Upper GI

Question 1

Define peptic ulcer

Answer 1

Break in the epithelial lining of the stomach or duodenum

Question 2

Symptoms of peptic ulcer disease (5)

Answer 2

Recurrent epigastric pain related to eating
Early Satiety
Nausea & Vomiting
Potential anorexia & weight loss

Question 3

Signs of peptic ulcer disease

Answer 3

Epigastric tenderness

Pointing sign

Question 4

Duodenal vs gastric ulcer pain and weight

Answer 4

Duodenal
Pain 2-3 hours after and commonly awakens patients at night
Often overeat and causes weight gain

Gastric
Pain shortly after eating
Often avoid eating - weight loss

Question 5

RF of peptic ulcer (4)

Answer 5

H pylori
NSAIDs
Bisphosphonates
Smoking

Question 6

Ix for H pylori (2)

Answer 6

Breath test - need to stop PPI first

Stool antigen test

Question 7

Mx of H pylori (4)

Answer 7

Triple therapy
PPI, Clarithromycin,
Amoxicillin OR Metronidazole

Question 8

Define Zollinger-Ellison syndrome

Answer 8

Neuroendocrine tumour in the pancreas secreting gastrin leading to increased gastric acid secretion and so peptic ulcers

Question 9

Association of Zollinger Ellison syndrome

Answer 9

MEN1

Question 10

When to consider Zollinger Ellison syndrome

Answer 10

Multiple ulcers refractory to treatment

FHx of MEN

Question 11

Ix for Zollinger Ellison syndrome (3)

Answer 11

Fasting serum gastrin
Serum calcium
Gastric acid secretory tests, stimulation tests, Imaging

Question 12

Mx for Zollinger Ellison syndrome (2)

Answer 12

PPI

Surgical resection if required

Question 13

What is a Cushing ulcer

Answer 13

patients suffering head trauma developed peptic ulcers.
Why?
Raised ICP thought to stimulate vagus nerve – leads to increased gastric acid secretion

Question 14

Why do Cushing’s ulcers occur

Answer 14

patients suffering head trauma developed peptic ulcers.
Why?
Raised ICP thought to stimulate vagus nerve – leads to increased gastric acid secretion

Question 15

What is a Curlings ulcer

Answer 15

Following severe burn injuries
Why?
Reduced plasma volume leads to ischaemia and necrosis of gastric muscosa

Question 16

Why do Curlings ulcers occur

Answer 16

Following severe burn injuries
Why?
Reduced plasma volume leads to ischaemia and necrosis of gastric muscosa

Question 17

What are red flags indicating endoscopy (7)

Answer 17

over 55, weight loss, bleeding, anaemia, vomiting, early satiety, or dysphagia

Question 18

H pylori negative Mx of peptic ulcer disease

Answer 18

H. Pylori negative: PPI or H2 antagonist

Question 19

Complications of peptic ulcer disease (20

Answer 19

Haemorrhage

Perforation

Question 20

Most common type of gastric cancer

Answer 20

Adenocarcinoma

Question 21

Symptoms of gastric cancer (5)

Answer 21

Epigastric pain
Nausea, vomiting ±blood
Anorexia
Weight loss

Question 22

RF of gastric cancer (3)

Answer 22

Smoking
H. Pylori
Chronic gastritis – and therefore peptic ulcer disease

Question 23

Signs of gastric cancer (3)

Answer 23

Palpable epigastric mass
Virchow’s node/Troisier’s sign
Sister Mary Joseph node

Question 24

Ix for gastric cancer (2)

Answer 24

Endoscopy

Biopsy and histology

Question 25

Causes of increased gastric acid secretion (3)

Answer 25

Diet Smoking Zollinger Ellison syndrome

Question 26

Which drugs can cause lower oesophageal sphincter hypotension and so GORD

Answer 26

anti-muscarinics, CCBs, nitrates, smoking

Question 27

Ix for hiatus hernia (3)

Answer 27

Barium swallow Chest X-ray Endoscopy

Question 28

Mx of hiatus hernia (3)

Answer 28

Conservative – risk factor modification Pharmacological (PPI) Surgery – Nissen fundoplication

Question 29

Suspected GORD is untreated with PPI, next step?

Answer 29

UGI endoscopy

Question 30

Define Barretts oesophagus

Answer 30

Metaplasia of the oesophagus due to chronic oesophagitis

Question 31

What is the change in Barretts oesophagus

Answer 31

squamous epithelium changes to columnar epithelium

Question 32

Oesophageal cancer symptoms (3)

Answer 32

Progressive dysphagia from solids to liquids Burning Chest pain Red flag symptoms – particularly weight loss, anaemia

Question 33

2 types of oesophageal cancer

Answer 33

Adenocarcinoma | SCC

Question 34

Where in oesophagus is adenocarcinoma most common

Answer 34

Lower third

Question 35

Where in oesophagus is SCC most common

Answer 35

Middle third

Question 36

What are the RF/s for oesophageal adenocarcinoma

Answer 36

Barretts

Question 37

What are the RF/s for oesophageal SCC

Answer 37

Smoking, alcohol

Question 38

What is high dysphagia associated with

Answer 38

MND

Question 39

What is low dysphagia associated with

Answer 39

Obstruction/achalasia

Question 40

What is the issue in achalasia (2)

Answer 40

Absence of oesophageal peristalsis | Failure of lower oesophageal sphincter (LOS) to relax

Question 41

Ix for achalasia

Answer 41

Barium swallow

Question 42

What is seen in the barium swallow of achalasia

Answer 42

Birds beak appearance

Question 43

Neurological causes of dysphagia (2)

Answer 43

Mainly Stroke and Parkinson’s

Question 44

Clues that it a neurological cause of dysphagia (4)

Answer 44

Coughing: Immediately on swallow Choking: Also implies problem with swallow process. Slow eating Early dysphagia for liquids – functional problem

Question 45

Sign of Mallory-Weiss tear over other causes of haematemesis

Answer 45

Usually seen as blood streaked in vomit | Vomiting precedes bleeding

Question 46

What is Boerhaave syndrome

Answer 46

Complication of Mallory Weiss Tear – also know as oesophageal tear due to vomiting

Question 47

Ix for Boerhaave syndrome

Answer 47

CXR

Question 48

Oesophageal varices presentation (3)

Answer 48

Extreme Haematemesis May be unconscious or in shock Melaena

Question 49

Ix for oesophageal varices (6)

Answer 49

FBC: Macrocytic anaemia, ↓ platelets LFTs: ↑GGT, ↑bilirubin ↓albumin U&Es: ↑Urea Endoscopy

Question 50

Mx of oesophageal varices

Answer 50

``` ABCDE approach Fluids, regular monitoring. Reduce portal HTN: Terlipressin Endoscopy Band ligation is first line ```

Question 51

Presentation of ruptured peptic ulcer (3)

Answer 51

``` Background of PUD Long-term NSAID use H. pylori infection “Coffee ground” emesis Melaena ```

Question 52

Ix for ruptured peptic ulcer (2)

Answer 52

Observations: ↓BP FBC & LFTs: normal Endoscopy

Question 53

Mx of ruptured peptic ulcer (3)

Answer 53

Endoscopy IM adrenaline at site of ulcer PPI, e.g. Omeprazole Triple therapy (if H. pylori)