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Gastro AB > Upper GI Disorders AB > Flashcards

Upper GI Disorders AB Flashcards

1
Q

What constitutes normal oesophageal acidification?

A

Post-prandial

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2
Q

What are the complications of GORD?

A 
Ulceration / bleeding
Stricture / Schatzki ring
Barrett's oesophagus
Adenocarcinoma
Extra-intestinal manifestations
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3
Q

What lifestyle modification has the best evidence in the management of GORD?

A

Weight loss

Severity correlates with weight when BMI >30

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4
Q

Which medications can cause impairment of the lower oesophageal sphincter?

A 
Beta adrenergic medications
Anticholinergics
TCA
Diazepam
CCB
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5
Q

Which medications can damage the oesophageal mucosa?

A

Aspirin, NSAIDs
Doxycycline
Quinidine
Bisphosphonates

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6
Q

What are the complications of laparoscopic fundoplication?

A 
Excess flatus
Dysphagia
Inability to belch or vomit
Failure with time
Mortality 0.1%
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7
Q

Which investigations must be performed prior to laparoscopic fundoplication?

A

Oesophageal manometry

pH study

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8
Q

What is the relative risk of oesophageal adenocarcinoma in Barrett’s oesophagus?

A

40-100x the incidence

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9
Q

How frequently should surveillance endoscopy be performed in the context of Barrett’s oesophagus with and without dysplasia?

A

No dysplasia - 3-5 years
Low grade dysplasia - 6 months
High grade dysplasia - 3 months or consider resection/ablation

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10
Q

What are the clinical and laboratory features of a severe upper GI bleed?

A

Clinical: orthostatic hypotension, shock, need for 2 or more units of RBC

Laboratory: Hb decrease by more than 20, haematocrit decrease by more than 6%

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11
Q

Anatomically, what landmark demarcates the boundary between upper and lower GI bleeding?

A

The ligament of Treitz - 3rd and 4th part of the duodenum

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12
Q

What is the commonest cause of upper GI bleeding?

A

Peptic ulcer disease

Followed by oesophageal varices

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13
Q

What are some less common causes of chronic upper GI bleeding?

A

Portal hypertensive gastropathy (seen in cirrhosis)

Gastric antral vascular ectasia (watermelon stomach, seen in cirrhosis and CT disease)

Cameron lesions (hiatus hernia)

GI telangiectasias (i.e. Osler-Weber-Rendau disease)

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14
Q

Below what Hb level should you transfuse in upper GI bleeding?

A

Below 70

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15
Q

Below what INR should you delay an endoscopy to correct the coagulopathy?

A

INR greater than 3

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16
Q

How is eosinophilic oesophagitis diagnosed histologically?

A

Excess eosinophils (more than 15 per high powered field) in squamous mucosa in the mid and proximal oesophagus

Basal zone hyperplasia

Dilated intracellular spaces

17
Q

What is the treatment of eosinophilic oesophagitis?

A

PPI trial
Topical steroids (budesonide slurry)
Dilatation
Diet - six (or four) food elimination diet - wheat, eggs, milk, seafood, soy, nuts

18
Q

What are the features of distal oesophageal spasm on barium swallow?

A

Barium swallow:

Tertiary contractions
Diverticulae
Poor passage of bolus

19
Q

What are the features of distal oesophageal spasm on endoscopy?

A

Retained food

Uncoordinated or ring contractions

20
Q

What are the features of distal oesophageal spasm on manometry?

A

Synchronous pressure waves

21
Q

What medications can be used to treat distal oesophageal spasm?

A

Trial of acid suppression
CCB
GTN

Also botox into oesophageal body

22
Q

Achalasia - what is the characteristic pathological feature?

A

Incomplete relaxation of the lower oesophageal sphincter

23
Q

What is the most sensitive test for achalasia?

A

Manometry

  • Incomplete LOS relaxation
  • Aperistalsis
24
Q

What is the management of achalasia

A

Medications (GTN, CCB) - often not effective
Balloon dilatation - 5% perforation
Botox

25
Q

What gene makes H pylori more virulent?

A

Cag A gene

Associated with VacA toxin

26
Q

What is the best test to confirm H pylori eradication?

A

Urea breath test - 6 weeks post treatment

27
Q

What is the standard eradication treatment for H Pylori?

A

PPI + clarithromycin + amoxycillin (or metronidazole) for 10-14 days

28
Q

What is the most common resistance encountered in the treatment of H pylori?

A

Clarithromycin (previously Metronidazole)

29
Q

How do you diagnose Zollinger Ellison syndrome?

A
  1. Fasting gastrin greater than 1000pg/mL
  2. Gatate PET-CT - new standard

Also Secretin provocation (Gastrin greater than 200) and hypersecretion

Gastro AB (6 decks)

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