04. Gastroenterology (GIT) PART-A COURSE MRCS (UK) Lecture Note
MRCS (UK) PART-A COURSE 04. GIT New Edition: February, 2023 About The DrAcademy The Best Medical Academy for Postgraduate Medical Exams of The Royal Colleges of UK. The DrAcademy [Experienced 12+years] is led by a group of talented doctors from all over the world & managed by a very skillful administrative staff. Our mission is to provide the best quality medical education with a very convenient fees structure to all the doctors who are preparing for MRCP (UK) | MRCS (UK) | MRCOG (UK) | MRCPCH (UK) | FCPS | MD | MS | PLAB & OET. Published by The DrAcademy ፐፑፒፓፔፕፖ25/2, Level-3, Green Road, Dhanmondi, Dhaka-1205, Bangladesh � Web: www.thedracademy.com ൵ Facebook: www.facebook.com/thedracademy ✉ Email:
[email protected] ☎ Hotline: +88 0173355 2110 ༟༠༡༢༣ Office: +88 0179905 0606
Gastroenterology (GIT) TOPICS OVERVIEW TOPIC-01 | INSULINOMA.................................................................... 1 TOPIC-02 | DYSPHAGIA ..................................................................... 2 TOPIC-03 | NUTRITION OPTIONS IN SURGICAL PATIENTS............................ 5 TOPIC-04 | GASTRECTOMY SYNDROMES ................................................ 7 TOPIC-05 | GASTROINTESTINAL BLEEDING.............................................. 8 TOPIC-06 | OESOPHAGEAL DISEASE .................................................... 15 TOPIC-07 | BARRETT'S OESOPHAGUS .................................................. 18 TOPIC-08 | OESOPHAGEAL CANCER .................................................... 21 TOPIC-09 | OESOPHAGEAL CANCER - TREATMENT .................................. 23 TOPIC-10 | TREATMENT OF OESOPHAGEAL CANCER ............................... 25 TOPIC-11 | PANCREATIC CANCER ....................................................... 29 TOPIC-12 | BARIATRIC SURGERY ........................................................ 32 TOPIC-14 | LOWER GASTROINTESTINAL BLEEDING.................................. 41 TOPIC-15 | HIV: BILIARY AND PANCREATIC DISEASE ............................... 44 TOPIC-16 | UPPER GASTROINTESTINAL BLEEDING................................... 45 TOPIC-17 | GASTRIC EMPTYING ......................................................... 50 TOPIC-18 | POST GASTRECTOMY SYNDROMES....................................... 52
MRCS (UK) PART-A COURSE Gastroenterology (GIT) Lecture Note The DrAcademy, 25/2 Green Road (Level-3), Dhanmondi, Dhaka-1205 Web: www.thedracademy.com | Email:
[email protected] | facebook: fb.com/thedracademy Office: +88-017 9905 0606 Helpline: +88-017 3355 2110 Page | 1 Topic-01 | Insulinoma Insulin producing tumours of the pancreatic β cells Incidence of 1 per 1,000,000 per year 90% of lesions are benign Most tumours less than 2cm in size Between 5 and 10% have MEN type 1 75% of patients with MEN 1 will develop pancreatic islet cell tumours Typical features of insulinoma Symptomatic hypoglycaemia during fasting Concomitant blood glucose of less than 3mmol/L Relief of hypoglycaemia by use of glucose Testing When neuroglycopenic symptoms occur blood is taken for serum insulin levels, serum glucose, C- peptide and pro insulin concentrations. The plasma insulin concentration is >10 micro U/ml in patients with the disorder. Tumour localisation USS (25% accuracy), endoscopic USS better (75% accuracy) CT scanning (pancreatic protocol=40% accuracy) Malignant insulinomas are larger and diagnostic accuracy with MRI is nearly 100% in such cases Somatostatin receptor scintigraphy (50% accuracy) Treatment Since the majority of tumours are benign; the blind segmental resection of the pancreas (e.g. Whipples) cannot be justified, this may be considered acceptable for malignant lesions. The best approach at laparotomy is to corroborate pre operative imaging with intraoperative ultrasonography to identify the lesion. Tumours may be close of the pancreatic duct and this must be appreciated by the operating surgeon. The perioperative use of octreotide reduces the amount of pancreatic drainage, but not overall complications. Question: 1.1 A 45 year old man with recurrent episodes of confusion is found to have a 1.5cm insulinoma of the pancreatic head. S sweating,confusion,nausea,fits More accurate : MRI Early diagnosis by CT scan Mainly Benign
MRCS (UK) PART-A COURSE Gastroenterology (GIT) Lecture Note The DrAcademy, 25/2 Green Road (Level-3), Dhanmondi, Dhaka-1205 Web: www.thedracademy.com | Email:
[email protected] | facebook: fb.com/thedracademy Office: +88-017 9905 0606 Helpline: +88-017 3355 2110 Page | 2 What is the most appropriate management? A. Whipples procedure B. Total pancreatectomy and en bloc splenectomy C. Pylorus preserving pancreatico duodenectomy D. Enucleation of the lesion E. External beam radiotherapy Correct Answer: E- Enucleation of the lesion Explanation: Most insulinomas are benign and radical resection is therefore not justified. Topic-02 | Dysphagia Causes of dysphagia Extrinsic Mediastinal masses Cervical spondylosis Oesophageal wall Achalasia Diffuse oesophageal spasm Hypertensive lower oesophageal sphincter Intrinsic Tumours Strictures Oesophageal web Schatzki rings Neurological CVA Parkinson's disease Multiple Sclerosis Brainstem pathology Myasthenia Gravis Investigation non Usually Highly malignant · so RX : Radical ESurgery Primary site of Gastrinoma : most commonly Duodenum de One P type of wide local excision ancreas ↓ Stomach Verp rarely : Gi ,spikovan
English