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Year 3 Surgery > Upper GI Conditions > Flashcards

Upper GI Conditions Flashcards

1
Q

What is Cirrhosis?

A

Chronic Liver injury givens ongoing inflammation leading to structural changes

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2
Q

What does Liver Cirrhosis lead to?

A

Portal Hypertension

Impairment of function

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3
Q

What are some common causes of Liver Cirrhosis?

A

Alcoholic Liver Disease
Viral Hepatitis
Non-Alcoholic Fatty Liver Disease

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4
Q

What causes the liver changes in alcoholic liver disease?

A

Build up of Acetaldehyde leading to fatty liver changes and eventual Cirrhosis

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5
Q

What can fatty liver lead to?

A

Rapid Onset Jaundice
Hepatomegaly
RUQ Pain

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6
Q

What is NAFLD due to?

A

Accumulation of triglycerides and other lipids in hepatocytes

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7
Q

What are some less-common causes of cirrhosis?

A

Hereditary Haemochromatosis
Wilson’s Disease
Primary Sclerosing Cholangitis
Primary Biliary Cirrhosis

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8
Q

What is Hereditary Haemochromatosis?

A

An autosomal recessive condition giving abnormal iron metabolism and increased serum iron

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9
Q

What is Wilson’s Disease?

A

A disease giving abnormal copper metabolism leading to copper build-up. Presents with Kayser-Fleischer rings around the eyes

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10
Q

What is Primary Schlerosing Cholangitis?

A

A condition giving fibrosis of Intrahepatic/Extrahepatic bile ducts

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11
Q

What is Primary Biliary Cirrhosis?

A

A condition giving destruction of intrahepatic bile ducts

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12
Q

Why does liver cirrhosis lead to Portal Hypertension?

A

The fibrotic liver is not expandable and compresses the portal venous system.

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13
Q

What are varices?

A

Shunts of blood from the portal venous system to the systemic venous system leads to venous distension at the point of anastomoses

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14
Q

What are three common sites of varices?

A

Oesophageal
Umbilical
Anorectal

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15
Q

What are Gallstones?

A

Small stones formed from Bile

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16
Q

What are Gallstones made of?

A

Cholesterol
Bile Pigments
Phospholipids

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17
Q

What are some potential complications of Gallstones?

A

Biliary Colic
Acute Cholecystitis
Ascending Cholangitis
Pancreatitis

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18
Q

What is Biliary Colic?

A

RUQ pain due to temporary obstruction of the Cystic/Common Bile duct by a stone

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19
Q

What is the management of biliary colic?

A

Analgesia +/- Cholecystectomy

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20
Q

What is Acute Cholecystitis?

A

Impaction of a stone in the cystic duct

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21
Q

How does Acute Cholecystitis present?

A

Inflammatory features

Murphy’s +ve

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22
Q

What is Ascending Cholangitis?

A

Infection of the biliary tree

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23
Q

How does Ascending Cholangitis present?

A

Features of Charcot’s Triad:
Pain
Features of Inflammation
Jaundice

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24
Q

What is the management of Ascending Cholangitis?

A

IV Antibiotics

Fluid resuscitation

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25
Q

What is Pancreatitis?

A

Acinar cell injury and necrosis evokes an inflammatory response giving epigastric pain that radiates posteriorly

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26
Q

What clinical sign can pancreatitis demonstrate?

A

Cullens and Grey Turners signs

27
Q

What is the management for Pancreatitis?

A

Fluids
Manage Gallstones
Organ support

28
Q

What is the investigation of choice for suspected gallstones?

A

MRCP

29
Q

How can impacted gallstones be treated?

A

ERCP +/- stent

30
Q

What are some causes of pancreatitis?

A 
Gallstones
Ethanol
Trauma
Scorpion Bite
Mumps
Autoimmune
Steroid use
Hyperlipidaemia
ERCP
Drugs
31
Q

What is haematemesis?

A

Vomiting of blood due to bleeding from the Upper GI tract

32
Q

Which causes of haematemesis require emergency treatment?

A

Oesophageal Varices

Gastric Ulceration

33
Q

What are Oesophageal varices?

A

Dilation of the porto-systemic venous anastomoses in the oesophagus

34
Q

How are perforated oesophageal varices managed?

A

Endoscopic Banding

35
Q

What is the Glasgow-Blatchford bleeding score?

A

A scoring system used to assess the need for intervention in patients with an Upper GI bleed

36
Q

How does gastric ulceration lead to haematemesis?

A

Leads to erosion of the blood vessels supplying the upper GI tract

37
Q

Which causes of haematemesis do not require emergency treatment?

A

Mallory-Weiss Tear

Oesophagitis

38
Q

What is a Mallory-Weiss Tear?

A

A tear in the epithelial lining of the oesophagus after episodes of vomiting. Often benign and self-healing

39
Q

What is oesophagitis?

A

Inflammation of the intraluminal epithelium layer of the oesophagus. Usually due to GORD.

40
Q

What is Dyspepsia?

A

Complex of upper GI tract symptoms that are present for more than 4 weeks, that include upper abdo pain, heartburn, acid reflux, nausea and/or vomiting

41
Q

What is GORD?

A

Reflux due to abnormality of the lower oesophageal sphincter which is tonically contracted

42
Q

What is Acute Gastritis?

A

Exposure of gastric mucosa to chemical injury leads to damaged epithelial cells and reduced mucus production. The mucosa responds with vasodilation +/- oedema

43
Q

What is Chronic Gastritis?

A

Similar to acute gastritis, only over a longer timeframe

44
Q

What are some causes of Chronic Gastritis?

A

H.Pylori
Auto-Immune
Chemical/Reactive

45
Q

What is Peptic Ulcer disease?

A

Defects in the gastric/duodenal mucosa extending through the muscularis mucosa. Most commonly in the first part of the duodenum

46
Q

What are some causes of Peptic Ulcer disease?

A 
Stomach acid
H.Pylori
NSAIDs
Smoking
Stress
Burns
47
Q

What are the symptoms of Peptic Ulcer disease?

A

Epigastric Pain - Burning/Knawing, following meals
Anaemia
Satiety
Weight Loss

48
Q

What is a Hiatus hernia?

A

The protrusion of an organ from the abdominal cavity into the thorax through the oesophageal hiatus

49
Q

Which organ usually herniates in a hiatus hernia?

A

Stomach

50
Q

What are the subtypes of hiatus hernia?

A

Sliding Hiatus Hernia

Rolling Hiatus Hernia

51
Q

What is a sliding hiatus hernia?

A

The abdominal part of the oesophagus and the cardia of the stomach frequently move into the thorax

52
Q

What is a rolling hiatus hernia?

A

Just the fundus of the stomach herniates, creating a stomach bubble within the chest

53
Q

What are risk factors for a Hiatus hernia?

A

Age
Pregnancy
Obesity
Ascites

54
Q

What are clinical features of a hiatus hernia?

A 
Asymptomatic
GORD - Epigastric pain, worse when lay flat
Vomiting/Weight loss
Hiccups/Palpitations
Swallowing difficulties
55
Q

What are some differentials for a hiatus hernia?

A

Cardiac CP

Gastric Cancer

56
Q

What investigations are appropriate for a suspected hiatus hernia?

A

OGD - Disruption to “Z” line visible

Contrast swallow

57
Q

What are some conservative management options for hiatal hernias?

A

PPIs
Lifestyle changes
Smoking and Alcohol cessation

58
Q

What are surgical management options for hiatal hernias?

A

Cruroplasty

Fundoplication

59
Q

What is a Mallory-Weiss tear?

A

A linear mucosal tear occuring at the oesophagogastric junction due to a sudden increase in intra-abdominal pressure

60
Q

What are some common causes of a Mallory-Weiss tear?

A

Coughing
Retching
Alcoholic “Dry Heaves”

61
Q

What is the primary treatment recommended for a Mallory-Weiss tear?

A

Conservative, usually self resolving

62
Q

What is Boerhaave’s Syndrome?

A

Transmural perforation of the oesophagus typically after forceful emesis

63
Q

What is Boerhaave’s Syndrome also known as?

A

Spontaneous Oesophageal Rupture

64
Q

How does Boerhaave’s Syndrome present?

A

Mackler’s Triad:

Chest Pain
Vomiting
Subcutaneous Emphysema

Year 3 Surgery (10 decks)

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