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Case 6 > Case 6 - UPPER GI TOP TIPS & QUIZ > Flashcards

Case 6 - UPPER GI TOP TIPS & QUIZ Flashcards

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1
Q

what is an anatomical landmark that
separates the upper GI tract from lower GI tract

A

The ligament of Treitz

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2
Q

what is OESOPHAGOGASTRODUODENOSCOPY (OGD)

A

Endoscopic procedure that visualises the oesophagus, stomach
and first and second parts of the duodenum using a flexible
gastroscope, inserted via mouth

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3
Q

what can OESOPHAGOGASTRODUODENOSCOPY (OGD)
be used for

A

Can be used for diagnostic or therapeutic indications

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4
Q

risks with OESOPHAGOGASTRODUODENOSCOPY (OGD)

A
  • Bowel perforation, bleeding, mechanical damage to teeth or dental
    work, arrhythmia, aspiration pneumonia, respiratory depression
    (sedation).
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5
Q

what is ACHALASIA

A

Oesophageal motility disorder – inability of the lower oesophageal sphincter to relax in response to swallowing and loss of peristalsis
* ↑ Risk of squamous cell carcinoma

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6
Q

Clinical manifestations of Achalasia

A

Dysphagia to solids & liquids, regurgitation, retrosternal chest pain
(may be related to oesophageal spasm), coughing when supine,
weight loss and cachexia (reduced oral intake)

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7
Q

Investigations for Achalasia

A
  • OGD (not essential for achalasia but want to rule out more dangerous things first)
  • Oesophageal manometry (Gold standard)
  • Barium swallow
  • Consider CXR/CT chest if other diagnoses suspected
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8
Q

treatment for achalasia

A
  • Medical: calcium-channel blockers (nifedipine or verapamil),
    nitrates (isosorbide dinitrate)
  • Surgical: Heller’s cardiomyotomy (laparoscopic procedure)
  • Endoscopic: Pneumatic dilatation
  • Injection of botulinum toxin to lower oesophageal sphincter (for Patients who aren’t fit enough for surgical or endoscopic)
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9
Q

what is Barrett’s oesophagus

A
  • Premalignant condition – increases risk of oesophageal adenocarcinoma
  • Metaplasia of lower oesophageal lining from stratified squamous epithelium to mucous secreting columnar epithelium
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10
Q

signs and symptoms of Barrett’s oesophagus

A

No specific signs or symptoms

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11
Q

how is barrett’s oesophaguse typically diagnosed

A

Typically diagnosed on endoscopy when requested for UGI symptoms such as heartburn, indigestion, regurgitation, voice
hoarseness, reflux induced cough.

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12
Q

treatment of barrett’s oesophagus

A
  • Lifestyle changes – smoking cessation, weight loss, alcohol abstinent
  • Proton pump inhibitor (Omeprazole) – long term
  • Surveillance endoscopy with radiofrequency ablation or mucosal resection
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13
Q

RED FLAGS for oesophageal cancer

A
  • Anaemia (iron deficiency)
  • Loss of weight
  • Anorexia
  • Recent onset/progressive
    symptoms
  • Melaena/haematemesis
  • Swallowing difficulty

ALARMS

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14
Q

Clinical manifestations of oesophageal cancer

A

Progressive dysphagia (Solids to liquids), odynophagia, regurgitation, weight loss/cachexia, hoarse voice, lymphadenopathy, melaena, haematemesis (less common), iron deficiency anaemia, fevers, lethargy, pallor, retrosternal chest pain

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15
Q

investigations for oesophageal cancer

A
  • OGD with biopsies
  • CT chest-abdomen-pelvis, MRI or endoscopic ultrasound or occasional laparoscopy for staging
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16
Q

treatment for oesophageal cancer

A
  • Referral to an UGI MDT
  • Surgical (endoscopic or invasive)
  • Chemotherapy, radiotherapy or both
  • Targeted cancer drugs – Trastuzumab (Herceptin)
  • Palliative care
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17
Q

what is OESOPHAGEAL STRICTURES

Study These Flashcards
A

Abnormal narrowing of oesophageal lumen

18
Q

what is OESOPHAGEAL RUPTURE /
BOERHAAVES

Study These Flashcards
A

Transmural rupture of the oesophageal wall

19
Q

causes of OESOPHAGEAL RUPTURE /
BOERHAAVES

Study These Flashcards
A
  • Spontaneous – Vomiting/retching (Boerhaaves syndrome)
  • Iatrogenic – Medical procedures
  • Trauma – Foreign bodies, corrosive ingestion, penetrating
    injury
20
Q

Clinical manifestations of OESOPHAGEAL RUPTURE / BOERHAAVES

Study These Flashcards
A

Vomiting, Surgical emphysema, retrosternal chest pain radiating to left shoulder, odynophagia, tachycardia, cyanosis,
tachypnoea, fever, shock

21
Q

investigations of OESOPHAGEAL RUPTURE /
BOERHAAVES

Study These Flashcards
A
  • CXR - Pneumomediastinum, pneumothorax, widened mediastinum, subcutaneous emphysema
  • CT Thorax - oesophageal wall oedema/thickening, air in oesophagus (plus above)
  • Fluoroscopy/contract studies - Site & length of perforation
22
Q

treatment of OESOPHAGEAL RUPTURE /
BOERHAAVES

Study These Flashcards
A
  • Immediate surgical opinion!!
  • Conservative – Small perforation (NBM, IV PPIs, broad
    spectrum antibiotics)
    * Also, may require nutritional support –parenteral/enteral
    feeding
  • Surgical repair
23
Q

complications of OESOPHAGEAL RUPTURE /
BOERHAAVES

Study These Flashcards
A

mediastinitis, Sepsis

24
Q

what is Dyspepsia & Gastro-Oesophageal Reflux Disease (GORD)

Study These Flashcards
A

Reflux of stomach contents back into the oesophagus irritating the lining which causes troublesome symptoms and/or
complications.

25
what is HELICOBACTER PYLORI (H.PYLORI)
Gram negative urease-producing spiral shaped bacterium predominantly found in the gastric antrum and in areas of gastric metaplasia in the duodenum
26
H.Pylori is Closely associated with/increases risk of
* Chronic active gastritis * Peptic ulcer disease (Gastric & duodenal ulcers) * Gastric cancer (adenocarcinoma) * Gastric B cell lymphoma
27
investigations of H.Pylori
urea breath test, Stool antigen test, blood antibody test, rapid urease test (CLO test during OGD)
28
what is hiatus hernia
Protrusion of intra abdominal content into thoracic cavity through an enlarged oesophageal hiatus of diaphragm
29
what are the types of hiatus hernia
4 types: * Type I (Sliding) – Stomach slides through the diaphragm * Type II (rolling) – fundus herniates * Type III (Sliding & rolling) * Type IV (Large) – other organs herniate
30
treatment of hiatus hernia
Same as GORD & will depend if patient is symptomatic * Medical/conservative management 18 * Surgical repair [GORD treatment: * Lifestyle measures * Medication review * Antacids (Gaviscon/Rennies) * Proton pump inhibitors (Omeprazole) * H2 receptor antagonists (alternative to PPI or add in) * Surgery – Laparoscopic fundoplication]
31
Patients usually need to stop __________ prior to testing for H.Pylori
PPIs 2 weeks
32
what is GASTRIC OUTLET OBSTRUCTION (GOO)
Mechanical obstruction of the pylorus, distal stomach, or duodenum which causes an inability of stomach to empty
33
GASTRIC OUTLET OBSTRUCTION (GOO) is Associated with significant morbidity and decreased _______.
quality of life
34
Clinical manifestations of GASTRIC OUTLET OBSTRUCTION (GOO)
Persistent nausea or vomiting, abdominal discomfort/tenderness/distension, early satiety, dehydration, shock (hypovolemia, tachycardia, oliguric)
35
Causes of GASTRIC OUTLET OBSTRUCTION (GOO)
Strictures (relating to peptic ulcer disease), malignant tumours, pancreatic pseudocysts, Bouveret Syndrome (cholecystoduodenal fistula)
36
Acute Liver Injury - what about it
* Sudden onset – days or weeks. * Acute derangement in liver function tests. * Occurs in absence of underlying chronic liver disease. * Does not necessarily progress to liver failure but it is possible.
37
Acute Liver Failure - what about it
* Rapid onset. * Characterised by altered consciousness due to hepatic encephalopathy, jaundice and coagulopathy. * Typically, in patient without preexisting liver disease. * If patient who already have an established hepatic impairment/cirrhosis is it known as ‘acute on chronic’
38
Chronic Liver disease - what about it
* Long term liver injury. * Leads to progressive, irreversible damage and liver fibrosis (scarring). * Can lead to cirrhosis.
39
hepatic artery is a branch of what?
branch of coeliac axis
40
portal vein drains most of what?
portal vein drains most of the gastrointestinal tract & spleen
41
The blood flow from these vessels [hepatic artery, hepatic vein, hepatic portal vein] is distributed to the __1__ segments and flows into the __2___via the portal tract. Blood leaves the ___3___, entering the ___4___vein which joins into 3 main branches before entering the ___5____ and back into the heart.
1 - liver 2 - sinusoids 3 - sinusoids 4 - hepatic 5 - inferior vena cava
42

Case 6 (12 decks)

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