hiccups
  • pain
71
Q

Symptoms of oesophageal cancer caused by distant disease

A
  • mets

- hypercalcaemia

72
Q

Contraindications to oesophagectomy for oesophageal cancer

A
  • mets to N2 nodes
  • local structure invasion
  • severe comorbidities
73
Q

Possible interventions for oesophageal cancer

A
  • surgery
  • radiotherapy (palliative)
  • intubation (and stenting)
  • chemo (limited)
  • other (laser, photodynamic therapy)

Surgery Revision (8 decks)

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