Acute oesophageal and stomach disorders.

Acute oesophageal and stomach disorders.

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What is the Dutch physician Herman Boerhaave most known for?

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Describing death by uncontrolled blood loss from variceal bleeding.

Describing death by a rupture of the esophagus following a large vomit.

Describing death caused by obstruction of the airway with meat.

Describing death by severe alcoholic gastritis after a friend lost a bet and was forced to drink 2l whiskey.

He noted the death of the Admiral of the Dutch fleet who ruptured his esophagus following a strong retch / vomit. "Boerhaave's syndrome".

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How soon after ingestion should a button battery stuck in the esophagus be removed?

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Less than 30min.

Less than 2hrs.

Less than 4hrs.

Less than 6hrs.

As soon as possible but the recommendation is <2hrs to decrease the chance of liquefactive necrosis.

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Which of the following is TRUE if a patient presents post instrumentation with a suspected rupture of the esophagus?

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The patient is unlikely to present with chest pain.

Fortunately the death rate is <5%.

They may present with subcutaneous emphysema in the lower neck.

Acute mediastinitis is unusual.

This is an emergency as a delay in diagnosis will increase mortality. CXR can show pneumomediastinum. Fluoroscopy using a water soluble solution often shows it whilst CT is useful for complications. Mortality rates is up to 50%.

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In a patient with a gastric band what does the "O" sign mean on an AXR?

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That the stomach has herniated inferiorly pushing the band into an "O" appearance.

That the gastric band has eroded through the anterior wall of the stomach.

That the gastric band hs eroded through the posterior wall of the stomach.

That the stomach has herniated superiorly pushing the band into an "O" appearance

It is a useful radiological sign. Normally the gastric band lies horizontally. Usually this mean a surgical fix.

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Which of the following is INCORRECT about GORD (Gastroesophageal reflux disease).

reflux

It affects 10 to 15% of the Australian adult population.

Proton Pump inhibitors are an effective treatment.

Weight loss (if over weight) can help..

All patients with suspected GORD should have an endoscopy.

The primary use of endoscopy is to look for complications and exclude other diagnoses.

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Overall what is the 5yr survival rate for esophageal cancer?

About 10%.

About 40%.

About 20%.

About 60%.

Pictured is the ABC Broadcaster James Valentine who is being treated for esophageal cancer. 30 years ago overall survival rate from esophageal cancer was 9%.

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Which of the following is CORRECT about corrosive ingestion?

CONCORD

Alkaline corrosives are more dangerous because they cause coagulative necrosis.

Airway compromise is often the immediate life threat.

Use Activated Charcoal orally early.

Get the patient to drink at least 300mls of skim or A2 milk.

Alkalines cause liquifactive not coagulative necosis. Keep them NBM. Do not put down an NG tube. Anticipate airway compromise. Call 131126 and look up LITFL.

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A 61yr old patient present with vomiting. He is found to have gastric outlet from "kissing" duodenal ulcers. Which of the following venous gases is he likely to have?

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Respiratory acidosis.

Incompletely compensated respiratory alkalosis (with low K).

Compensated Metabolic acidosis (with high K).

Incompletely compensated Metabolic alkalosis (with low K and Cl).

It is like an infant with pyloric stenosis. An NG tube with N/S fluid resuscitation and IV replacement of K would be a good start in ED.

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Which statement about variceal bleeds is WRONG?

50% of varices are esophageal, 50% gastric.

Giving Ceftriaxone IV improves outcomes.

Octreotide IV is used to decrease splanchnic flow and therefore shunt blood away from te varices.

Endoscopic options include banding and sclerotherapy.

In fact 90% of varices are esophageal, only 10% gastric.

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One of these famous people did NOT die from complications of a peptic ulcer---which one?

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James Joyce (famous Irish incomprehensible author).

Rudolph Valentino (silent film star and heart throb).

Peter Jackson (Director of "The Hobbit" and "Lord of the Rings" trilogy).

Rudyard Kipling (Author of "The Jungle Book).

Peter Jackson developed a perforated peptic ulcer whilst directing "The Hobbit" in New Zealand.

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