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Flashcards in Upper GI Deck (19)
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1
Q

List the RFs for GORD (7)

A
Hiatus hernia
Raised IAP (preg/obesity)
Fatty foods
Large meals
Caffeine
Smoking
Drugs: antiACh / nitrates / TCAs / CCBs
2
Q

What are the 2 different types of hiatus hernias and how do they present?

A

Sliding: GOJ slides above diaphragm (T10)
Presents as reflux/asymp (30% adults >50)

Para-oesophageal rolling: fundus (sphincter competent/below)
Presents (rarely) as severe pain (gastric volvulus/strang)

3
Q

What are the sx of oesophagitis? (4 + 2)

A

Heartburn/indigestion
Regurgitation food/acid (poss aspiration)
Waterbrash
Odynophagia

Atypical chest pain (distal oesophageal spasm)
Nocturnal cough/wheeze - asthma type sx

4
Q

What further Ix can be done in GORD? (2)

A
Barium swallow (if suspect hiatus hernia)
24hr pH/manometry (sphincter competence)
5
Q

What are the red flag sx for dyspepsia?

A
Anorexia
Loss of wt
Anaemia (Fe defc)
Recent onset/progressive sx
Malaena/haematemesis
Swallowing difficulties
55yrs+
6
Q

Describe the management of GORD

A

If no red flags: empirical full-dose PPI 4-8wks

Lifestyle: wt loss / smoking
smaller meals + >3hr before bed (+ w. hot drinks/alc)
raise head of bed
avoid exac drugs

Medical: (stepwise - for chronic)
1st - antacids (gaviscon)
2nd - PPI/H2RA
Adjunct - metoclopramide/domperidone

Surgical: only for hiatus hernia w. refractory sx + pH evidence

7
Q

What are the complications of GORD (5)

A
Oesophagitis
Ulcers
Benign strictures
Barrett's
Oesophageal cancer
8
Q

Describe the differences b/wn oropharyngeal dysphagia + oesophageal dysphagia

A

Oropharyngeal:
Neuromuscular cause
Difficult initiating swallowing ± Choking/Aspiration

Oesophageal:
Dysmotility/Stricture/Oesophagitis/Pouch
Food sticks ± regurg

9
Q

List 3 causes of oesophageal motility disorder

A

Achalasia
DM
Scleroderma

10
Q

What further Ix are done for confirmed oesophageal cancer?

A

OGD + Biopsy
CT Thorax/Abdo
PET – assess mets
Laparoscopy – exclude peritoneal mets before resection

11
Q

How may achalasia present?

A

Younger pt ~30
Dysphagia ± regurg
Nocturnal cough

12
Q

What effects do H.Pylori have on peptic ulcers?
What effects do smoking have on peptic ulcers?
What effects do NSAIDs have on peptic ulcers?

A

H.Pylori:
Acid secrn↑
Abnormal mucus prodn → epithelial damage

Smoking:
Nicotine ↑acid secrn
↓Gastric mucosal healing

NSAIDs:
↓PGs thus ↓inhibitory effect → Acid↑

13
Q

What are the diff methods for testing for H.Pylori

A

13C urea breath test (must be off Abx/PPIs prior)
Stool/serum antigen test
Gastric biopsy - add phenol red - colour change

14
Q

Outline the further management of H.Pylori if Triple Therapy hasn’t worked

A

Bismuth chelate
2Abx (2wks)
Prolonged PPI

Still persists:
Re-scope / Re-check H.Pylori tests / Consider DDx

15
Q

What does triple therapy of H.Pylori consist of

A

PPI
2 of: Amoxi / Clarithro / Metro
For 7d

16
Q

List some causes for UGI bleeding (5 common; 3 rare)

A
Peptic ulcer (40%)
Gastric-duod erosion (15%)
Oesophagitis (15%)
Mallory-Weiss (15%)
Varices (10%)

Oesophageal malignancy (1%)
Vascular malformn
Coagulopathy

17
Q

List some complications of peptic ulcers (4)

A

Haemorrhage
Perforation
Malignant change
Strictures

18
Q

What are some RFs for gastric cancer (7)

A

H.Pylori
Smoking
High salt/nitrate diet (red meat)
Low socio-economic

Genetic (e.g. HNPCC, Blood GrpA)
Adenomatous polyps
Pernicious anaemia

19
Q

Outline the management of gastric cancers

A

Gastrectomy:
Partial if lower 1/3
OR Total ± lymph clear

Other:
Endoscopic mucosal resection (confined)
Wide local excision (stromal)
Pylorus stenting (palliative)

PLUS: Combo Chemo