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Upper GI Flashcards

1
Q

Common causes of upper GIT bleeding

A

Oesoph

  • varices
  • Mallory Weiss

Stomach

  • ulcer
  • erosive hemorrhagic gastritis

Duodenum

  • ulcer
  • erosive duodenitis
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2
Q

Uncommon causes of upper GI bleeding

A
  • tumours
  • stomal/anastomotic ulcers
  • vascular malformations
  • oesophagitis
  • oesophageal ulcers
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3
Q

Most common causes of major GI bleeding

A
  • PUD

- oesophageal varices

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4
Q

Clinical findings in major haemorrhage

A
  • hypotension
  • pallor
  • weak and rapid pulse
  • poor peripheral perfusion
  • cool extremities
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5
Q

NB things to think of if a patient with upper GI bleeding has liver failure

A
  • avoid Na-containing fluids
  • give 5% dextrose
  • octreotide to lower portal pressure
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6
Q

NB diagnostic investigations for upper GI

A
  • endoscopy

- angiography

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7
Q

Forrest classification

A 
1A = spurting blood
1B = oozing blood
2A = non-bleeding visible vessel
2B = adherent clot
2C = pigmented spot
3 = clean ulcer base
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8
Q

Risk stratificaiton score for upper GI rebleed

A

Roackall Risk score

  • age
  • haemodynamic status
  • co-morbidities
  • endoscopic Dx
  • stigmata of recent Hg
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9
Q

Patients at risk of rebleeding

A
  • age >60 yrs
  • shock on admission
  • endoscopic stigmata of recent bleed
  • large ulcers (>2cm)
  • lesser curvature gastric and post-duodenal bulb ulcer
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10
Q

Indications for surgery for upper GI bleeding

A
  • exsanguinating Hg
  • associated perforation
  • failed endoscopy of active bleeding in shocked patient
  • recurrent bleeding after endoscopic therapy
  • patients at risk of rebleeding where endoscopy not avail.
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11
Q

Management of high risk upper GI patient

A
  • resus
  • admit to highcare
  • endoscopic therapy
  • commence IV PPIs
  • oral intake of clear fluids 6 hrs after endoscopic haemostasis
  • transition to oral PPIs
  • test for HP and eradicate
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12
Q

Symptoms of duodenal ulcers

A
  • upper abdo pain releived by food
  • nocturnal pain
  • heart burn, anorexia, vomiting and weight loss related to gastric outlet obstruction
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13
Q

Medical management of PUD

A
  • PPI

- amoxicillin and metronidazole

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14
Q

When is surgery indicated for PUD

A

To fix complications

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15
Q

Complications of PUD

A
  • haemorrhage
  • perforation
  • duodenal stenosis
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16
Q

Investigations for perforated peptic ulcer

A
  • erect chest and abdo XRAY
  • raised serum amylase
  • gastrografin swallow if doubtful

NO ENDOSCOPY

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17
Q

Surgical management of perforated peptic ulcer

A

primary closure with omental patch

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18
Q

2 types of pathology of duodenal stenosis as a result of PUD

A
  • large penetrating ulcers with inflammation and oedema
  • healed ulcer with fibrosis

Compensatory muscular hypertrophy

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19
Q

Metabolic end results of duodenal stenosis

A
  • severe dehydration
  • raised urea and heamatocrit
  • low serum Cl, Na, K
  • serum alkalosis and intra-cellular acidosis
  • decreased ionised calcium (tetany)
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20
Q

Clinical features of duodenal stenosis

A
  • long history of dyspepsia and LOW
  • anorexia, nausea and vomiting (undigested food)
  • metabolic and nutritional derangements
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21
Q

Examination findings of duodenal stenosis

A
  • dehydration
  • upper abdo distension
  • visible peristalsis
  • succussion splash
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22
Q

Investigations of duodenal stenosis

A
  • abdo XRAY
  • barium meal
  • endoscopy to exclude carcinoma
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23
Q

Treatment of duodenal stenosis

A
  • rehydration and electrolyte correction
  • enteral feeds
  • stomach washouts
  • ulcer therapy
  • endoscopic dilatation
  • often, surgery is necessary
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24
Q

3 types of gastric ulcers

A
  • prepyloric
  • combo duodenal and gastric
  • > 2cm from the pylorus on the lesser curve
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25
Symptoms of gastric ulcer
- pain precipitated by meals | - LOW
26
Complications of gastric ulcers
- bleeding - perforation - penetration into pancreas - gastric outlet obstruction
27
4 layers of the small intestine
- mucosa - submucosa - muscularis - serosa
28
Hormones produced by the small intestine
- gastrin - cholecystokinin - secretin - motilin - vasoactive intestinal polypeptide
29
Most common causes of small bowel obstruction
- adhesions | - hernias
30
Symptoms of small bowel obstruction
- abdo discomfort/pain - abdo distension - N + V (bile-stained) - obstipation
31
Causes of small bowel perforation
- TB - typhoid - CMV - malignancy - Crohn's disease - steroids - radiotherapy
32
Describe short bowel syndrome
- diarrhoea, steatorrhoea, malnutrition - 100cm or less - most need life-long TPN
33
Causes of small intestinal haemorrhage (excl. ulcers)
- vascular abnormalities - Crohn's - Meckel's
34
Mets that go to the small bowel
- melanoma - renal - breast
35
Risk factors for chronic atrophic gastritis
- autoimmune disorders - chronic bile reflux - H. pylori - alcohol - smoking - poor nutrition
36
Describe Correa's hypothesis
- nutritional defects cause gastritis - cell damage leads to defective acid production and bacterial prolif - bacteria produce nitrate reductase - reduces dietary nitrate to nitrites which combine with amines - nitrosamines are carcinogenic
37
Risk factors for gastric cancer
- H. pylori - EBV - gastric surgery - abdominal radiation - blood group A - family history - hereditary diffuse gastric cancer - gastric polyps - hypertrophic gastropathy (Menetiers) - gastric ulcer - pernicious anaemia
38
2 types of gastric cancer
- intestinal | - diffuse
39
Difference between intestinal and diffuse gastric adenocarcinomas
Intestinal - ulceration - acinar formation - antrum Diffuse - constricting linitis plastica - no acini - fundus - worse prognosis
40
Presentation of gastric carcinoma
- dyspepsia - local complications - insidious onset - dysphagia (prox stomach) - paraneoplastic manifestations
41
Differential diagnoses of dyspepsia
- functional dyspepsia - PUD and gastritis - GORD - oesophagitis - Drug SE - biliary disease - gastric Ca
42
Causes of gastric outlet obstruction
- Gastric carcinoma - PUD - pancreatic pathology - corrosive stricture - rarities (volvulus, bezoars)
43
Surgical decision making steps for gastric cancer
- confirm with endoscopic biopsy - metastatic screen - assess extent - assess fitness for surgery
44
Operation for localised disease of gastric cancer
Billroth 2 (distal gastrectomy)
45
What are GI stromal tumours?
- sub-epithelial neoplasms found usually in the stomach | - symptoms only really occur when large
46
Mutation found in GIST
CD 117Ag (part of tyrosine kinase receptor) - responsive to Imatinib (blocks tyrosine kinase receptor)
47
What type of lymphoma is gastric lymphoma usually?
- non-Hodgkin | - most are aggressive and treated with CHOP chemo
48
Benign disease of the pharynx/oesophagus
- GORD - Para-oesoph hernia - motility disorders - achalasia - diverticula - oesoph perforation - dysphagia
49
Possible investigations for benign oesophageal diseases
- chest and abdo XRAY - barium swallow and meal - endoscopy - CT - endoscopic US - manometric studies - 24 hr pH monitoring
50
What is the pathology in GORD?
Incomplete/inappropriate relaxation of the LOS | - many have sliding hiatus hernia
51
Symptoms of GORD
- burning substernal/epigastric distree - acid regurg after meals or when lying down - associated aspiration, asthma and hoarseness
52
Complications of GORD
- oesophagitis - ulceration (stenosis and bleeding) - Barrett's oesophagus
53
Complications of para-oesophageal hernia
- gastric volvulus - obstruction - incarceration - strangulation - pulmonary complications
54
Types of achalasia
- hypofunctional | - hyperfunctional
55
What causes hypofunctional achalasia
- destruction of Auerbach's nerve plexus - oesoph gradually dilates - test with manometry
56
Management of hypofunctional achalasia
Heller's myotomy
57
Causes of hyperfunctional achalsia
- diffuse oesophageal spasm | - nutcracker oesophagus
58
3 types of oesophageal diverticulae
- pharyngo-oesophaegeal (Zenkers) - Traction diverticula - Epiphrenic diverticula
59
Types of oesophageal perforation
- instrumental | - non-instrumental
60
Causes of non-instrumental perforation
- post-emetic - foreign body - penetrating injury - anastomotic leak
61
Severe result of oesophageal perforation
Virulent necrotising mediastinitis
62
Benign causes of dysphagia
- GORD - caustic - Webs - Schatzki ring - motility disorders - drug-induced - post-Nissen - eosinophilic oesophagitis
63
Malignant causes of dysphagia
- squamous carcinoma - adenocarcinoma - metastases
64
Causes of odynophagia
- hypermobility disorders - candidiasis - herpes simplex - drugs
65
Two types of oesophageal cancer
- squamous cell (upper) | - adenocarcinoma (glandular cells at junction)
66
Risk factors for oesophageal cancer
- race - sex (M) - age - smoking - alcohol - GORD - other (HPV, PlummeriVinson, tylosis, achalasia)
67
What is Plummer- Vinson
association of postcricoid dysphagia, upper esophageal webs, and iron deficiency anemia
68
What is tylosis?
A genetic disorder characterized by thickening (hyperkeratosis) of the palms and soles, white patches in the mouth (oral leukoplakia), and a very high risk of esophageal cancer
69
Local symptoms of oesophageal cancer
- dysphagia - cough and regurg - odynophagia - weight loss - upper GI bleeding
70
Symptoms of oesophageal cancer caused by surrounding invasion
- resp fistula - hoarseness - hiccups - pain
71
Symptoms of oesophageal cancer caused by distant disease
- mets | - hypercalcaemia
72
Contraindications to oesophagectomy for oesophageal cancer
- mets to N2 nodes - local structure invasion - severe comorbidities
73
Possible interventions for oesophageal cancer
- surgery - radiotherapy (palliative) - intubation (and stenting) - chemo (limited) - other (laser, photodynamic therapy)

Surgery Revision (8 decks)

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