Upper GI

Question 1

what does a barium swallow show in achlasia?

Answer 1

dilated tapering of oesophagus

Question 2

treatment of achlasia

Answer 2

endoscopic balloon dilatation

Question 3

ALARMS pneumonic for red flags linked to dyspepsia

Answer 3

Anaemia 
Loss of weight 
Anorexia 
Recent onset/progressive
Manaemia/haematemesis
Swallowing difficulty

Question 4

motility disorders causing dysphagia (

Answer 4

• systemic sclerosis
• achlasia
• neuromuscular bulbar palsy (myasthenia gravis, wilsons, parkinsons, pseudobulbar palsy)
• diffuse oesophageal spasm

Question 5

malignant stricture causing dysphagia

Answer 5

• pharyngeal cancer
• gastric cancer
• oesophageal cancer

Question 6

benign strictures causing dysphagia

Answer 6

• oesophageal web/ring

- peptic structure

Question 7

extrinsic pressure causing dysphagia

Answer 7

• mediastinal lymph nodes
• lung cancer
• retrosternal goitre
• left atrial enlargement
• aortic aneurysm

Question 8

which ulcer is more common (duodenal or gastric)

Answer 8

duodenal ulcer

Question 9

factors contributing to increased acid (5)

Answer 9

• smoking
• alcohol
• too much caffeine
• stress
• spicy foods

Question 10

eating worsens which ulcer

Answer 10

eating worsens a gastric ulcer

Question 11

complications of peptic ulcers (3)

Answer 11

• perforation
• bleeding
• scarring & strictures

Question 12

what (3) can breakdown the protective layer of the stomach mucosa?

Answer 12

• Medications (Steroids/NSADIs)
• Helicobacter Pylori
• increased acid

Question 13

medications causing peptic ulcer disease

Answer 13

NSAIDs
Corticosteroids
Alcohol

Question 14

Other causes of peptic ulcer disease

Answer 14

zollinger ellison syndrome

acute stress

malignancy

inflammatory - chrons

Question 15

describe H pylori

Answer 15

gram negative, spiral shaped, flagellated, micro-aerophilic bacterium

Question 16

mechanism of NSAIDs

Answer 16

COX 1 inhibitor

Question 17

what causes zollinger ellison sydnrome?

Answer 17

hyper-secreting gastrinoma within the pancreas, leading to the development of multiple peptic ulcers

Question 18

zollinger ellison syndrome is part of what genetic condition?

Answer 18

MEN type 1

Question 19

what consists of 7-day course of triple-therapy

Answer 19

PPI
Amoxicillin
Clarithromycin/metronidazole

Question 20

peptic ulcer eroding through which artery can lead to massive haemorrhage

Answer 20

gastroduodenal artery

Question 21

type of lining in stomach

Answer 21

columnar epithelial lining

Question 22

type of lining in oesopahgus

Answer 22

squamous epithelial lining

Question 23

red flags indicating 2 week wait referral:

Answer 23

• Dysphagia at any age
• Age over 55
• Weight loss
• Upper abdo pain/reflux
• Treatment resistant dyspepsia
• N &V
• Low haemoglobin
• Raised platelet count

Question 24

medication that is alternative to PPI

Answer 24

Ranitidine

Question 25

Ranitidine mechanism?

Answer 25

H2 receptor antagonist

Question 26

name of surgery for acid reflux

Answer 26

Laparoscopic fundoplication

Question 27

PPI mechanism

Answer 27

inhibition of H+/K+ ATPases in parietal cells thereby preventing acid production

Question 28

what is a stricture

Answer 28

scarring and narrowing of the oesophagus due to repeated damage. Can cause dysphagia. May require dilatation or stenting.

Question 29

what do chief cells secrete

Answer 29

pepsinogen

Question 30

what cells are in the cardia & fundus of stomach?

Answer 30

peptic cells & chief cells

Question 31

what do G cells secrete and where are they located

Answer 31

gastrin located un pyloric antrum

Question 32

role & location of brunner glands?

Answer 32

located in duodenum secrete mucus & bicarbonate ions that neutralize the acid

Question 33

blood vessel in stomach that can be eroded by gastric ulcers causing massive haemorrhage

Answer 33

left gastric artery, in lesser curvature of stomach

Question 34

what is the metaplasia that occurs in barrets oesopahgus?

Answer 34

transformation of cells from squamous epithelium to columnar epithelium

Question 35

2 cancers of the oesophagus

Answer 35

squamous cell carcinoma adenocarcinoma

Question 36

4 most common causes of upper GI bleeding

Answer 36

- oesophageal varices - mallory weiss tear - peptic ulcers - cancers of stomach/duodenum

Question 37

scoring system in suspected upper GI bleed

Answer 37

Glasgow-Blatchford score

Question 38

what factors does Glasgow-Blatchford take into account?(6)

Answer 38

- Drop in Hb - Rise in Urea - Blood pressure - Heart rate - Melaena - Syncopy

Question 39

score used to calculate the risk of rebleeding & overall mortality in patients that have had an endoscopy

Answer 39

Rockall score

Question 40

factors the Rockall score takes into account? (5) (ABCDE)

Answer 40

``` Age Blood pressure & HR Comorbidity Diagnosis Endoscopic findings ```

Question 41

3 components of fresh frozen plasma

Answer 41

- blood - platelets - clotting factors

Question 42

medical (2) & endoscopic (2) management of variceal upper GI bleeding

Answer 42

Medical - Terlipressin - Prophylactic abx Endoscopic - Band ligation - TIPS

Question 43

mechanism of terlipressin

Answer 43

terlipressin in a vasopressin analogue & causes splanchic vasoconstiction which reduces portal pressures

Question 44

why give antibiotic prophylaxis in variceal bleeding?

Answer 44

reduces the risk of spontaneous bacterial peritonitis