gastric: ulcers, bleeds + cancer

Question 1

what warrant urgent dyspepsia cancer referrals (5/6)

Answer 1

dysphagia // upper abdo mass // >55 with weight loss + dyspepsia OR reflex OR abdo pain

Question 2

what warrants non-urgent dyspepsia cancer referrals

Answer 2

haematemesis // treatment resistant dyspepsia // low hb // raised platelets

Question 3

what is treatment for dyspepsia without need for OGD

Answer 3

1. med review 2. lifestyle 3. 1 month PPI OR H pylori treatment

Question 4

what gram is H pylori

Answer 4

negative

Question 5

what conditions are associated with H pylori (4)

Answer 5

peptic ulcers // gastric cancer // MALT // atrophic gastritis

Question 6

what is the most sensitive and specific test for H pylori (3)

Answer 6

urea breath test // rapid urea test (CLO) - less sensitive // stool antigen

Question 7

what test is used to determine eradication of H pylori

Answer 7

urea breath test

Question 8

mx H pylori

Answer 8

PPI + amox + clarithromycin OR metro // triple therapy no amox if pen allergy

Question 9

what drugs can cause peptic ulcers

Answer 9

NSAIDs, SSRIs, corticosteroids, biphosphonates

Question 10

how do gastric and duedenal ulcers present differently and which is most common

Answer 10

duodenal - more common and relieved by eating // gastric worse on eating

Question 11

how are peptic ulcers treated if H. pylori negative

Answer 11

PPI until healed

Question 12

what artery is usually involved in peptic ulcer acute bleeds

Answer 12

gastroduodenal

Question 13

presentation of peptic ulcer acute bleeds

Answer 13

haematemesis, maleana, hypotension, tachycardia

Question 14

mx peptic ulcer acute bleeds

Answer 14

ABCDE —>first line endoscopy

Question 15

what symptom is common in peptic ulcer perforation

Answer 15

syncope

Question 16

invx for perforated peptic ulcer

Answer 16

erect CXR

Question 17

what are risk cancers/ demographic for gastric cancer (7)

Answer 17

male, elderly, H pylori, atrophic gastritis, diet, smoking

Question 18

what lymph nodes does gastric cancer spread too

Answer 18

left supraclavicular (virchow’s) and periumbilical

Question 19

what type of gastric cancer is H pylori accos with

Answer 19

adenocarcinoma (most common) and MALT lymphoma

Question 20

what is seen on biopsy in gastric cancer

Answer 20

OGD + biopsy –> signet cells

Question 21

how js gastric cancer staged

Answer 21

CT

Question 22

what surgical options are available for gastric cancer

Answer 22

endoscopic mucosal resection –> partial gastrectomy –> total gastrectomy

Question 23

what adjuvant can be given in gastric cancer

Answer 23

chemo

Question 24

what are complications of gastrectomy

Answer 24

dumping syndrome / weight loss / anaemia / osteoporosis / vit B12

Question 25

what is dumping syndrome

Answer 25

rebound hypoglycaemia

Question 26

what blood restult can a MALT lymphoma be associated with

Answer 26

paraproteinaemia

Question 27

what autoimmune condition is MALT assoc with

Answer 27

Thyroid + sjorgens

Question 28

what are the most common causes of an upper GI bleed

Answer 28

varisces, peptic ulcer, (mallor weiss, boeerhaave)

Question 29

what blood test may indicate upper GI bleed

Answer 29

raised urea (blood in stomach broken down to urea)

Question 30

what is the glasgow blatchford score used for

Answer 30

determine whether GI bleeds need urgent care

Question 31

what are the components of the glasgow blatchford score (4)

Answer 31

urea // Hb // BP // pulse or malena or syncope or hepatic or cardiac disease

Question 32

what score on glasgow blatchford score would indicate discharge

Answer 32

0

Question 33

what is 1st mx step in upper GI bleed

Answer 33

ABC, wide bore IV // platelets if bleeding // FFP if needed //

Question 34

when would prothrombin complex be indicated in upper GI bleed

Answer 34

if on warfarin and actively bleeding

Question 35

in what time frame should all upper GI patients have an endoscopy

Answer 35

24hrs

Question 36

when should PPI's be given in a GI bleed

Answer 36

after OGD if non-variceal bleed ie peptic ulcer