Upper GI Flashcards

Question

Management of hiatus hernia?

Answer 1

Lifestyle changes (1st line) = lose weight. elevate bd rest, avoid largem emas, avoid alcohol, acid foods PPI Correct defect = fundoplication (nissen = 360, Toupet = 270, Watson = 180

Answer 2

Obstruction, volvulus, Upper GI bleed, irreversible necrosis or ischaemia of stomach

Answer 3

Most common = adneocarcinoma Smoking, H.pylori, diet (salt, kow fruit and veg) Familial, EBV infection and pernicious anaemia

Answer 4

``` ABdo pain (epigastric and vague) FLAWS ``` ``` Lymphaenopathy (Virchows) Sister mary joseph node = periumbilical Irish node (left axillary) ```

Answer 5

OGD and biopsy = 1st line ``` EUS + FNA CT/abdo pelvis for staging CXR PET Cancer = CEA or Ca19-9 ```

Answer 6

Normally = inibitoary neurones release NO for LOS relaxation Achalasia = loss of ganglion cells in myenetric pleux leads to series of inflammatory responses ending in destruction of post-ganglionic inhibitory neurones which contain NO so no NO or LOS relaxation

Answer 7

``` Autoimmunity Chagas disease Genes fro RH Allgrove syndrome Allgroves has triad of oesophageal achalasia, alacrime and adrenal insufficiency due to ACTH insensitivity ```

Answer 8

AKA American trypanosomiasis by parasirt trypanosoma cruzi Latin america Associated with poverty and poor housing and apread by urine, faeces of kissingbugs?

Answer 9

Dysphagi or liquids and solids and Odynophagia (also oesophageal cancer PC) Hepatosplenomgealy Abdo pain Jaundice

Answer 10

``` Dysphagia to liquids and solids Posturing to aid swallowing Restrosternal pressure/pain Regurgitation different to GORD Weight loss = gradual/mild ```

Answer 11

OGD + Biopsy = 1st line Barium swallow = BEAK sign, loss of peristalsi and delayed emptying High resolution manometry = diagnositc CXR = absence of gastric bubble and dilated oesophagus

Answer 12

``` Anything that increases intrabadominal pressure Vomiting (alcoholism) Coughing Straining Hiccups Trauma ```

Answer 13

ANy condition predisposing to vomiting, coughing, retchingm straining Hiatal hernia Significant alcohol use PMH or recent endoscopy

Answer 14

Haematemesis Light headedness Posturla hypotension dysphagia, odynophagia, pain, haematochezia, shock, anaemia signs

Answer 15

How many times, has it happened before, quantify bloods, what colour, associated pain and stool changes

Answer 16

``` ABC 1st FBC (anaemia)and LFT for alocholic Cross match CXR - normal OGD is diagnostic ROCKALL score ```

Answer 17

IV PPI Anti-emetics 1st line endoscopy = adrenaline injection and band ligation. Maybe thermal, haemoclips or thermocoagulation 2nd line= Sengstaken-blakemore tube Surgery = last cALL

Answer 18

Complication of MW tear and surgical emergency. Spontaneous due to force and RF = alcphl and obesity. Retrosternal chest pain and crackling sounds on examination with decreased breath sounds Pneumomediastiunnum on xray and needs surgery

Answer 19

Trachea, bronchial tree, aorta, recurrent laryngeal nerve | Lungs, livers, lymph nodes

Answer 20

GORD and Barrets oesophagus Smoking, alcohol and obesity Diet low in fruit and veg Fhx f upper Gi cancers

Answer 21

Squamous cell = 15% and upper 2/3rds of oesophagus. RFs = smoking, alcohol and HPV Adenocarcinoma = 80% and lower 1/4 and LOS. RF = chronic GORD amd barrets, obesity and diet. Others = 5%

Answer 22

``` Dysphagia Odynophagia Reflux Weight loss and FLAWS Hoarse voice from recurrent laryngeal nerve invasion Hiccups from phrenic nerve invasion ```

Answer 23

1st line = OGD and biopsy with biopsy as diagnostic | Metabolic profile and CT chest abdo, MRI for mets and PET scan

Answer 24

Early diagnosis = oesophagectomy Intramuousal lesion = OGD removal Late = CHemo +-radiotherapy + resection