Upper GI Conditions**** Flashcards

1
Q

ONLY DO UPPER GI BLEED FOR EMERGENCIES

Upper GI bleed:

Causes:

  • How does PUD cause an upper GI bleed?
  • Diseases with inflammation?
  • Usually, caused by alcohol disease?
  • Found after severe vomiting?
  • One more obvious thing
A

Erodes into a blood vessel - typically posterior duodenal ulcer

Oesophagitis
Gastritis
Duodenitis

Oesophageal or gastric ulcers

Mallory-Weiss tear following severe vomiting

Upper GI cancer

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2
Q

Upper GI bleed:

What questions should you ask in history?

A
Post GI bleeds 
Dyspepsia 
Known liver disease 
Dysphagia 
Vomiting 
Weight loss
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3
Q

Upper GI bleed - S+S

What 2 ways can the pain present?

Haematemesis - What does it look like if it is active and if it is settled?

What is melena? What can it be also caused by? - 2

What systemic presentation might there be?

A

Epigastric pain
Diffuse Abdo pain

Red if active
Coffee-ground I settled

Black and foul-smelling stool

Ascending colon cancer and iron tablets

Shock - hypovolaemia

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4
Q

Upper GI bleed - gastro-oesophageal varices:

What is it?

Cause?

Management - surgical and medical

A

Submucosal venous dilatation secondary to increased portal pressures

CLD

Endoscopic banding/sclerotherapy

Beta-blockers - Lowers HR, therefore, lower BP meaning reduced risk of bursting veins

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5
Q

Upper GI bleed - Portal Hypertension

Pre-hepatic cause - 1

Intra-hepatic cause - 1 example

Post-hepatic cause - 2

Risk factors of variceal bleeds - 4

A

Thrombosis in portal/splenic vein

Cirrhosis

Right HF
Constrictive Pericarditis

Increase portal pressure
Variceal size
Endoscopic features of variceal wall
Advanced liver disease

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6
Q

Upper GI bleed - Investigations:

Bloods:

  • Why do the haemoglobin?
  • What should be done for surgery?
  • What can be done to assess liver function? - 2
  • Why do the urea?

Imaging

A

May be normal before fluid resuscitation

Crossmatch

Coagulation and LFT’s

Erect CXR and Abdo CXR
CT abdo-chest

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7
Q

Upper GI bleed - Risk Assessment:

What score can be used in the first assessment to see whether intervention is needed?

What score can be used to identify patients at risk of adverse outcome following acute upper gastrointestinal bleeding?

A

Blatchford score

Rockall score

SO BR - bilirubin

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8
Q

Upper GI bleed - Management - unstable

(1) What to do if unstable?

(2) What 2 drugs can be given for non-variceal bleeds?
- one reduces urination to maintain blood vol and the
- other is a vasoconstrictor which is also a statin?
- what drug should be added if it is a variceal bleed?

A

Resuscitate - ABCDE - Oxygen, fluids and consider transfusion

Terlipressin (ADH analogue)
Somatostatin

Prophylactic antibiotics

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9
Q

Upper GI bleed - Management - unstable

(3) What should the patient be instructed to do?

Endoscopic diagnosis and repair

  • What is done for a non-variceal bleed?
  • What is done for oesophageal varices?
  • What is done for a gastric bleed?
A

Nil by mouth

Endoscopic diagnosis and repair

Clipping OR Thermal coagulation with adrenaline

Band ligation

Cyanoacrylate (glue)

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10
Q

Upper GI bleed - Management - unstable

(4) If endoscopy fails:
- What surgery can be done if variceal?
- TIPS can also be done if variceal

(5) What medication should be given for PUD bleeding? post-endoscopy?

Upper GI bleed - Management

  • What should be done if the patient is stable?
A

Suture ligation

Transjugular intrahepatic portosystemic shunt

PPI - Initially IV to increase gastric pH and aid ulcer healing
- THEN PO as part of H.pylori eradication or as a protective measure if restarting NSAIDs

Endoscopy

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11
Q

Achalasia:

What is it?

Presentation - 2

A

Failure of smooth muscle relaxation in the lower oesophagus due to the impaired nerve supply

Fluid regurgitation
Aspiration pneumonia

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12
Q

Achalasia:

Investigations:

What is the standard investigation needed?

What sign do you see on Barium swallow on XR?

What can be done to measure the pressure in the upper and lower oesophageal sphincters?

A

Upper GI endoscopy

Bird peak sign - look at pics

Oesophageal manometry

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13
Q

Achalasia - Management - Medical

Why do you give them CCB’s? Give one example

What does botulinum toxin do and why is it given?

A

Causes muscle relaxation - nifedipine

Causes relaxation via injection into the LOS

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14
Q

Achalasia - Management - Interventional Treatment

First-line invasive treatment?

What is cardiomyotomy? - Look at pics

A

Endoscopic (pneumatic) dilatation of LOS

A longitudinal cut of the lower oesophagus and stomach cardia
Relieves the grip of the non-relaxing muscle from the outside

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15
Q

Pharyngeal Pouch:

What is another name for it?

What is it?

A

Zenker’s diverticulum

Pouch at anatomically weak point of the pharynx
Killian dehiscence

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16
Q

Pharyngeal Pouch:

Symptoms - 2 biggest symptoms

What is another thing they complain about that could be quite embarrassing?

What might happen in the night?

A

Dysphagia
Regurgitation

Bad breath

Nocturnal cough

17
Q

Pharyngeal Pouch:

Management - surgical - 2

A

Open excision of the pouch - removal

Stapling

18
Q

Hiatus hernia:

Define a sliding hernia and rolling hernia?

S+S

A

Oesophagogastric junction into the thorax

Stomach rolling up into the oesophagus

GORD
Bowel sounds heard in left chest

19
Q

Hiatus hernia - Management:

Lifestyle - 2 - Eating habits - 2

Medical - 1

Surgical - what is a floppy Nissen fundoplication?

A

Lose weight
Stop smoking

Avoid large meals in the late evening
Raise the head of the bed

PPI

Stomach fundus is wrapped around the lower oesophagus

20
Q

Oesophageal perforation - Causes

Iatrogenic - 1
2 obvious causes

What is Boerhaave’s syndrome?

A

Endoscopy

Swallowed sharp foreign body - fishbone
Chest trauma

Boerhaave’s syndrome - spontaneous perforation of the oesophagus that results from a sudden increase in intraesophageal pressure combined with negative intrathoracic pressure (eg, severe straining or vomiting).

21
Q

Oesophageal perforation - Presentation

Mackler’s triad - what is it? - 3

GI symptoms - 2

Investigations:

3 types needed

A

Neck, chest or epigastric pain - EXCRUCIATING
Vomiting
Subcutaneous emphysema

Haematemesis and/or melaena
Dysphagia

Endoscopy
CXR and contrast swallow
CT

22
Q

Oesophageal perforation - Management

First-line Rx

2 meds needed

What surgery can be done?

A

Nasogastric decompression and nasojejunal feeding

Antibiotics and PPI’s

Debridement of mediastinum and T-tube for oesophagocutaneous drainage

23
Q

Oesophageal perforation - Complications

A

Mediastinitis
Pneumonia
Sepsis
Oesophagpleural fistula