Upper GI Flashcards by Helen Lashwood

What is the most common symptom of both gastric and duodenal ulcers?

Epigastric pain

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Can antacids provide relief for gastric and duodenal ulcers?

Only duodenal

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Differentiate the eating pattern seen in duodenal and gastric ulcer disease

Duodenal: over-eating
Gastric: anorexia

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Which of gastric/duodenal ulcers are more likely to wake patients at night?

Duodenal

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Recall 2 ways of testing for H pylori

13C Urea breath test

Stool antigen test

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Recall the management of H pylori

1 week triple therapy:
PPI
Clarithromycin/ Metronidazole
Amoxicillin

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Is H pylori gram pos or neg?

Gram neg

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What are the 2 ways that H pylori can be tested for?

Breath test (urease)
Stool Ag test

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Which two types of cancer does H pylori increase risk of?

Gastric Ca

Lymphoma

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What is Zollinger-Ellison syndrome?

A condition in which a gastrin-secreting tumour or hyperplasia of the islet cells in the pancreas causes overproduction of gastric acid, resulting in recurrent peptic ulcers

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Which comorbidity increases risk of gastrinomas?

Men1

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What investigation should be done for Zollinger-Ellison syndrome?

Fasting serum gastrin

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What are the 2 most common complications of PUD?

Bleeding and perforation

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Recall the medical management of a bleeding or perforated peptic ulcer

Bleeding: IV PPI and AD injection (AD –> vasoconstriction)
Perforated: IV Abx (as if GI contents exit tract they pose an infection risk)

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What is the complication to be aware of in peptic ulcer perforation?

Air under diaphragm: peritonitis + pneumoperitoneum

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What is Sister Mary Joseph’s node?

Metastatic nodule on umbilicus

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Why does smoking increase the risk of GORD?

Relaxes the lower oesophageal sphincter

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What are the subtypes of non-traumatic hiatus hernia?

Sliding hiatal hernia

Paraoesophageal hiatal hernia

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What is the first line investigation for hiatus hernia?

Barium swallow

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What is the main surgical option ofr management of hiatus hernia?

Nissen fundoplication

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Recall 3 investigations that may be done in GORD if endoscopy does not reveal cause of disease

Ambulatory pH monitoring
Oesophageal manometry
Barium swallow (to look for hiatus hernia)

What is oesophageal manometry able to diagnose?

Disorders of motility eg. achalasia

Recall the treatment options for Barrett’s oesophagus

Depends on endoscopic findings:
High grade dysplasia: radiofrequency ablation and PPI
Nodule: endoscopic mucosal resection and PPI

Differentiate the location of squamous cell oesophageal cancer and adenocarcinoma of the oesophagus

SCC: middle 1/3
Adenocarcinoma: lower 1/3

By what factors is dysphagia classified?

1. High vs low | 2. Functional vs structural

Recall 2 structural causes of high dysphagia

Cancer | Pharyngeal pouch

Does stricture cause high or low dysphagia?

Low

Classify the dysphagia caused by Plummer-Vinson syndrome

Structural low dysphagia

Recall 3 causes of low functional dysphagia

Achalasia Oesophageal spasm Limited cutaneous scleroderma

Recall 3 causes of high functional dysphagia

Stroke Parkinson's Myasthenia gravis

Recall 2 factors of a history that can help you differentiate structural and functional dysphagia

1. Intermittent or progressive? Intermittent suggests neurological/motility issue, progressive suggests structural 2 . Solids vs liquids: solids progressing to liquids suggests structural (eg cancer growing)

What symptom is suggestive of oesophageal cancer until proven otherwise

New-onset dysphagia in pts over 55

What is the most common investigation for low dysphagia?

Endoscopy

What is videofluoroscopy?

Between investigation and treatment: similar to barium swallow, allows SALT to see how a pt swallows and help them correct issues

What does manometry assess?

Pressure in lower oesophageal sphincter

What is the buzz-word finding of achalasia on barium swallow?

Bird's-beak

Which disease produces an identical pathophysiology to achalasia?

Chagas disease

Recall 3 signs OE of IDA

Cheilosis Atrophic glossitis Koilonychia

Which rheumatological condition is associated with dysphagia?

CREST (limited cutaneous scleroderma)

How is the barium swallow described in cases of oesophageal spasm?

Corkscrew oesophagus

What is Boerhaave's syndrome?

Full tear in oesophageal wall

What will CXR show in Boerhaave's?

Pneumomediastinum

Within how many hours should Boerhaave's be operated on?

What are oesophageal varices?

Extremely dilated sub-mucosal veins in lower third of oesophagus

What are oesophageal varices a consequence of?

Portal hyptertension due to cirrhosis

Describe the presentation of ruptured oesophageal varices

Extreme haematemesis May be unconscious or in shock Melaena

Is the anaemia produced by oesophageal varix rupture macrocytic or microcytic?

Macrocytic

Which drug is used in portal HTN management?

IV Terlipressin

What is the first line surgical management of oesophageal varices?

Band ligation

Recall the steps of management of ruptured peptic ulcer

1. Endoscopy with IM AD at site of ulcer 2. PPI 3. Triple therapy if H pylori +ve