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MedEd > Upper GI > Flashcards

Upper GI Flashcards

1
Q

Difference between gastritis and PUD?

A

Gastritis = histological presence of gastric mucousal inflammation

Ulcer: break in the mucousal lining of the stomch or duodenum with depth to the submucosa >5mm

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2
Q

Main causes of PUD?

A

H.Pylori as increased inflammatory response and mucousal permeability

NSAIDs = decrease gastric mucousal blood flow = loss of protective barrier

Zollinger-ellsion syndrome
Bisphosphonates, infections e.g. CMV, ICU stay >48hours, Crohns and idiopathic

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3
Q

What is Zollinger-Ellison syndrome?

A

Gastric acid hypersecretion by gastrin-secreting neuro-endocrine tumour.

PC: abdo pain, diarrhoea and multiple recurrent duodenal ulcers

HPC = MEN

Ix = Inreased fasting serum gastrin level >1000pg/ml

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4
Q

PC for PUD/Gastritis?

A

Abdo pain = POINTING SIGN
Related to eating
Nocturnal

N+V
Early satiety
Weight loss
Diarrhoea (think Zollinger)

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5
Q

Main tests for PUD/Gastritis?

A

H.Pylori (1st line) via urea breathe test or stool antigen

OGD (gold standard)

FBC = low Hb = anaemia, bleeding ulcer

IF Dyspepsia +>60 or weight loss +>55 = OGD 1st line

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6
Q

What is the treatment for H.Pylori?

A

Triple therapy
PPI = omeprazole
Clarithromycin
Amoxicillin (or metronadizole

Discontinue NSAIDS

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7
Q

How to manage acute bleeding in PUD/Gastritis?

A

OGD: adrenaline. clips and thermocoagulation

Use Blatchford score for patient needs
Rockall score for severity of GI bleeding

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8
Q

Difference where the ulcer is in PUD?

A

Gastric = 5-6th decade peak, NSAIDS>H.Pyloir, pain shortly after eating

Dueodenal = 4-5th decade peak, H.Pylori?NSAIDS, pain a few hours after eating and may radiate to the back

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9
Q

RFs for PUD?

A

Poor diet, NSAIDS< smoking, increasing age, high alcohol

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10
Q

Pathology of GORD?

A

Relaxation of LOS so reflux of grastric contents into the oesophagus

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11
Q

RFs for GORD?

A

OBESITY, HIATUS HERNIA, alcohol, smoking, Fhx, ol age, NSAIDS< acidic food e.g. coffee, mints, citrus

CCB can cause LOS relaxation

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12
Q

PC For GORD?

A 
Heartburn (after meals and worse lying down or bending over)
Acid regurgitation (bitter taste and after eating/waterbrash)

Other = dysphagia, bloating early satiety, laryngitis, halitosis and dyspepsia

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13
Q

Ix for GORD?

A

PPI trial for 8 weeks is 1st line

If persistent then DDx so OGD, oesophageal manometry and barium swallow

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14
Q

GORD management?

A

PPI trial for 8 weeks
Lifestyle changes: weight loss, bed elevation, avoid late ight eating, avoid chocolate, caffeine alcohol and acidic spicy foods

Adjuntc: H2 antagonists

Persistent GORD = fundoplication surgery

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15
Q

What are the complications of GORD?

A

Ulcer, bleeding, perforation, BArrets -> adenocarcinoma

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16
Q

Histology of Barrets?

A

Squamous epithelium -> columnar epithlium + intestinal metaplasia + goblet cells

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17
Q

RFs for Barrets?

A 
Same as GORD
GORD
obesity
smoing
FHx
Age
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18
Q

PC for Barrets?

A

Same as GORD with heartburn and regurgitation

Dysphagia (may indicate malignancy)
CHest pain

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19
Q

Ix for Barrets?

A

OGD + Biopsy = diagnostic
(show salmon colour mucosa and columnar lined epitheliun)

Barium oesophogram (if dysphagic)

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20
Q

Barrets management?

A

PPI + surveillance

Endoscopic ablation or resection
Fundoplication as anti-reflux surgery
Oesophagectomy

21
Q

WHat is a hiatal hernia and types?

A

protrusion of the stomach through an enlarged oesophageal hiatus on the diaphragm

1 = sliding (most common 90%)
2 = para-oesophagela hernia/rolling
3 = mixed: sliding + rolling
4= giant hernai +stomach + 1 more structure)
22
Q

RFs for hiatal hernia>

A

OBESITY, previous gastro-oesophageal proceudres
Elevated intra-abdomincal pressure
PMH of other hernias

23
Q

PC of hiatus hernia?

A

GORD like: Heartburn, regurgitation, chest pain, dysphagia, odynophagia, haematemesis, SOB

Bowel sounds in chest and oropharyngitis

24
Q

Ix for hiatal hernia?

A

CXR: retrocardiac air bubble = OSCE buzz

Upper GI series = barium swall / criterion test

OGD for dysplasia

CT/MRI for other patholgies

25
Q

Management of hiatus hernia?

A

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

26
Q

Complication of hiatus hernia?

A

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

27
Q

Gastric cancer type and RFS?

A

Most common = adneocarcinoma

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

28
Q

PC for gastric cancer?

A 
ABdo pain (epigastric and vague)
FLAWS
Lymphaenopathy (Virchows)
Sister mary joseph node = periumbilical
Irish node (left axillary)
29
Q

Gastric cancer Ix?

A

OGD and biopsy = 1st line

EUS + FNA
CT/abdo pelvis for staging
CXR
PET
Cancer = CEA or Ca19-9
30
Q

What is the pathophysiology behind Achalasia?

A

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

31
Q

RFs for achalasia/

A 
Autoimmunity
Chagas disease
Genes fro RH
Allgrove syndrome
Allgroves has triad of oesophageal achalasia, alacrime and adrenal insufficiency due to ACTH insensitivity
32
Q

Features of Chagas disease?

A

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

33
Q

PC of Chagas?

A

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

34
Q

Achalsia PC?

A 
Dysphagia to liquids and solids
Posturing to aid swallowing
Restrosternal pressure/pain
Regurgitation different to GORD
Weight loss = gradual/mild
35
Q

Achalasia Ix?

A

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

36
Q

What is the pathophysiology of a Mallory-weiss tear?

A 
Anything that increases intrabadominal pressure
Vomiting (alcoholism)
Coughing
Straining
Hiccups
Trauma
37
Q

RFs for Mallory-weiss tear?

A

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

38
Q

PC of MW tear?

A

Haematemesis
Light headedness
Posturla hypotension

dysphagia, odynophagia, pain, haematochezia, shock, anaemia signs

39
Q

OSCE haematemesis questions?

A

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

40
Q

IX for MW tear?

A 
ABC 1st
FBC (anaemia)and LFT for alocholic
Cross match
CXR - normal
OGD is diagnostic
ROCKALL score
41
Q

Management for MW tear?

A

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

42
Q

What is a boerhaves perforsation?

A

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

43
Q

what mediastinal structures can oesophageal cancer invade?

A

Trachea, bronchial tree, aorta, recurrent laryngeal nerve

Lungs, livers, lymph nodes

44
Q

RFs for oesophageal cancer?

A

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

45
Q

Types of oesophageal cancers?

A

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%

46
Q

PC of oesophageal cancer?

A 
Dysphagia
Odynophagia
Reflux
Weight loss and FLAWS
Hoarse voice from recurrent laryngeal nerve invasion
Hiccups from phrenic nerve invasion
47
Q

Oesophageal cancer Ix?

A

1st line = OGD and biopsy with biopsy as diagnostic

Metabolic profile and CT chest abdo, MRI for mets and PET scan

48
Q

Oesophageal cancer management?

A

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

MedEd (32 decks)

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