Upper GI Flashcards
What is the most common symptom of both gastric and duodenal ulcers?
Epigastric pain
Can antacids provide relief for gastric and duodenal ulcers?
Only duodenal
Differentiate the eating pattern seen in duodenal and gastric ulcer disease
Duodenal: over-eating
Gastric: anorexia
Which of gastric/duodenal ulcers are more likely to wake patients at night?
Duodenal
Recall 2 ways of testing for H pylori
13C Urea breath test
Stool antigen test
Recall the management of H pylori
1 week triple therapy:
PPI
Clarithromycin/ Metronidazole
Amoxicillin
Is H pylori gram pos or neg?
Gram neg
What are the 2 ways that H pylori can be tested for?
Breath test (urease) Stool Ag test
Which two types of cancer does H pylori increase risk of?
Gastric Ca
Lymphoma
What is Zollinger-Ellison syndrome?
A condition in which a gastrin-secreting tumour or hyperplasia of the islet cells in the pancreas causes overproduction of gastric acid, resulting in recurrent peptic ulcers
Which comorbidity increases risk of gastrinomas?
Men1
What investigation should be done for Zollinger-Ellison syndrome?
Fasting serum gastrin
What are the 2 most common complications of PUD?
Bleeding and perforation
Recall the medical management of a bleeding or perforated peptic ulcer
Bleeding: IV PPI and AD injection (AD –> vasoconstriction)
Perforated: IV Abx (as if GI contents exit tract they pose an infection risk)
What is the complication to be aware of in peptic ulcer perforation?
Air under diaphragm: peritonitis + pneumoperitoneum
What is Sister Mary Joseph’s node?
Metastatic nodule on umbilicus
Why does smoking increase the risk of GORD?
Relaxes the lower oesophageal sphincter
What are the subtypes of non-traumatic hiatus hernia?
Sliding hiatal hernia
Paraoesophageal hiatal hernia
What is the first line investigation for hiatus hernia?
Barium swallow
What is the main surgical option ofr management of hiatus hernia?
Nissen fundoplication
Recall 3 investigations that may be done in GORD if endoscopy does not reveal cause of disease
- Ambulatory pH monitoring
- Oesophageal manometry
- Barium swallow (to look for hiatus hernia)
What is oesophageal manometry able to diagnose?
Disorders of motility eg. achalasia
Recall the treatment options for Barrett’s oesophagus
Depends on endoscopic findings:
High grade dysplasia: radiofrequency ablation and PPI
Nodule: endoscopic mucosal resection and PPI
Differentiate the location of squamous cell oesophageal cancer and adenocarcinoma of the oesophagus
SCC: middle 1/3
Adenocarcinoma: lower 1/3
By what factors is dysphagia classified?
- High vs low
2. Functional vs structural
Recall 2 structural causes of high dysphagia
Cancer
Pharyngeal pouch
Does stricture cause high or low dysphagia?
Low
Classify the dysphagia caused by Plummer-Vinson syndrome
Structural low dysphagia
Recall 3 causes of low functional dysphagia
Achalasia
Oesophageal spasm
Limited cutaneous scleroderma
Recall 3 causes of high functional dysphagia
Stroke
Parkinson’s
Myasthenia gravis
Recall 2 factors of a history that can help you differentiate structural and functional dysphagia
- Intermittent or progressive? Intermittent suggests neurological/motility issue, progressive suggests structural
2 . Solids vs liquids: solids progressing to liquids suggests structural (eg cancer growing)
What symptom is suggestive of oesophageal cancer until proven otherwise
New-onset dysphagia in pts over 55
What is the most common investigation for low dysphagia?
Endoscopy
What is videofluoroscopy?
Between investigation and treatment: similar to barium swallow, allows SALT to see how a pt swallows and help them correct issues
What does manometry assess?
Pressure in lower oesophageal sphincter
What is the buzz-word finding of achalasia on barium swallow?
Bird’s-beak
Which disease produces an identical pathophysiology to achalasia?
Chagas disease
Recall 3 signs OE of IDA
Cheilosis
Atrophic glossitis
Koilonychia
Which rheumatological condition is associated with dysphagia?
CREST (limited cutaneous scleroderma)
How is the barium swallow described in cases of oesophageal spasm?
Corkscrew oesophagus
What is Boerhaave’s syndrome?
Full tear in oesophageal wall
What will CXR show in Boerhaave’s?
Pneumomediastinum
Within how many hours should Boerhaave’s be operated on?
12
What are oesophageal varices?
Extremely dilated sub-mucosal veins in lower third of oesophagus
What are oesophageal varices a consequence of?
Portal hyptertension due to cirrhosis
Describe the presentation of ruptured oesophageal varices
Extreme haematemesis
May be unconscious or in shock
Melaena
Is the anaemia produced by oesophageal varix rupture macrocytic or microcytic?
Macrocytic
Which drug is used in portal HTN management?
IV Terlipressin
What is the first line surgical management of oesophageal varices?
Band ligation
Recall the steps of management of ruptured peptic ulcer
- Endoscopy with IM AD at site of ulcer
- PPI
- Triple therapy if H pylori +ve
