Upper GI Flashcards
(88 cards)
1
Q
barretts esophagus
A
endoscopically visible columnar epithelium within the esophagus regardless of length , with interstitial metaplasia and histological examination
- IRREVERSIBLE
2
Q
percentage of Barrets esophagus that goes to cancer
A
1%
3
Q
causes of difficulty / painful swallowing
A
ANATOMICAL
- FB, malignancy, web, pharyngeal pouch, strictures, schedlasia
- EXTRENSIC lesions: LAD, retrosternal loiter, bronchial CA, left atrial enlargement due to MS
FUNCTIONAL NEURO - post CVD, MND, globus hystericus ESOPHAGEAL dysmotility - diffuse esophageal spasm - scleroderma
4
Q
Plummer vinson syndrome
A
non b islet cell tumour secreting gastrin ass. w/ acid hyper secretion and severe PUD
5
Q
ph study score
A
DeMESSTER score - composite that measures of reflux episodes and length of occasions that the PH is <4
6
Q
CXR of achalasia
A
air fluid level in the mediastinal shadow with dilated esophagus
7
Q
achalasia
A
characteristic increase pressure in LE and failure to relax due to a damage of ganglion in Auerbach’s plexus resulting in poor parastasis throughout the esophagus
8
Q
investigation achalasia
A
- endoscopy
- barium swallow - bird beak
- manometry - absence parastasis
9
Q
complicationachalasia
A
nocturnal aspiration
bronchiectasis
lung abscess
carcinoma - 3% - SCC
10
Q
treatment achalasia
A
- ballon dilatation
- Heller’s cardiomyotomy
- injection of botulinum toxin - injection into LOS
11
Q
diffuse esophageal spasm
A
retrosternal pain radiating to the jaw and inter capsular region and you get NUTCRACKER ESOPAHgus with high amplitude peristalsis
12
Q
treatment diffuse esophageal spasm
A
nifdepine and reassurance
13
Q
chagas disease
A
similar to achalechia due to trypanosome cruzi . also ass. w/ megacolon, CM, megaduodenum, megaureter
14
Q
manometry findings in scleroderma
A
HYPOTENSIVE
15
Q
what is the number one test for hiatus hernia
A
Barium swallow
16
Q
GERD Definitionn
A
reflux of gastric contents into the esophagus, esophageal ph <4 for 4% over a 24 hour period on ph Monitoring
17
Q
Cause of GERd
A
- esophageal clearance - relies on gravity, saliva flow, normal motility, fixation to efficient peristalsis
- LES competence
- OCP, smoking, pregnancy lose LOS tone - Gastric clearance
- gastic outlet obstruction can reflux
- obseity and pregnancy- causes low clearance b/c increase pressure in abdomen
18
Q
What surgery for GERD
A
nissen fundoplication - wraps the funds of the stomach around the intra=abdominal esophagus to augment high pressure zones
INDICATIONS:
- persistent symptoms despite max medical treatment
- large reflux with aspiration pneumonia
- Complication of reflux - stricture and severe ulcerations
19
Q
test for H.pylori
A
urease testing (from Bx on endoscopy)
Urea breath testing
stool antigen test
serology
20
Q
failure of PU to heal with meds
A
- NSAID sbuse
- non compliant
- chrons
- gastric secreting tumour
- malignancy
21
Q
treatment of haemorrhage in pUD
A
- injection of adrenaline, thermo-coagulation , clipping, hawmostasis, nano powered spray
if these fail
- surgery - overseeing of the artery
22
Q
treatment of perf PUD
A
ulcer overseen and secured with a plug of omentum
23
Q
Gastric outlet obstruction how?
A
pylorus / pre pylori are areas of chronic ulcerations , healing with fibrosis leads to stricture formation and pyloric stenosis
24
Q
Gastric outlet obstruction clinical
A
projectile vomitting unrelated to eating, episodic
SUCCUSSION SPLASH on abdo exam
HYPOCLOREMIC ALKALSIS
DILATED STOMACH
25
Gastric outlet obstruction Tx
```
aggressive resuscitation
gastric drainage
gastro-enterostomy
truncal vagotomy
prloroplasty
rare:
- partial gastrectomy
```
26
treatment adenocarcinoma in the esophagus
SRUGERY
| CTX
27
treatment of SCC of esophagus
surgery
| RTX
28
causes adenocarcinoma of esophagus
```
GERD
Baretts
obesity
high fat intake
cigarettes
high alcohol intake
```
29
causes SCCof esophagus
```
high alcohol intake
tobacco use
nitrosamines
vita and C
coeliac idsase
strictures and webs
achalasia
PUD
```
30
staging of esophagus investigation
local: endoluminal Ultrasound
regional: CT scanning and laparoscopy (to asses peritoneal disease)
Disseminated: PET scanning may be use to exclude occult disseminated disease in patients otherwise consider potentially curative tx
31
surgical treatment for esophageal cancer
Ivor Leis procedure (abdomen - throat opened)
McKwoen three phase esophagectomy (ado-thorax- neck)
Transmittal resection (abdo- neck opened)
32
CTX treatment for esophageal cancer
- adeno
- patient is fit
- curative
- mets
33
RTX treatment for esophageal cancer
- SCC
- strictures
- fistulas
34
palliative treatment for esophageal cancer
1. incubation
2. stent - SEMS - self expanding metal stenting
3. laser treatment
- good for intrinsic tutors
- carries risk of perforation
35
R.F for gastric adenocarcinoma
- diet rich in Nitrosamines (smoked fresh fish, pickled fruit)
- chronic Atrophic gastritis
- blood group A
- chronic gastric ulceration related to H. pylori
NAAH
36
symptoms of gastric adenocarcinoma
- DYSPEPSIA (indigestion)
- N V WL Anorexia
Anemia - Fe deficiency
EARLY SAIETY
37
signs gastric adenocarcinoma
- WL
palpable epigastric mass
Supraclavicular nodes - VIRCHOWS and Troisers sign
38
Dx gastric adenocarcinoma
```
- gastroscopy and Bx
Staging investigation
- CT TAP
- endoluminal US
- laparoscopy
```
39
treatment gastric adenocarcinoma - GOLD STANDARD
1. SURGERY
| - resection - GOLD STANDARD
40
Treatment gastric adenocarcinoma
surgery - number 1
if advanced disease - not surgical candidates
total or partial gastrectomy
chemotherapy
palliation (with limited radiation therapy (palliative gastrojejunostomy to control symptoms
41
dumping syndrome
late complication post gastrectomy
- general weakness, faint and sweating
Early: rapid transit of hyperosmolar solutions
late: hypoglycaemia due to increase insulin secretion
42
epidemiology gastric adenocarcinoma
Men > 50
43
acute complication of gastrectomy
```
ACUTE PANCREATITIS
others:
- haemorrhage
anastomotic leak
duodenal stump disribution
respiratory compromised
```
44
how long before OGD do you have to go without food and water
6 hours fasting
| 2 hours water
45
what medication do you have to stop prior to OGD
PPI for 2 weeks before OGD
| tell patient to warn doctor if they are on warfarin aspirin or plavix
46
prehaptic causes of Jaundice
H.A
Congenital hyperbilirubinemia
transfusion reactions
Drug toxicity
47
intraheptatic causes of Jaundice
UCB:
- CN (absence UGT uridine glucoronyl transferase)
- Gilbert syndrome ( defect in the bilirubin canicular transport
```
CB
- viral hepatits
alcoholic liver disease
toxic drug jaundice
mets
```
48
post hepatic obstructive jaundice cause
Intramural - cholidocolithaisis
Mural - biliary stricture , PBC
Extrinsic - pancreatitis , pancreas carcinoma
enlarged LN , Mirizzi syndrome
-
49
Mirizzi syndrome
external biliary compression from stone impacted in the neck of the gallbladder
50
medications that cause Jaundice
Chlorpromazine
51
Spider Navei pathological
>3 in the Superior Vena Cava distribution
52
Ascites in abdomen
Hypoproteninaemia
| intra abdo malignancy - pancreas , stomach, ovary, colon
53
Caput medusae
Portal hypertension ass. w/ CLD
54
large tender smooth live
Hepatitis
55
Large irregular liver
mets
56
Courvoisor's Law
non tender palpable gallbladder in the presence of jaundice is UNLIKELY to be gallstones and duet malignant obstruction of the gland
57
LFT of hemolysis
RISED UCB
| NORMAL Alk P, GGT, transaminase, lactate dehydrogenase
58
LFT in hepatocellular
RAISED AST and ALT
less raised GGT, lactate dehydrogenase
NORMAL alk phospate
RASIED UCB
59
OBSTRUCtive LFT
VERY RAISED ALK P, GGT
Transaminase normal
lactate dehydrogenase - Normal
UCB - normal
60
what autoantibodies do you test in liver disease
anti-microsomal (PBC)
anti-nuclear
anti-smooth muscle
61
US findings in gallstones
dilated cystic duct
thickened gallbladder wall
gallstone
62
General treatment of Liver disease
correct dehydration
monitor urine output
clotting factors (vit K if PT is prolonged)
Diet - enternal feeding, dietician
ERCP: sphincterotomy, stent insertion , percutaneous transhepatic cholangiogram , surgical drainage
63
hemolytic jaundice treatment
steroids for autoimmune cases
| splenectomy
64
hepatic failure
transplantation
65
head of pancreas tumour tx
whipples prancreATICOduodeneCTOMY
66
definition acute pancreatitis
is an inflammatory process of the pancreas , resulting in release of inflammatory cytokines and pancreatic enzyme (lipase, trypsin) initiated by pancreatic injury
67
acute pseudocyst
collection of pancreatic juice surrounded by a wall of fibrous tissue that occurs 6-8 weeks after acute pancreatitis
68
pancreatic abscess
circumscibred intra-abdominal collection of pus arising close primximity to the pancreas but containing LITTLE TO NO pancreatic necrosis which arises as a consequence of acute pancreatitis
69
medications that can cause acute pancreatitis
Metronidazole tetracycline
azathioprine mercaptopurine
H2 blockers
70
metabolic causes of acute pancreatitis
hyperglycaemia
jhypercalcaemia
hypertriglyceridemia
71
acute pseudocyst treatment
percutansou ultrasound guided drainage
72
clinical pancreatitis necrosis
SWINING PYREXIA
73
late complication of acute pancreatitis
DM
| Malabsorption (due to loss of secretion of pancreatic digestive enzymes
74
within first 2 weeks complication of acute pancreatitis
multiple organ failure
- cardiovascular collapse from fluid shifts
- pulmonary failure
- pneumonia
- ARD
- renal failure from hypotension.
Pancreatic necrosis and peri-pancreatic necrosis
75
after 2 weeks complication of acute pancreatitis
pancreatic psudeocyst
| pancreatic abscess
76
chronic pancreatitis
characterized by recurrent or persistent abdominal pain and pancreatitis , often ass. with either exocrine or endocrine pancreatic insufficiency
77
chronic inflammation in chronic pancreatitis cases
- glandular atrophy
- ductal ectasia
- micro calcification
- intraductal stone formation
- cystic changes secondary to duct formation
-
78
Causes chronic pancreatitis
1/ recurrent episodes of acute pancreatitis usually alcohol induced
2/ secondly to pancreatic duct obstruction
- pancreatic head tumours and cyst
- pancreatic duct stricture
- congenital pancreatic abnormality
- cystic fibrosis
3/ autoimmune - PBC, PSC
79
clinical chronic pancreatitis
Recurrent abdo pain
STEATORRHEA
- WL and anorexia
-INSULin dependant DM
80
how do you differentiate chronic pancreatitis from tumour
endoscopic US combined with aspiration cytology / biopsies
81
how do you test exocrine function in chronic pancreatitis
fecal elastase
82
Treatment of chronic pancreatitis
Treat cause - stop alcohol, cholecystectomy , treat A.I disease
```
Diet change
CREON
PPI
INSULIN - if DM
ANALGESIA
CONSIDER if not responding
- extracorporeal shock wave lithotripsy
- celiac nerve block
- denervation surgery
SRUGERY
- only if not responding to medical treatment with obstructed pancreatic duct
- Whipples
- partial or distal pancreatectomy
pancreaticojejunostomy
```
83
R.F for pancreatic cancer
smoking
alcoholism
Dm
chronic pancreatitis
84
type of pancreatic cancer
ductal adenocarcinoma
Cystic neoplasm (7%)
3% islet cell tumours
85
tumour marker for pancreatic Ca
CA 19-9
86
images for pancreatic Ca
US abdomen - to investigate obstructive jaundice - gallstone
CT - to see pancreatic mass, local invasion, mets
endoscopic US - detecting SMALL CA and peripancreatic node involvement
US or CT guided FNA cytology
ERCP
PET
LAPrascopy - for staging (outule peritoneal disease)
87
most common endocrine pancreatic tumour
INSULINOMA - whipple's triad
Symptoms due to hypoglycemia especially after fasting or heavy exercise
A low plasma glucose with symptoms
Relief of symptoms when the glucose is raised to normal
88
endocrine pancreatic tumour investigation
abdominal CT scanning and selective pancreatic arteriography
