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Y4 GI / Surgery > Oesophagus & Stomach > Flashcards

Oesophagus & Stomach Flashcards

(90 cards)

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1
Q

Define dysphagia and odynophagia

A

Difficulty swallowing

Painful swallowing

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2
Q

Dysphagia to liquids and then solids suggests what cause?

A

Neurological eg myasthenia, MND

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3
Q

Dysphagia to solids then liquids suggests what cause?

A

Benign or malignant stricture

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4
Q

Dysphagia to both solids and liquids from the start suggests what cause?

A

Motility disorder eg spasm, achalasia

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5
Q

Oesophageal candidiasis is a known cause of odynophagia, true or false

A

True

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6
Q

Pharyngeal pouch

  • what age group commonest in?
  • what gender commonest in?
  • associated with nausea?
  • associated with weight loss?
  • symptoms consistent or intermittent?
A

Elderly males
No nausea or weight loss
Symptoms consistent when eating + drinking

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7
Q

What investigation diagnoses a pharnygeal pouch?

A

Barium swallow

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8
Q

What is the management of pharyngeal pouch?

A

Surgical treatment

However usually elderly population so reassure isn’t progressive for malignant

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9
Q

A female with dysphagia and iron deficiency anaemia due to a post cricoid oesophageal web describes what disorder?

A

Patterson Kelly brown

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10
Q

What features of the history should alert you to a malignant cause of odynophagia / dysphagia?

A

Progressive symptoms + weight loss

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11
Q

Corkscrew appearance on barium swallow is diagnostic of what cause of odynophagia?

A

Diffuse oesophageal spasm

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12
Q

Are diffuse oesophageal spasm symptoms consistent or intermittent? Does odynophagia or dysphagia predominate?

A

Intermittent severe pain when swallowing

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13
Q

GORD and radiotherapy are both risk factors for what cause of dysphagia?

A

Benign oesophageal stricture

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14
Q

Failure of the LOS to relax + failure of peristalsis describes what disorder?

A

Achalasia

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15
Q

Pathology in Zenker’s diverticulum is associated with what cause of dysphagia?

A

Pharyngeal pouch

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16
Q

Pathology in Auerbach’s plexus is associated with what cause of dysphagia?

A

Achalasia

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17
Q

What test is diagnostic of achalasia?

A

Barium swallow bird beak appearance

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18
Q

What is the management of achalasia?

A

1st line try CCB / GTN to relax sphincter

Last line surgical / botox

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19
Q

What is the 1st line investigation for most cases of dysphagia? If this comes back as normal what investigation is usually done next?

A

1st OGD

2nd barium swallow

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20
Q

Delayed gastric emptying is the description of what disorder?

A

Gastroparesis

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21
Q

What investigation diagnoses gastroparesis?

A

Gastric emptying study

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22
Q

What is the aetiology of gastroparesis?

A

Idiopathic or diabetic neuropathy

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23
Q

N&V on eating, early satiety and epigastric pain is the presentation of what disorder?

A

Gastroparesis

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24
Q

Why is pregnancy and obesity a risk factor for reflux?

A

Raised intra abdominal pressure

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25
What are the two types of hiatus hernia?
Sliding or paraesophageal
26
Can hiatus hernia be seen on OGD?
Yes, can also be seen on barium swallow
27
What is the first line management of hiatus hernia?
Conservative weight reduction + PPI
28
What is the first line investigation and management of reflux/dyspepsia?
If 1st presentation no Ix; give PPIs should respond in 4-6wk | If no response arrange OGD to assess severity and look for Barrett's
29
What time should PPIs be taken in relation to eating?
30 minutes before eating
30
Cimetidine and ranitidine are in what class of drugs?
H2 antagonists - used in the management of reflux
31
Salmon coloured mucosa in the distal third of the oesophagus suggests what?
Barrett's oesophagus
32
What is Barretts oesophagus? What is the risk?
Premalignant metaplasia squeamish to columnar epithelium | Risk of oesophageal adenocarcinoma
33
Where in the oesophagus are oesophageal adenocarcinoma and squamous carcinoma found?
Adenocarcinoma distal 1/3 | Squamous carcinoma proximal 2/3
34
What is the management of Barretts oesophagus?
Surveillance/ oesophageal resection/ radio frequency ablation/ mucosectomy
35
What is the management of oesophageal adenocarcinoma?
Surgery / palliative
36
What is the management of oesophageal squamous carcinoma?
Chemo / radio
37
What are the criteria for referral for suspected oesophageal adenocarcinoma?
``` 2wk wait OGD if: dysphagia OR >55yr + weight loss + any of (upper abdo pain, reflux, dyspepsia) ```
38
Haematemesis is defined as vomiting of blood from the upper GI tract. Red blood suggests what? Coffee grounds suggest what?
Bright red = active bleeding | Coffee grounds = bleeding ceased
39
What is "black tarry offensive odour stool" What is it caused by?
Melena Upper GI haemorrhage (black appearance caused by oxidation of iron in haemoglobin as it passes through ileum/colon)
40
Is a Mallory-Weiss tear a longitudinal or transverse tear? What is it caused by?
Longitudinal tear at gastroesophageal junction Repetitive/strenuous vomiting (bleeding stops spontaneously for most)
41
What is the clinical significance of the ligament of Treitz?
Above/below = upper v lower GI bleeding | its in duodenum
42
What is a Blatchford score?
Need for intervention pre-OGD in upper GI bleeding
43
What is a Rockall score?
Mortality in upper GI bleeding
44
What is Boerhaave syndrome?
Oesophageal rupture
45
What are the indications for fresh frozen plasma transfusion in upper GI bleeding?
If actively bleeding + prothrombin time greater than 1.5X normal
46
What are the indications for platelet transfusion in upper GI bleeding?
If actively bleeding + platelet count <50
47
When should OGD be offered in upper GI bleeding?
Immediately after resuscitation if severe bleeding, otherwise within 24 hours
48
Subcutaneous chest wall emphysema is associated with what cause of upper GI bleeding?
Boerhaave syndrome
49
What is the management of a Mallory-Weiss tear?
Bleeding stops spontaneously for most | If acutely unwell (HR) admit for IV fluids + IV PPI infusion
50
Aorto-duodenal fistula can cause upper GI bleeding, what surgical procedure is it a complication application off?
AAA
51
How is upper GI bleeding classified in terms of aetiology?
Variceal and non-variceal
52
When is RBC transfusion offered an upper GI bleeding?
If Hb <70
53
What is the management of non-variceal upper GI bleeding?
``` ABCDE IV fluid resuscitation Transfuse it Hb<70 Bladder catheterisation Correct clotting Everyone gets an OGD IV PPI after OGD (80mg bolus followed by 8mg/hr infusion) ```
54
How does cirrhosis cause varices?
Cirrhosis > portal HTN > collaterals between systemic / portal circulations > varices
55
What effect does portal hypertension have on the spleen?
Hypersplenism splenomegaly due to blockage of blood backflow - as a result can get thrombocytopenia
56
What is the management of variceal bleeding?
IV fluids + IV terlipressin at 2mg every 6hr + prophylactic IV antibiotics - then OGD - during OGD do band ligation of esophageal varices (Terlipressin is a vasopressor)
57
In the management of variceal bleeding if variceal band ligation isn't successful at controlling bleeding, what can be done next?
TIPS
58
What is the role of the urea breath test in h pylori infection?
Test of h pylori eradication | - don't think done as a diagnostic test but double check this
59
How can you clinically differentiate a gastric v duodenal ulcer?
Gastric exacerbated by eating | Duodenal relieved by food (pain before eating + at night)
60
Why do you need a follow up OGD after a gastric ulcer?
Risk of malignant transformation so need to make sure eradicated
61
"Gram negative urease producing bacteria, faecal oral spread" describes what
H pylori
62
What is the treatment of h pylori infection?
omeprazole + amoxicillin + clarithromycin triple therapy | metronidazole if penicillin allergic
63
What type of cancer is associated with h pylori infection?
Gastric MALT lymphoma and gastric adenocarinoma
64
How is h pylori infection diagnosed?
IDK | Biopsy CLO urease test
65
What is the management of a bleeding peptic ulcer?
OGD - IJ adrenaline / clips
66
What common drug class aggravates / causes gastritis ?
NSAIDs incl aspirin
67
In a patient with gastritis/PUD, if NSAIDs have to be used what can you do to prevent more harm?
Co-prescribe a PPI | Use selective COX-2 inhibitors like Coxib
68
What is the definition of diarrhea?
>3 unformed stools/day
69
What is the commonest infectious agent in gastroenteritis?
Campylobacter
70
Which infectious agent in gastroenteritis is associated with the O-antigen?
Salmonella
71
Which infectious agent in gastroenteritis is associated with the VTEC toxin?
E coli 0157
72
Which infectious agent in gastroenteritis is associated with GBS?
Campylobacter
73
Which infectious agent in gastroenteritis is associated with reheated rice?
Bacillus cerus
74
Which infectious agent in gastroenteritis is associated with unpasteurized milk and is harmful in pregnancy?
Listeria
75
Which infectious agent in gastroenteritis is associated with cruise ships?
Norovirus
76
Which infectious agent in gastroenteritis is associated with outbreaks in daycare?
Rotavirus
77
Which infectious agent in gastroenteritis is associated with HUS?
E coli 0157
78
Which infectious agent in gastroenteritis is associated with BBQs?
Think e coli ???
79
Can campylobacter cause bloody diarrhea?
Yes
80
Can bacillus cereus cause bloody diarrhea?
No
81
Can e coli 0157 cause bloody diarrhea?
Yes
82
Can rotavirus cause bloody diarrhea?
No
83
Can norovirus cause bloody diarrhea?
No
84
Can c diff cause bloody diarrhea?
Yes
85
Which infectious agent in gastroenteritis is associated with pseudomembranous colitis?
C diff
86
What organisms are tested for in a standard stool sample?
``` Salmonella Shigella Campylobacter E coli 0157 Cryptosporidium C diff (if >4y.o) (Other tests you have to request) ```
87
What is the most important aspect of management in norovirus & rotavirus infection?
Hydration
88
How is c diff diagnosed?
Stool toxin
89
What is the management of c diff infection?
Less severe PO metron | Severe PO vancomycin
90
Which infectious agent in gastroenteritis is associated with recent antibiotic use / hospital acquired?
C diff

Y4 GI / Surgery (11 decks)

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