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1. 4th year > Upper GI (stomach and oesophagus) > Flashcards

Upper GI (stomach and oesophagus) Flashcards

1
Q

describe the dysphagia associated with motility issues

A

intermittent
both solids and liquids from outset
non-progressive

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2
Q

what are the features of systemic sclerosis

A 
calcinosis
Raynauds
oEsophageal dysmotility
sclerodactyly
telangiectasia 
(CREST)
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3
Q

oesophageal dysmotility + blurred vision / ptosis

A

myasthenia gravis

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4
Q

1st line Ix for dysphagia

A

OGD

+ FBC

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5
Q

Ix required if consideration for fundoplication

A

ambulatory oesophageal pH and manometry studies

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6
Q

tx benign oesophageal stricture

A

dilation and high dose PPI

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7
Q

triad of plummer vinson

A

oesophageal webs + glossitis + iron deficiency anaemia

in post-menopausal wmoen

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8
Q

tx of plummer vinson

A

dilation and iron supplement

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9
Q

virus associated with SCC of oesophagus

A

HPV

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10
Q

cancer of lower 1/3 oesophagus

A

adenocarcinoma

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11
Q

ix oesophageal cancer

A

OGD + biopsy

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12
Q

initial staging in oesophageal cancer

A

CTCAP

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13
Q

staging in oesophageal cancer if localised disease seen on CTCAP

A

EUS +/- FNA

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14
Q

staging in oesophageal cancer if metastasis/not localised seen on CTCAP

A

PET CT

or laparoscopy to detect peritoneal disease

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15
Q

tx localised SCC oesophageal cancer

A

radical chemo/radio

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16
Q

best treatment of oesophageal cancer

A

surgery - endoscopic resection or oesophagectomy (stage 2 and above)

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17
Q

diagnositic test achalasia

A

oesophageal manometry

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18
Q

barium swallow of achalasia

A

birds beak

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19
Q

pharmacological tx achalasia

A

nitrates or CCB

Botox - if not suitable for surgery

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20
Q

1st line surgical tx of achalasia

A

endoscopic balloon dilation

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21
Q

definitive surgical tx of achalasia if recurrent or persistent symptoms

A

hellers cardiomyotomy + lifelong PPI

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22
Q

CXR/barium swallow of Diffuse oesophageal spasms

A

corkscrew appearance/nut cracker

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23
Q

1st line ix for Diffuse oesophageal spasms

A

OGD

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24
Q

young male
atopic
OGD - mucosal furrows
schatzi rings

A

eosinophilic oesophagitis

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25
Q

retrosternal discomfort made worse with eating/lying down

odynophagia

A

GORD

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26
Q

ix of GORD

A

usually trial of treatment before OGD unless red flags

> 55
symptoms > 4 weeks 
weight loss 
dysphagia 
persistent symptoms despite treatment
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27
Q

lifestyle advice for GORD

A

o Diet change, weight loss, reduce alcohol and smoking.
o Small, regular, meals, avoid eating before going to bed.
o Elevate the end of the bed

review meds

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28
Q

tx GORD in patients who have not had OGD

A

PPI for 1 months

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29
Q

tx GORD in patients who have oesophagitis on OGD

A

full dose PPI 1-2 months

  • if this works then low dose
  • if not then double dose for 1 month
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30
Q

tx GORD in patients who do not have oesophagitis on GORD

A

full dose PPI 1 month

- if no response then H2 receptor blocker (ranitidine)

31
Q

Risk of PPI

A

risk of osteoporosis

32
Q

what is red velvety oesophageal mucosa on OGD

A

barretts

33
Q

how often should patients with oesophageal metaplasia but not dysplasia get endoscopy

A

3-5 years

34
Q

tx oesophageal dysplasia (barretts)

A

endoscopic mucosal resection + RFA

35
Q

most sensitive investigation for hiatus hernia

A

barium swallow

36
Q

1st line ix for hiatus hernia

A

OGD

37
Q

tx hiatus hernia

A

nissen fundoplication

38
Q

2 tests for H pylori

A

urea (carbon 13) breath test
or
H pylori stool antigen (primary care)

39
Q

how long do PPI and antibiotics need to be stopped before H pulori test

A

ppi - 2 weeks

abx - 4 weeks

40
Q

how long should PPI be stopped before OGD

A

2 weeks

41
Q

what is used for repeat H pylori testing

A

breath test

42
Q

do you do a repeat H pylori test if symptoms resolve

A

no

43
Q

1st line ix for dyspepsia

A

H pylori or OGD

44
Q

1st line tx of dyspepsia

A

medication review
lifestyle advice
antacid /alginate

45
Q

tx for dyspepsia after lifestyle/medication if not needing OGD

A

full dose PPI for 1 month and / or test and treat for H pylori

46
Q

what is the treatment for H pylori - normal and pen all

A

amoxicillin + clarithromycin + omeprazole 1 week

pen al - clarithromycin + metronidazole + omeprazole

47
Q

ulcers that are sore when hungry

A

duodenal - more common

48
Q

ulcers that are more sore when eating

A

gastric

49
Q

ix peptic ulcer

A

H pylori

50
Q

tx peptic ulcer H pylori +ve

A

H pylori eradication

51
Q

tx peptic ulcer H pylori negative

A

PPI for 4 weeks

52
Q

ix possible perforated peptic ulcer

A

erect CXR

53
Q

what is a zollinger ellison syndrome and when it is seen

A

MEN1
tumour of pancreas/duodenum
produces gastrin leading to treatment resistant dyspepsia and steatorrhoea

54
Q

ix for ZE syndrome

A

high fasting gastrin

MRI

55
Q

what gastric cancer has the highest associated with H pylori

A

adenocarcinoma

56
Q

adenocarcinoma on histology

A

signet ring

57
Q

2 nodes seen in gastric cancer

A

virchows

sister mary joseph (periumbilical)

58
Q

diagnostic ix for gastric cancer

A

OGD + biopsy

59
Q

staging gastric cancer

A

CTCAP

60
Q

tx gastric cancer in proximal 1/3 stomach

A

total gastrectomy

61
Q

tx gastric cancer in distal 2/3 stomach

A

subtotal gastrectomy

62
Q

what is the mainstay treatment of gastric cancer

A

surgery +/- chemo

63
Q

tx functional dyspepsia

A

lifestyle

PPI PRN or lowest possible dose

64
Q

dx gastropareisis

A

gastric scintigraphy

65
Q

tx gastropareisis

A

prokinetic- domperidone, metoclopramide

anti emetic - prochlorperazine, ondansentron

66
Q

stool if upper GI bleed will appear like what

A

black sticky smelly tar like tool

67
Q

blood marker that might indicate upper GI bleed

A

High urea out of proportion of creatinine

68
Q

treatment variceal bleed

A

FTKAB

  • FFP
  • vitamin K
  • terlipressin
  • antibiotic prophylaxis - ciprofloxacin
  • endoscopic band ligation
69
Q

uncontrolled variceal haemorrhage

A

senstaken-blakemore tube

70
Q

last line variceal bleed

A

TIPS

71
Q

drug to reduce risk of further variceal bleed

A

propranolol

72
Q

tx upper GI bleed due to peptic ulcer/gastritis

A

IV PPI infusion - given after OGD, not in acute phase, if evidence of non-variceal bleeding
endoscopic treatment on ulcer - adrenaline, thermal ablation, clipping

73
Q

what should all patients with severe upper GI be offered

A

OGD immediately after resus, within 24 hours

74
Q

general treatment of upper GI bleed

A

IV access, fluid resus, ABCDE
FFP - if low fibrinogen levels or high PT
prothrombin complex and vit K to warfarin patients actively bleeding

1. 4th year (23 decks)

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