Upper GI Surger Flashcards

Question

complications of GI ulcers

Answer 1

bleeding perforation gastric outflow obstruction malignancy

Answer 2

FBC - microcytic anaemia, raised urea if GI bleed OGD after 2 weeks no PPI breath test H pylori ulcer biopsy gastrin levels if suspect Zoll El syndrome suspected

Answer 3

avoid risk factors lanzoprazole eradication therapy surgery: vagotomy - cut vagal nerve supply to reduce acid secretion, widening of outlet needed too antrectomy and anastom

Answer 4

``` Ca: ↑ risk of gastric Ca • Reflux or bilious vomiting (improves ¯c time) • Abdominal fullness • Stricture • Stump leakage ```

Answer 5

Dumping syndrome § Abdo distension, flushing, n/v, fainting, sweating § Early: osmotic hypovolaemia § Late: reactive hypoglycaemia • Blind loop syndrome → malabsorption, diarrhoea § Overgrowth of bacteria in duodenal stump • Vitamin deficiency § ↓ parietal cells → B12 deficiency § Bypassing proximal SB → Fe + folate deficiency § Osteoporosis • Wt. loss: malabsorption of ↓ calories intake

Answer 6

RESUS • Head down • 100% O2, protect airway • 2 x 14G cannulae + IV crystalloid infusion up to 1L. • Bloods: FBC, U+E (↑ urea), LFTs, clotting, x-match 6u, ABG, glucose BLOOD if shocked (O neg and send G+S) maintenance and correct blood abnormalities (thiamine if alcohol) terlipressin and abx if variceal URGENT OGD

Answer 7

2 of: banding, sclerotherapy, adrenaline, coagulation • Balloon tamponade ¯c Sengstaken-Blakemore tube § Only used if exsanguinating haemorrhage or failure of endoscopic therapy • TIPSS if bleeding can’t be stopped endoscopically

Answer 8

* Adrenaline injection * Thermal / laser coagulation * Fibrin glue * Endoclips

Answer 9

``` Re-bleeding • Bleeding despite transfusing 6u • Uncontrollable bleeding at endoscopy • Initial Rockall score ≥3, or final >6. • Open stomach, find bleeder and underrun vessel ```

Answer 10

``` • Previous bleeds • Dyspepsia, known ulcers • Liver disease or oesophageal varices • Dysphagia, wt. loss • Drugs and EtOH • Co-morbidities blood thinning meds ```

Answer 11

``` Signs of CLD • PR: melaena • Shock? § Cool, clammy, CRT>2s § ↓BP (<100) or postural hypotension (>20 drop) § ↓ urine output (<30ml/h) § Tachy ```

Answer 12

* peptic ulcer: 40% ( * Acute erosions / gastritis:20% * Mallory-Weiss tear: 10% * Varices: 5% * Oesophagitis: 5% * Ca stomach / oesophagus:<3%

Answer 13

• Pre-hepatic: portal vein thrombosis • Hepatic: cirrhosis (80% in UK), schisto (commonest worldwide), sarcoidosis. • Post-hepatic: Budd-Chiari, RHF, constrict pericarditis

Answer 14

IR creates artificial channel between hepatic vein and portal vein → ↓ portal pressure. • Colapinto needle creates tract through liver parenchyma which is expand using a balloon and maintained by placement of a stent. • Used prophylactically or acutely if endoscopic therapy fails to control variceal bleeding.

Answer 15

• Sudden onset severe pain, beginning in the epigastrium and then becoming generalised. • Vomiting • Peritonitis consider Pancreatitis • Acute cholecystitis • AAA • MI

Answer 16

bloods G+S, clotting, coag urine dip erect CXR (stand for 15 mins) - air under diaphragm Rigler's sign - air either side of gut wall

Answer 17

``` NBM fluid resus abx analgesia antiemetic ``` can consider conservative if no peritonism (1/2 will self-seal) surgery- duodenal = washout and omental repair, gastric - excise and repair screen ulcer for cancers treat afterwards for H pylori

Answer 18

cancers or | late peptic ulcer causing strictures

Answer 19

• Hx of bloating, early satiety and nausea ``` • Outlet obstruction § Copious projectile, non-bilious vomiting a few hrs after meals. § Contains stale food. § Epigastric distension f ```

Answer 20

ABG: Hypochloraemic hypokalaemic met alkalosis • AXR § Dilated gastric air bubble, air fluid level § Collapsed distal bowel • OGD • Contrast meal

Answer 21

``` • Correct metabolic abnormality: 0.9% NS + KCl • Benign § Endoscopic balloon dilatation § Pyloroplasty or gastroenterostomy • Malignant § Stenting § Resection ```

Answer 22

6-8wks • Projectile vomiting minutes after feeding • RUQ mass: olive • Visible peristalsis

Answer 23

Dx • Test feed: palpate mass + see peristalsis • Hypochloraemic hypokalaemic metabolic alkalosis • US Mx • Resuscitate and correct metabolic abnormality • NGT • Ramstedt pyloromyotomy: divide muscularis propria

Answer 24

Borrmann ``` 4 types • Polypoid / fungating • Excavating • Ulcerating and raised • Linitis plastica: leather-bottle like thickening ¯c flat rugae ```

Answer 25

``` diet smoking ulcers metaplasia FH ```

Answer 26

``` Usually present late • Wt. loss + anorexia • Dyspepsia: epigastric or retrosternal pain/discomfort • Dysphagia • vomiting and nausea ``` ``` Anaemia • Epigastric mass • Jaundice • Ascites • Hepatomegaly • Virchow’s node (= Troisier’s sign) • Acanthosis nigricans ```

Answer 27

perf bleed obstruction

Answer 28

``` Bloods § FBC: anaemia § LFTs and clotting • Imaging § CXR: mets § USS: liver mets § Gastroscopy + biopsy § Ba meal • Staging § Endoluminal US § CT/MRI § Diagnostic laparoscopy ```

Answer 29

if very lucky can do gastrectomy and cure palliative care stenting

Answer 30

``` Arise from intestinal cells of Cajal § Located in muscularis propria § Pacemaker cells • OGD: well-demarcated spherical mass ¯c central punctum ``` mass effects bleeding

Answer 31

enterchromaffin cell origin secrete hormones flushing diarrhoea mainly paroxysms as hormones released in random bursts

Answer 32

most common extranodal site often gastric MALToma due to H pylori eradication can cure

Answer 33

tumour secretes gastrin refractory peptic ulcers diagnose gastrin levels MRI/CT somatostatin receptor scintigraphy (also used for finding carcinoid) PPI and resect

Answer 34

• All the criteria must be met § BMI ≥40 or ≥35 ¯c significant co-morbidities that could improve ¯c ↓ wt. § Failure of non-surgical Mx to achieve and maintain clinically beneficial wt. loss for 6mo. § Fit for surgery and anaesthesia § Integrated program providing guidance on diet, physical activity, psychosocial concerns and lifelong medical monitoring § Well-informed and motivated pt. • If BMI >50, surgery is 1st-line Rx

Upper GI Surger Flashcards

(58 cards)