Upper GI Disorders AB Flashcards
What constitutes normal oesophageal acidification?
Post-prandial
What are the complications of GORD?
Ulceration / bleeding Stricture / Schatzki ring Barrett's oesophagus Adenocarcinoma Extra-intestinal manifestations
What lifestyle modification has the best evidence in the management of GORD?
Weight loss
Severity correlates with weight when BMI >30
Which medications can cause impairment of the lower oesophageal sphincter?
Beta adrenergic medications Anticholinergics TCA Diazepam CCB
Which medications can damage the oesophageal mucosa?
Aspirin, NSAIDs
Doxycycline
Quinidine
Bisphosphonates
What are the complications of laparoscopic fundoplication?
Excess flatus Dysphagia Inability to belch or vomit Failure with time Mortality 0.1%
Which investigations must be performed prior to laparoscopic fundoplication?
Oesophageal manometry
pH study
What is the relative risk of oesophageal adenocarcinoma in Barrett’s oesophagus?
40-100x the incidence
How frequently should surveillance endoscopy be performed in the context of Barrett’s oesophagus with and without dysplasia?
No dysplasia - 3-5 years
Low grade dysplasia - 6 months
High grade dysplasia - 3 months or consider resection/ablation
What are the clinical and laboratory features of a severe upper GI bleed?
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%
Anatomically, what landmark demarcates the boundary between upper and lower GI bleeding?
The ligament of Treitz - 3rd and 4th part of the duodenum
What is the commonest cause of upper GI bleeding?
Peptic ulcer disease
Followed by oesophageal varices
What are some less common causes of chronic upper GI bleeding?
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)
Below what Hb level should you transfuse in upper GI bleeding?
Below 70
Below what INR should you delay an endoscopy to correct the coagulopathy?
INR greater than 3
How is eosinophilic oesophagitis diagnosed histologically?
Excess eosinophils (more than 15 per high powered field) in squamous mucosa in the mid and proximal oesophagus
Basal zone hyperplasia
Dilated intracellular spaces
What is the treatment of eosinophilic oesophagitis?
PPI trial
Topical steroids (budesonide slurry)
Dilatation
Diet - six (or four) food elimination diet - wheat, eggs, milk, seafood, soy, nuts
What are the features of distal oesophageal spasm on barium swallow?
Barium swallow:
Tertiary contractions
Diverticulae
Poor passage of bolus
What are the features of distal oesophageal spasm on endoscopy?
Retained food
Uncoordinated or ring contractions
What are the features of distal oesophageal spasm on manometry?
Synchronous pressure waves
What medications can be used to treat distal oesophageal spasm?
Trial of acid suppression
CCB
GTN
Also botox into oesophageal body
Achalasia - what is the characteristic pathological feature?
Incomplete relaxation of the lower oesophageal sphincter
What is the most sensitive test for achalasia?
Manometry
- Incomplete LOS relaxation
- Aperistalsis
What is the management of achalasia
Medications (GTN, CCB) - often not effective
Balloon dilatation - 5% perforation
Botox
What gene makes H pylori more virulent?
Cag A gene
Associated with VacA toxin
What is the best test to confirm H pylori eradication?
Urea breath test - 6 weeks post treatment
What is the standard eradication treatment for H Pylori?
PPI + clarithromycin + amoxycillin (or metronidazole) for 10-14 days
What is the most common resistance encountered in the treatment of H pylori?
Clarithromycin (previously Metronidazole)
How do you diagnose Zollinger Ellison syndrome?
- Fasting gastrin greater than 1000pg/mL
- Gatate PET-CT - new standard
Also Secretin provocation (Gastrin greater than 200) and hypersecretion
