Gastroenterology
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Primary cause of pill oesophagitis
doxycycline
What causes zolliger ellison syndrome?
Secretion of gastrin from neuroendocrine tumours (gastrinoma)
Barrett;s eosphagus histo
metaplastic columnar epithelium
how long is barretts when it has higher risk of malignancy?
> 3cm
Characetistic findings of oesinophilic eosophagitis
stacked circular rings strictures linear furrows
Microscopy which is diagnostic of eosinophilic oedeophagitis
> 15 eosinophils on high power field
eosinophilic oesophagitis mangement
PPI for 8 weeks, if no improvement fluticasone or budesonide slurry
pathology of achalasia
progressive degeneration of ganglion cells in myenteric plexus -> failure of relaxation of lower oesophageal sphincter and loss of peristalsis in distal oesophagitis
secondary causes of achalasia
chagas disease amyloidosis sarcoidosis
investigation findings in achalasia
barium - oesophageal dilatation, bird beak oesophageal junction manometry - failure of relation of LOS
Achalasia management
pneumatic dilatation of LOS surgical myotomy botox (elderly) nitrates, CCB POEM
risk of dilation of LOS
3% perforation
What pressure do varices occur and when do they bleed
Seen when presure gradient between portal and hepatic veins >12mmHg Bleeding when >18 gastric varices bleed more than oesophageal varices
What causes risk of AKI and Na and fluid retention in liver disease
shunting of blood flow from cardiac circulation to splanchnic leads to relative renal hypoperfusion
Therapies in acute variceal bleeds
AIm Hb >80 antibiotic prophylaxis (oral norflox or IV cipro) somatostatin or octreotide for 3-5 days TIPS when not controlled bleeding or recurrent can use balloon tamponade
Prevention of varicies
non-selective beta blockers (propranolol, carvedilol) and maximal tolerated dose ligation (same outcomes)
Most common reason for inadequate treatment of H pylori
clarithromycin resistance
Virulence factor of H pylori
CagA VacA
H pylori resistance in australia
clarithromycin resistance 10% Metronidazole 30% amox 10%
How to test for H pylori eradication
breath test 8 weeks after treatment
Which type of ulcer do you repeat endocopy after 8 weeks of PPI therapy?
Gastric not duodenal (higher risk of malignancy)
What does forrest classification predict
risk of rebleeding and which lesions need therapy
Why PPI 72 hours post bleeding
helps prevent re-bleeding
Genetic associations with coeliac
HLA-DQ2 DQ8