Upper GI tract Flashcards
What’s the anatomical location of a pharyngeal pouch?
Posteromedial diverticulum through Killians dehiscence.
Above oesophageal sphincter (c5-c6)
What’s the treament for bleeding oesophageal varices?
Terlipressin,
Endoscopy with endoscopic variceal band ligation.
Sengstaken- blakemore tube
Transjugular intrahepatic portosystem shunt
What’s the preventative management of variceal haemorrhage?
Propanaolol
Endoscopic band ligation
Referral guidelines for urgent upper GI cancer?
1) all dysphasia
2) all upper abdominal masses
3) pt >55 with weight loss and upper abdominal mass or reflux or dyspepsia.
Referral guidelines for non-urgent upper GI cancer?
1) patients with haematemesis
2) pts >55 with treatment resistant dyspepsia, upper abdo pain and low Hb levels, raised platelet count, nausea or vomiting with another Reg flag symptom.
What drugs must be stopped before a urea breath test for H. Pylori?
Antibiotics - 4 weeks before
Anti secretory - 2 weeks before (eg PPI)
Difference in presentation between oesophageal cancer and achalasia?
Cancer dysphagia to solids then progresses to liquids
Achalasia - both solid and liquids cause dysphagia
What is the blatchford score?
For first assessment of upper GI bleed.
Considers : urea (raised in blood meal), Hb (low with bleed), blood pressure (shock), other markers: pulse, melena, syncope, hepatic disease, cardiac disease.
Treatment for upper GI bleed
1) resuscitation (including platelets, FFP..)
2) urgent endoscopy
If variceal - terlipressin and abx ASAP. Oesophagela do Banding
Gastric do injections of n-butyl-2-cyanoacrylate
Consider TIPS
If non-variceal - haemostatis with adrenaline, thermal coagulation, fibrin glue or endoclips.
What’s the Rockall score?
Predicts bleeding and mortality
Initial score : age, shock, comorbiditis,
Final score: final dx and evidence of haemorrhage, active bleeding, visible vessel, adherent clot,
Surgery needed if intial score >3 or final >6
Whats the management for Barrett’s oesophagus?
High dose PPI and endoscopic surveillance
If dysplasia found need - endoscopic resection or radiofrequency ablation
How does gord lead to oesophageal Ca?
Gord - Barrett’s (squamous epithelium becomes columnar) - dysplasia - cancer (adenocarcinoma)
What are the investigations for achalasia?
1) manometry - high LOS tone
2) barium swallow - birds beak, expanded oesophagus, fluid level
3) CXR - wide mediastinum, fluid level
What is oral hairy leukoplakia a sign of?
White patches on the side of the tongue. Seen in EBV, almost always in HIV patients.
What is strophic glossittis?
Smooth sore tongue, with loss of papillae.
Sign of iron, b12 or folate deficiency
What is geographic tongue?
Discrete areas of depapilation on the dorsum of tongue. Unknown causes.
Trouble with salivation and CN VIII palsy indicated what?
?Parotid malignancy
Whats the first line test in suspected oesophageal cancer?
Upper GI endoscopy
Then CT CAP for staging
What’s the treatment for oesophageal cancer?
Ivor-Lewis oesophagectomy, with stomach moved up into chest and anastomosed with the oesophagus.
Other ways include Mc Keown total oesphagectomy w/ cervical anastomosis.
Challenges are anastomotic leak. Especially causing mediastinitis.
What are the causes of oesophagitis?
Infection - HSV/Candida, GORD, drugs - slow release potassium, bisphosphonates
How often do people with Barrett’s oesophagus undergo surveillance?
ODG with multiple biopsy every 2/3-5 years.
And are treated with PPIs prophylactically.
What is achalasia?
Oesophageal Aperistalisis and failure of LOS to relax. Due to a decrease in ganglionic cells and vagus nerve inervation.
Sx: dysphagia to solids AND liquids, +- regurgitation.
What’s the work up for achalasia?
Barium swallow (birds beak) dilated oesophagus and tapered LOS.
Manometry confirms the Dx. PH studies.
ODG to exclude oesophageal cancer,
Treatment for achalasia?
1) surgical - Balloon dilation or surgical division of the LOS (Hellers cardiomyotomy).
2) medical Rx - nitrates or nifedipine, or injection of Botox to relax the LOS
Complications - gord, rupture 2%,
2) line used in frail and elderly people
Progression of achalasia to squamous cell cancer.
What are the types of hiatus hernia?
Sliding (95%)
Rolling ( paraoesophageal) - more of a risk of gastric volvulus, bleeding and respiratory complications. Treat surgically.
What’s the difference between mallory Weiss and boerhaave syndrome?
Both severe vomiting.
MW - mucosal lacerations at gastroesophageal junction causes haematemesis.
BS - oesophageal rupture
What is Plummer Vinson syndrome?
Triad : dysphagia (oesophageal webs), glossitis and iron D anaemia.
Immediate management of upper GI bleed?
Bloods
X Match
CXR - air under diaphragm
ECG - ischemia ?hypovolemia
Not ODG - until done previous tests
When not to give terlipressin in GI bleed
??
PVD - causes vasoconstriction and can cause Critial limb ischemia
Only give if you know that it is variceal
Important to give Abx
