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Y3 MedEd > Upper GI > Flashcards

Upper GI Flashcards

1
Q

Define peptic ulcer

A

Break in the epithelial lining of the stomach or duodenum

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2
Q

Symptoms of peptic ulcer disease (5)

A

Recurrent epigastric pain related to eating
Early Satiety
Nausea & Vomiting
Potential anorexia & weight loss

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3
Q

Signs of peptic ulcer disease

A

Epigastric tenderness

Pointing sign

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4
Q

Duodenal vs gastric ulcer pain and weight

A

Duodenal
Pain 2-3 hours after and commonly awakens patients at night
Often overeat and causes weight gain

Gastric
Pain shortly after eating
Often avoid eating - weight loss

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5
Q

RF of peptic ulcer (4)

A

H pylori
NSAIDs
Bisphosphonates
Smoking

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6
Q

Ix for H pylori (2)

A

Breath test - need to stop PPI first

Stool antigen test

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7
Q

Mx of H pylori (4)

A

Triple therapy
PPI, Clarithromycin,
Amoxicillin OR Metronidazole

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8
Q

Define Zollinger-Ellison syndrome

A

Neuroendocrine tumour in the pancreas secreting gastrin leading to increased gastric acid secretion and so peptic ulcers

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9
Q

Association of Zollinger Ellison syndrome

A

MEN1

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10
Q

When to consider Zollinger Ellison syndrome

A

Multiple ulcers refractory to treatment

FHx of MEN

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11
Q

Ix for Zollinger Ellison syndrome (3)

A

Fasting serum gastrin
Serum calcium
Gastric acid secretory tests, stimulation tests, Imaging

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12
Q

Mx for Zollinger Ellison syndrome (2)

A

PPI

Surgical resection if required

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13
Q

What is a Cushing ulcer

A

patients suffering head trauma developed peptic ulcers.
Why?
Raised ICP thought to stimulate vagus nerve – leads to increased gastric acid secretion

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14
Q

Why do Cushing’s ulcers occur

A

patients suffering head trauma developed peptic ulcers.
Why?
Raised ICP thought to stimulate vagus nerve – leads to increased gastric acid secretion

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15
Q

What is a Curlings ulcer

A

Following severe burn injuries
Why?
Reduced plasma volume leads to ischaemia and necrosis of gastric muscosa

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16
Q

Why do Curlings ulcers occur

A

Following severe burn injuries
Why?
Reduced plasma volume leads to ischaemia and necrosis of gastric muscosa

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17
Q

What are red flags indicating endoscopy (7)

A

over 55, weight loss, bleeding, anaemia, vomiting, early satiety, or dysphagia

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18
Q

H pylori negative Mx of peptic ulcer disease

A

H. Pylori negative: PPI or H2 antagonist

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19
Q

Complications of peptic ulcer disease (20

A

Haemorrhage

Perforation

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20
Q

Most common type of gastric cancer

A

Adenocarcinoma

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21
Q

Symptoms of gastric cancer (5)

A

Epigastric pain
Nausea, vomiting ±blood
Anorexia
Weight loss

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22
Q

RF of gastric cancer (3)

A

Smoking
H. Pylori
Chronic gastritis – and therefore peptic ulcer disease

23
Q

Signs of gastric cancer (3)

A

Palpable epigastric mass
Virchow’s node/Troisier’s sign
Sister Mary Joseph node

24
Q

Ix for gastric cancer (2)

A

Endoscopy

Biopsy and histology

25
Q

Causes of increased gastric acid secretion (3)

A

Diet
Smoking
Zollinger Ellison syndrome

26
Q

Which drugs can cause lower oesophageal sphincter hypotension and so GORD

A

anti-muscarinics, CCBs, nitrates, smoking

27
Q

Ix for hiatus hernia (3)

A

Barium swallow
Chest X-ray
Endoscopy

28
Q

Mx of hiatus hernia (3)

A

Conservative – risk factor modification
Pharmacological (PPI)
Surgery – Nissen fundoplication

29
Q

Suspected GORD is untreated with PPI, next step?

A

UGI endoscopy

30
Q

Define Barretts oesophagus

A

Metaplasia of the oesophagus due to chronic oesophagitis

31
Q

What is the change in Barretts oesophagus

A

squamous epithelium changes to columnar epithelium

32
Q

Oesophageal cancer symptoms (3)

A

Progressive dysphagia from solids to liquids
Burning Chest pain
Red flag symptoms – particularly weight loss, anaemia

33
Q

2 types of oesophageal cancer

A

Adenocarcinoma

SCC

34
Q

Where in oesophagus is adenocarcinoma most common

A

Lower third

35
Q

Where in oesophagus is SCC most common

A

Middle third

36
Q

What are the RF/s for oesophageal adenocarcinoma

A

Barretts

37
Q

What are the RF/s for oesophageal SCC

A

Smoking, alcohol

38
Q

What is high dysphagia associated with

A

MND

39
Q

What is low dysphagia associated with

A

Obstruction/achalasia

40
Q

What is the issue in achalasia (2)

A

Absence of oesophageal peristalsis

Failure of lower oesophageal sphincter (LOS) to relax

41
Q

Ix for achalasia

A

Barium swallow

42
Q

What is seen in the barium swallow of achalasia

A

Birds beak appearance

43
Q

Neurological causes of dysphagia (2)

A

Mainly Stroke and Parkinson’s

44
Q

Clues that it a neurological cause of dysphagia (4)

A

Coughing: Immediately on swallow
Choking: Also implies problem with swallow process.
Slow eating
Early dysphagia for liquids – functional problem

45
Q

Sign of Mallory-Weiss tear over other causes of haematemesis

A

Usually seen as blood streaked in vomit

Vomiting precedes bleeding

46
Q

What is Boerhaave syndrome

A

Complication of Mallory Weiss Tear – also know as oesophageal tear due to vomiting

47
Q

Ix for Boerhaave syndrome

A

CXR

48
Q

Oesophageal varices presentation (3)

A

Extreme Haematemesis
May be unconscious or in shock
Melaena

49
Q

Ix for oesophageal varices (6)

A

FBC: Macrocytic anaemia, ↓ platelets
LFTs: ↑GGT, ↑bilirubin ↓albumin
U&Es: ↑Urea
Endoscopy

50
Q

Mx of oesophageal varices

A 
ABCDE approach
Fluids, regular monitoring.
Reduce portal HTN: Terlipressin
Endoscopy
Band ligation is first line
51
Q

Presentation of ruptured peptic ulcer (3)

A 
Background of PUD
Long-term NSAID use
H. pylori infection
“Coffee ground” emesis
Melaena
52
Q

Ix for ruptured peptic ulcer (2)

A

Observations: ↓BP
FBC & LFTs: normal
Endoscopy

53
Q

Mx of ruptured peptic ulcer (3)

A

Endoscopy
IM adrenaline at site of ulcer
PPI, e.g. Omeprazole
Triple therapy (if H. pylori)

Y3 MedEd (34 decks)

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