Upper GI Flashcards
ALARMS >55
refer 2WW to endoscopy
Hiatus hernia IX
barium swallow
if endoscopy normal but still GORD symtpoms
24hr luminal pH monitoring + manometry (measures sphincter competence)
GORD 1st Line
Lifestyle
- weight loss, stop smoking
- regular small meals >3hours before sleeping
- avoid hot drinks and alcohol and fizziness
GORD Medical MX
- Antacids (Aluminium = constipation, Mg = diarrhoea)
2. H2RA/PPI
If symptoms return after initial course?
H.Pylori test and treat
blood test 1st, breath test if blood test has prev. been +ve
Surgery
never on asymptomatic hiatus hernia
Nissen fundoplication
Barret’s –> carcinoma in situ
endoscopic resection
Dysphagia IX
barium swallow
OGD
biopsy
Plummer vinson syndrome (triad + treatment)
IDA, kolinychia, dysphagia
treat w/ oesophageal dilatiation + iron
oesophageal malignancy treatment
oesophagectomy
pre-op chemo
palliation
oesophageal stenting to restore swallowing
Achalasia management
- lifestyle - chew food, eat upright, drink
- botox injection
- endoscopic balloon dilatation
- heller’s cardiomyotomy
triple therapy
PPI + clarithromycin/amoxicillin, metronidazole if allergic
Use bismuth chelate in resistant cases then prolonged PPI therapy
Surgery in complications/non tolerant of medical therapy
selective vagotomy - severs vagus to decrease acid production, keeps nerve of laterget so gastric emptying is fine
Zollinger Ellinson
may need gastrectomy
GI haemorrhage
asses using Glasgow Blatchford score
A–>E
suspected variceal bleeding
endoscopy w/i 4 hours / band/sclerotherapy
if shocked on admission/comorbidity
Endoscopy w/i 12-24 hours
Gastric cancer
partial gastrectomy if in distal 2/3rd of stomach otherwise total + lymph node clearance
combination chemo
tumors confined to mucosa
endoscopic mucosal resection
gastric outlet obstruction
palliative stenting of pylorus
