Upper GI Tract Disorders

Question 1

Treatment for Mallory Weiss syndrome

Answer 1

1. Bleeding often stops spontaneously
2. Persistent bleeding may be treated with injection or electrocautery
3. Severe bleeding may be treated surgically with oversweing the laceration

Question 2

Treatment for esophageal varices

Answer 2

In sequential order:

1. Band the bleeding esophageal varices
2. Correct the coagulopathy with FFP; correct the thrombocytopenia with platelet transfusion
3. Lower the portal pressure with IV octreotide or IV vasopressin (SFX = coronary vasoconstriction and thus is c/i in pts with CAD with Beta blocker or older pts)
4. If pt continues to bleed, repeat endoscopy to reassess bleeding source and attempt to control again with banding
5. Portosystemic shunt surgery; balloon tamponade (risk of aspiration pneuomonia, recurrence, esophageal necrosis, and perforation), TIPS procedure forms artifical connection btwn the hepatic vein and portal vein branch
6. Beta blocker will lessen rick of rebleeding

Question 3

Workup for gastric lymphoma

Answer 3

1. Chest/Abd CT
2. Biopsy of enlarged peripheral nodes
3. Bone marrow biopsy
4. Examination of oropharynx to r/o lymphoma in Waldeyer ring

Question 4

Treatment for gastric lymphoma

Answer 4

1. Pts with MALT lymphoma respond to H. Pylori tx
2. Surgery only indicated if pts fail to respond to H. Pylori tx

Stage 1 = surgery only, Stage 2 = total gastrectomy + regional LN dissection + radiation/CTX, Stage 3/4 require chemoradiation