Gastro: Oesophageal + stomach

Question 1

Common in north Aficans , hx of atropy
Endoscopic Biopsy:
> 15 eosinophils per high power microscopy field.
-reduced vasculature, -thick mucosa,
- mucosal furrows,
-strictures &laryngeal oedema

Answer 1

Eosinophilic oesophagitis

Question 2

rx Eosinophilic oesophagitis

Answer 2

RX:
Diet - ppi
If diet fails Topical steroids e.g. fluticasone and budesonide
Oesophageal dilatation
Complications: strictures, Mallory Weiss tears

Question 3

Barium swallow: shows irreg filling defect
Endoscopy: white patches
With a hx of immunosuppression

Answer 3

Oesophageal candidiasis

Question 4

oesophageal manometry (most important diagnostic test)=
excessive LOS tone which doesn’t relax on swallowing

Barium swallow
expanded oesophagus, fluid level
‘bird’s beak’ appearance

chest x-ray
wide mediastinum
fluid level

Answer 4

Achalasia

Question 5

Rx Achalasia
1st line
High risk
recurrent

Answer 5

Rx: 1st ln- pneumatic (balloon) dilation
Recurrent = Heller myotomy
High risk injection of botulinum toxin

Question 6

What causes

Sx: are dysphagia, regurgitation, aspiration & chronic cough. Halitosis

Might have midline lump in the neck that gurgles on palpation

Answer 6

Pharyngeal pouch
Zenker’s diverticulum

Question 7

IX & RX for

Answer 7

Pharyngeal pouch
Zenker’s diverticulum

Question 8

Barrett’s oesophagus
Risk factor & define

Answer 8

Risk factors: GORD, male, smoking, Central obesity NOT alcohol

metaplasia of the lower oesophageal mucosa, with the usual squamous epithelium being replaced by columnar epithelium.

Question 9

Rx Barrett’s oesophagus
What is the largest complication

Answer 9

Rx: ALL high-dose PPI

Pt w/ metaplasia (but not dysplasia) endoscopy every 3-5 years

Pt w/ dysplasia = 1st ln : radiofrequency ablation:
endoscopic mucosal resection

Increased risk oesophageal adenocarcinoma (50-100%)

Question 10

Indications for upper GI endoscopy:

Answer 10

age > 55 years
symptoms > 4 weeks or persistent symptoms despite treatment
dysphagia
relapsing symptoms
weight loss

Question 11

Most common type of Oesophageal cancer in the world, in the UK

Answer 11

Adenocarcinoma most common found in UK gastroesophageal junction

-Squamous cell tumours most common in the world found in the upper 2/3 of the oesophagus.the world is square

Question 12

Dysphasia for solids then liquids indicates

Answer 12

Oesophageal cancer

Question 13

IX& Rx Oesophageal cancer

Answer 13

-Upper GI endoscopy with biopsy

-Endoscopic ultrasound is the preferred method for locoregional staging

CT scanning of the chest, abdomen and pelvis is used for initial staging

Rx surgical resection; complication anastomotic leak

Question 14

What cause (DIE)
* Dysphagia (2dary to oesophageal webs)
* Iron-deficiency anaemia/Glossitis
* Esophageal webs

Answer 14

Plummer-Vinson syndrome

Question 15

Plummer-Vinson syndrome
Increases risk to
RX

Answer 15

Squamous cell carcinoma

RX iron & dilatation of webs

Question 16

What is caused by severe vomiting & is
Common in alcoholics

Answer 16

Mallory-Weiss syndrome

Question 17

What causes the Mackler triad
1. Severe /repeated vomiting,
2. sudden onset CP

3. Subcutaneous emphysema

Answer 17

Boerhaave syndrome

Question 18

Acute treatment of variceal haemorrhage (4)

Answer 18

1. correct clotting: FFP, vitamin K

2.Terlipressin -benefit in initial haemostasis and prevents rebleeding

3. prophylactic IV antibiotics :Quinolones - reduce mortality in patients with liver cirrhosis
4. endoscopic variceal band ligation is superior to endoscopic sclerotherapy.
   * Sengstaken-Blakemore tube if uncontrolled haemorrhage
   * Transjugular Intrahepatic Portosystemic Shunt (TIPSS) if above measures fail- connects the hepatic vein to the portal vein
   o exacerbation of hepatic encephalopathy

Question 19

Prophylaxis of variceal haemorrhage

Answer 19

• propranolol: reduced rebleeding and mortality compared to placebo
• endoscopic variceal band ligation (EVL) is superior to endoscopic sclerotherapy. It should be performed at two-weekly intervals until all varices have been eradicated. PPI is given to prevent EVL-induced ulceration..’

Question 20

2 causes of gastritis

Answer 20

1. Autoimmune Gastritis - Type 4 hypersensitivity
   Type A (Fundus to Body)
2. H-Pylori -MOST Common Helicobacter pylori is a Gram-negative bacteria; secretes urease = alkalinization
   Type B (Antrum to Body)

Question 21

What is impaired Autoimmune Gastritis

Answer 21

Decrease in intrinsic factor B1
Decrease Fe2+ absorption

Question 22

Risks associated with H-Pylori

Answer 22

MALT
Neuroendocrine tumours
duodenal ulcers

Question 23

Dx Autoimmune Gastritis

Answer 23

biopsy
antibodies to IF & parietal cells

Question 24

test for eradication of H-pylori

Answer 24

Urea breath test
should not be performed within 4 wks of rx w/ an antibacterial or within 2 weeks PPI

Question 25

tests for H-pylori

Answer 25

Urea breath test- sensitivity 95-98%, specificity 97-98%; not before 2wks after PPI use or 4 abx Rapid urease test (e.g. CLO test)- sensitivity 90-95%, specificity 95-98% Stool antigen test- sensitivity 90%, specificity 95%

Question 26

Rx h pylori

Answer 26

* 7 days: PPI + amoxicillin + (clarithromycin OR metronidazole) * if penicillin allergic: a PPi + metronidazole + clarithromycin

Question 27

Duodenal Ulcer relationship to h. Pylori How is pain relieved

Answer 27

- More common 90% due to H-Pylori - pain when hungry, relieved by eating

Question 28

What worsens Gastric ulcer pain

Answer 28

70% due to H-Pylori -worsened by eating H- pylori makes acid more basic and induces inflammation -NSAIDS- Stop production of prostaglandins (normally promote H+ production and mucus secretion)= decreased mucosal protection

Question 29

Acid difference in Gastric and duodenal ca

Answer 29

duodenal = increase H more acidic Gastric = more basic

Question 30

Where do gastric ulcers tend to bleed from

Answer 30

left gastric artery on the the lesser curvature

Question 31

gastric ulcers what are they a risk factor for

Answer 31

MALT gastric adenocarcinoma

Question 32

Where do duodenal ulcers tend to bleed from

Answer 32

gastroduodenal artery posterior wall of the duodenum

Question 33

What is the most common type of gastric ca and where is it most likely to form ?

Answer 33

Gastric Adenocarcinoma lesser curvature of the antrum

Question 34

Common sign of adenocarcinoma

Answer 34

Question 35

Sign of gastric adenocarcinoma and mer

Question 36

Pathology of Acute Pancreatitis

Answer 36

Autodigestion of the pancreas= Inflammation & Haemorrhaging

Question 37

Pathology of chronic Pancreatitis

Answer 37

Chronic Pancreatitis Most common type of pancreatic insufficiency lack digestive enzymes = malabsorption, steatorrhea, DM, Vit deficiency E, A, D

Question 38

Common caused of acute Pancreatitis

Answer 38

Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia, Hypertriglyceridemia, ERCP and Drugs. Inflammation causes enzymes released Proteases, lipase and amylase

Question 40

Causes of Chronic Pancreatitis

Answer 40

Question 41

Sx of chronic pancreatitis

Answer 41

Question 42

Signs of acute pancreatitis

Answer 42