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Year 3 MedEd slides > Upper GI > Flashcards

Upper GI Flashcards

1
Q

What is the most common symptom of both gastric and duodenal ulcers?

A

Epigastric pain

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2
Q

Can antacids provide relief for gastric and duodenal ulcers?

A

Only duodenal

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3
Q

Differentiate the eating pattern seen in duodenal and gastric ulcer disease

A

Duodenal: over-eating
Gastric: anorexia

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4
Q

Which of gastric/duodenal ulcers are more likely to wake patients at night?

A

Duodenal

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5
Q

Recall 2 ways of testing for H pylori

A

13C Urea breath test

Stool antigen test

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6
Q

Recall the management of H pylori

A

1 week triple therapy:
PPI
Clarithromycin/ Metronidazole
Amoxicillin

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7
Q

Is H pylori gram pos or neg?

A

Gram neg

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8
Q

What are the 2 ways that H pylori can be tested for?

A 
Breath test (urease)
Stool Ag test
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9
Q

Which two types of cancer does H pylori increase risk of?

A

Gastric Ca

Lymphoma

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10
Q

What is Zollinger-Ellison syndrome?

A

A condition in which a gastrin-secreting tumour or hyperplasia of the islet cells in the pancreas causes overproduction of gastric acid, resulting in recurrent peptic ulcers

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11
Q

Which comorbidity increases risk of gastrinomas?

A

Men1

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12
Q

What investigation should be done for Zollinger-Ellison syndrome?

A

Fasting serum gastrin

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13
Q

What are the 2 most common complications of PUD?

A

Bleeding and perforation

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14
Q

Recall the medical management of a bleeding or perforated peptic ulcer

A

Bleeding: IV PPI and AD injection (AD –> vasoconstriction)
Perforated: IV Abx (as if GI contents exit tract they pose an infection risk)

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15
Q

What is the complication to be aware of in peptic ulcer perforation?

A

Air under diaphragm: peritonitis + pneumoperitoneum

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16
Q

What is Sister Mary Joseph’s node?

A

Metastatic nodule on umbilicus

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17
Q

Why does smoking increase the risk of GORD?

A

Relaxes the lower oesophageal sphincter

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18
Q

What are the subtypes of non-traumatic hiatus hernia?

A

Sliding hiatal hernia

Paraoesophageal hiatal hernia

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19
Q

What is the first line investigation for hiatus hernia?

A

Barium swallow

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20
Q

What is the main surgical option ofr management of hiatus hernia?

A

Nissen fundoplication

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21
Q

Recall 3 investigations that may be done in GORD if endoscopy does not reveal cause of disease

A
  1. Ambulatory pH monitoring
  2. Oesophageal manometry
  3. Barium swallow (to look for hiatus hernia)
22
Q

What is oesophageal manometry able to diagnose?

A

Disorders of motility eg. achalasia

23
Q

Recall the treatment options for Barrett’s oesophagus

A

Depends on endoscopic findings:
High grade dysplasia: radiofrequency ablation and PPI
Nodule: endoscopic mucosal resection and PPI

24
Q

Differentiate the location of squamous cell oesophageal cancer and adenocarcinoma of the oesophagus

A

SCC: middle 1/3
Adenocarcinoma: lower 1/3

25
Q

By what factors is dysphagia classified?

A
  1. High vs low

2. Functional vs structural

26
Q

Recall 2 structural causes of high dysphagia

A

Cancer

Pharyngeal pouch

27
Q

Does stricture cause high or low dysphagia?

A

Low

28
Q

Classify the dysphagia caused by Plummer-Vinson syndrome

A

Structural low dysphagia

29
Q

Recall 3 causes of low functional dysphagia

A

Achalasia
Oesophageal spasm
Limited cutaneous scleroderma

30
Q

Recall 3 causes of high functional dysphagia

A

Stroke
Parkinson’s
Myasthenia gravis

31
Q

Recall 2 factors of a history that can help you differentiate structural and functional dysphagia

A
  1. Intermittent or progressive? Intermittent suggests neurological/motility issue, progressive suggests structural
    2 . Solids vs liquids: solids progressing to liquids suggests structural (eg cancer growing)
32
Q

What symptom is suggestive of oesophageal cancer until proven otherwise

A

New-onset dysphagia in pts over 55

33
Q

What is the most common investigation for low dysphagia?

A

Endoscopy

34
Q

What is videofluoroscopy?

A

Between investigation and treatment: similar to barium swallow, allows SALT to see how a pt swallows and help them correct issues

35
Q

What does manometry assess?

A

Pressure in lower oesophageal sphincter

36
Q

What is the buzz-word finding of achalasia on barium swallow?

A

Bird’s-beak

37
Q

Which disease produces an identical pathophysiology to achalasia?

A

Chagas disease

38
Q

Recall 3 signs OE of IDA

A

Cheilosis
Atrophic glossitis
Koilonychia

39
Q

Which rheumatological condition is associated with dysphagia?

A

CREST (limited cutaneous scleroderma)

40
Q

How is the barium swallow described in cases of oesophageal spasm?

A

Corkscrew oesophagus

41
Q

What is Boerhaave’s syndrome?

A

Full tear in oesophageal wall

42
Q

What will CXR show in Boerhaave’s?

A

Pneumomediastinum

43
Q

Within how many hours should Boerhaave’s be operated on?

A

12

44
Q

What are oesophageal varices?

A

Extremely dilated sub-mucosal veins in lower third of oesophagus

45
Q

What are oesophageal varices a consequence of?

A

Portal hyptertension due to cirrhosis

46
Q

Describe the presentation of ruptured oesophageal varices

A

Extreme haematemesis
May be unconscious or in shock
Melaena

47
Q

Is the anaemia produced by oesophageal varix rupture macrocytic or microcytic?

A

Macrocytic

48
Q

Which drug is used in portal HTN management?

A

IV Terlipressin

49
Q

What is the first line surgical management of oesophageal varices?

A

Band ligation

50
Q

Recall the steps of management of ruptured peptic ulcer

A
  1. Endoscopy with IM AD at site of ulcer
  2. PPI
  3. Triple therapy if H pylori +ve

Year 3 MedEd slides (16 decks)

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