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Surgery > Upper GI > Flashcards

Upper GI Flashcards

1
Q

ΔΔ dysphagia

A 
intraluminal
• infection (candidiasis, pharyngitis, retropharyngeal abscess)
• oesophagitis
• foreign body
• polyps
intramural
• benign strictures (GORD)
• CA
• achalasia
• spasm
• systemic sclerosis
• web (Plummer Vinson) or ring (Schatzi)
extramural
• pharyngeal pouch
• rolling hiatus hernia
• CA
• retrosternal goitre
• thoracic AA
neuro
• stroke
• myaesthenia gravis
• MS
• MND
• PD
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2
Q

key Qs in a dysphagia Hx?

“MUNCH LOT”

A 
• M
- difficult to make swallow Movement? (ΔΔ bulber palsy)
• U
- underweight
• N
- neck bulges when drinking (ΔΔ pharyngeal pouch)
• C
- cough on lying (ΔΔ achalasia, pharyngeal pouch)
• H
- heartburn (ΔΔ GORD)
• L
liquids a problem from start?
- YES = motility problem (ΔΔ sclerosis, myeasthenia, bulbar palsy, achalasia)
- NO, solids 1st = ΔΔ stricture
• O
- odynophagia (painful swallow) (ΔΔ CA, ulcer, spasm
• T
time pattern:
- intermittent (ΔΔ spasm)
- constant/worsening (ΔΔ CA)
- both ^ (ΔΔ achalasia)
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3
Q

odynophagia relieved by GTN?

A

oesophageal spasm

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4
Q

ΔΔ dyspepsia

A
  • functional dyspepsia
  • PUD
  • oesophageal: GORD, oesophagitis, CA
  • gastric: gastritis, CA
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5
Q

ΔΔ N, V (GI causes)

A
  • GE
  • cholecystitis
  • pancreatitis
  • obstruction
  • gastric CA
  • PUD
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6
Q

ΔΔ N, V (non-GI causes)

“ABCDEFGHI”

A
  • AKI, Addison’s
  • brain (migraine, ↑ICP)
  • cardiac (MI)
  • DKA
  • ears (labyrinthitis, Meniere’s)
  • foreign substance (alcohol, drugs)
  • gravid (pregn)
  • hyper↑Ca+, hypoNa+, ↑thyroid
  • infection (UTI, sepsis)
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7
Q

ΔΔ weight loss

“FIND THAT MAN”

A 
GI
• Flour (coeliac)
• IBD
• Neoplasia (CA)
• Dysphagia

endocrine
• TH-yrotoxicosis
• Addison’s
• T1DM

psychiatric
• ↓ Mood
• Anorexia
Nervosa

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8
Q

ΔΔ upper GI bleed

A
  • PUD* (erodes into blood vessel)
  • inflammation: oesophagitis, gastritis, duodenitis
  • varices
  • Mallory-Weiss tear
  • CA
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9
Q

Hx: patient comes in with Sx of epigastric pain and vomiting fresh red blood, and passed a bowel movement which was tarry black and foul smelling?

A

active upper GI bleed

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10
Q

coffee ground V?

A

upper GI bleed that has settled

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11
Q

black and foul smelling stool?

A

malaena
(upper GI bleed, or ascending colon CA)
(can be from Fe tablets - less smelly)

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12
Q

Ix upper GI bleed?

A

BEDSIDE:
• ECG (tachycardia)

BLOODS:
• FBC (Hb, may be normal before resusc)
• crossmatch, coag
• urea (GI absorption and metabolism of blood)
• LFTs (varices)

IMAGING:
• erect CXR (perforated PUD)
• AXR
• CT abdo-chest (CA, etc)

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13
Q

risk assessment of upper GI bleed?

A 
Blatchford score
Rockall score (post-endo)
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14
Q

Tx upper GI bleed?

A
  • ABCDE
  • resuscitation, IVT, O2 +/- transfuse
  • terlipressin (ADH) + Abx (if variceal)
  • NBM
  • urgent endo
  • clipping/diathermy with Adr
  • band ligation if variceal
  • surgery if unsuccessful

• post-endo IV PPIs, then oral

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15
Q

Hx: patient presents with fluid regurgitation, SOB, and pleuritic chest pain?

A

achalasia

aspiration pneumonia

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16
Q

can achalasia lead to CA?

A

YES

5 percent risk of oesophageal squamous cell CA

17
Q

Ix achalasia?

A

upper GI endo

Ba swallow shows “bird’s beak”

18
Q

Tx achalsia

A

medical:
• CCBs
• botox

surgery
• endoscopic dilatation of lower oesophageal spinchter
• myotomy (cut through muscle)

19
Q

what’s achalasia?

A

failure of SM relaxation in lower oesophagus (impaired nerve supply)

20
Q

Hx: patient presents with bad breath, a cough at night, regurgitation and difficulty swallowing?

A

pharyngeal pouch

21
Q

Tx pharyngeal pouch?

A
  • excision

* endo + stapling

22
Q

Hx: patient presents with GORD, and O/E bowel sounds are heard in the left chest?

A

hiatus hernia

23
Q

Tx hiatus hernia?

A 
conservative:
• weight
• smoking
• avoid large meals late
• raise head of bed

medical
• PPIs

surgical
• fundoplication (fundus wrapped around lower oes)

24
Q

Hx: patient presents having swallowed a fish bone, with neck and epigastric pain, dysphagia, SOB, V and heamatemesis?

O/E S/C emphysema

A

oesophageal perforation

Surgery (30 decks)

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