Upper GI Flashcards
Give 7 indications for 2 week referral to oral surgery
Unexplained ulceration/mass >3weeks
Unexplained painful/swollen/bleeding patches
Unexplained unilateral head/neck pain >4weeks with earache but normal otoscopy
Unexplained recent neck lump or change in neck lump
Unexplained persistent sore throat
Signs/symptoms in oral cavity>6weeks not definitively benign
Give 5 signs of scurvy
Gingivitis Easy bruising Curly hair Eye bulging Brown flaky skin
Give 4 causes of gingival hyperplasia
Phenytoin
Ciclosporin
Calcium channel blockers especially nifedipine
AML (myelomonocytic/monocytic types)
What is the most common cause of leukoplakia?
Smoking
What is the cause of erythroplakia?
Irritation
What is the management of oral candidiasis?
Nystatin
What antibodies are associated with limited systemic sclerosis?
Anti-centromere
What antibodies are associated with diffuse systemic sclerosis?
Anti-Scl70
Which type of oesophageal cancer is associated with smoking?
Squamous cell carcinoma
What is the management of Barrett’s oesophagus?
Endoscopy and biopsy every 3-5 years
High dose PPI therapy
What is the first line antibiotic in suspected variceal bleeding?
Ceftriaxone
What are the indications for fluconazole in suspected variceal bleeding?
If at risk of fungal sepsis e.g. jaundice or renal impairment
What does the Glasgow-Blatchford score take into account?
Blood urea, Hb, pulse, systolic BP, comorbidities (melaena, syncope, heart failure, hepatic disease)
What is the first line management of gastric varices?
Endoscopic injection of N-butyl-2-cyanoacrylate
Give 3 contraindications of TIPSS
Portal vein thrombosis
Severe systemic infection
Severe pulmonary hypertension
What is the definitive management of acute non-variceal upper GI bleeds (e.g. Mallory-Weiss tears, bleeding peptic ulcers)?
Endoscopic clipping with/without adrenaline, thermal coagulation + adrenaline or fibrin/thrombin + adrenaline
What is the key investigation for Boorhaeve syndrome?
CT chest with oral contrast
What is Mackler’s triad?
Vomiting
Chest pain
Subcutaneous emphysema
Give 6 side effects of PPIs
Hyponatraemia Hypomagnesaemia Osteoporosis Diarrhoea Increased risk of C difficile infection Microscopic colitis
Give 2 indications for hiatus hernia repair
Severe disease refractory to medical management
Complications e.g. Barrett’s oesophagus
What blood group is at increased risk of gastric cancer?
A
What is Sister Mary Joseph’s node?
Painful palpable umbilical node due to metastatic abdominal or pelvic cancer
How soon should PPIs be stopped before endoscopy?
2 weeks
What type of stomach cancer has signet ring cells?
Gastric adenocarcinoma
What is the management of T1A gastric cancers?
Endoscopic mucosal resection
Give 7 types of drugs that increase risk of peptic ulcers
NSAIDs SSRIs TCAs Steroids Bisphosphonates Nitrates Anticholinergics
What are Cushing’s ulcers?
Peptic ulcers secondary to neurosurgery
What are Curling’s ulcers?
Erosions secondary to hypovolaemic shock in burns
What are the key investigations for Zollinger-Ellison syndrome?
Fasting gastrin level
Secretin stimulation test (causes paradoxical increase in gastrin)
What are the components of triple therapy for H. pylori?
Lansoprazole, clarithromycin, amoxicillin
Give 1 neurological complication of Campylobacter infection
Guillaine-Barre syndrome
What is the management of Campylobacter infection?
Erythromycin/ciprofloxacin
When does pyloric stenosis present?
2-8 weeks
How does duodenal atresia present?
Vomiting straight after birth before feeding
What condition is associated with duodenal atresia?
Down’s syndrome
What is the first line antibiotic for cholecystitis?
IV co-amoxiclav
What is the first line antibiotic for cholecystitis (allergic to penicillin)?
Ciprofloxacin
What are the first and second most common causes of ascending cholangitis?
E. coli
Klebsiella
What are the indications for gallbladder polyp removal?
>1cm PSC Certain ethnic minorities Adjacent wall thickening Symptomatic
Name 9 drugs that can cause pancreatitis
Azathioprine Mesalazine Didanosine Bendroflumethiazide Furosemide Mentamidine Steroids Valproate Cytotoxics
What are the 8 factors in the modified Glasgow score for pancreatitis?
PaO2<8kPa Age>55 WCC>15 Calcium<2mM Urea>16mM LDH>600/AST>200 Albumin<32g/l Glucose>10mM
How does a trypsin R122H mutation lead to chronic pancreatitis?
Cationic trypsin produced and prematurely activated
How is faecal elastase altered in chronic pancreatitis?
Low
What is the gold standard investigation for chronic pancreatitis?
CT with IV contrast
What is the management of pancreatic pseudocysts?
Initially conservative
If non-resolved after 12 weeks, endoscopic or surgical cystogastrostomy or aspiration
