66 - dysphagia, 67 - haematemesis

Question 1

dysphagia DDx

Answer 1

Oral: abscess, tonsillitis, cancer, Bell’s palsy, diphtheria

Pharyngeal: foreign body, cancer, abscess,

Oesophageal: foreign body, cancer, abscess, atresia, strictures, achalasia, bulbar palsy, MG, Crohn’s, candida,

Question 2

oesophageal ca sx

Answer 2

dysphagia, pain, hoarse voice, lymphadenopathy, haemoptysis, cough.

Question 3

Rfs oesophageal ca

Answer 3

smoking, obesity, GORD, poor diet, alcohol

Question 4

rfs for gord

Answer 4

pregancy, obesity, smoking, hernia, stress

Question 5

Mx of GORD

Answer 5

Lifestyle

PPI Then double it or switch to an alternate PPI, then add a H2 receptor antagonist (ranitidine).

Question 6

what should you consider in GORD

Answer 6

H pylori

Question 7

GORD can progress to?

Answer 7

barretts / neoplasia

Question 8

What is achalasia ?

Dx?

Answer 8

Failure of smooth muscle relaxation. Lower oesophageal sphincter relaxation incomplete and peristalsis is uncoordinated or absent.

Barium swallow

Question 9

Mx of achalasia

Answer 9

Nifedipine Botox may manage.
Nothing is curative.
Surgery.

Question 10

Cell types and function in stomach

Answer 10

Foveolar cells produce mucus

Parietal cells secrete HCl and intrinsic factor, which is needed for B12 absorption.

Chief cells secrete digestive enzymes.

G cells secrete gastrin, which promotes HCl secretion.

Question 11

Where are oesophageal varices found?

Answer 11

Dilated sub-mucosal veins in the lower 1/3 of the oesophagus

Question 12

usual cause of varices?

Answer 12

portal HTN secondary to cirrhosis

Question 13

Dx of varices

Answer 13

endoscopy

Question 14

Mx of varices

Answer 14

sclerotherapy and banding

Question 15

What is portal HTN? signs?

Answer 15

High blood pressure in hepatic portal system.

Signs: ascities, dilated veins, splenomegaly, jaundice, tenderness

Question 16

Causes of portal HTN

Answer 16

Pre / intra / post hepatic

Thrombus formation, atresia, liver cirrhosis, fibrosis, sarcoid, TB, pericarditis.

Question 17

Mx of portal HTN

Answer 17

portosystemic shunt.

Question 18

Portal HTN -> risk of

Answer 18

varices and bleeding, also hepatorenal syndrome and encephalopathy.

Question 19

What is a mallory weiss tear

Answer 19

Laceration in stomach and oesophageal lining following protracted vomiting.

Question 20

Causes of mallory weiss

Answer 20

alcoholism, bulimia, hyperemesis gravidarum.

Question 21

How deep is tear in mallory weiss

Answer 21

submucosa but not muscular layer (Boerhaave syndrome)

Question 22

Mx of serious mallory weiss

Answer 22

Endoscopy + cauterisation / adrenaline injections

surgical if needed

Question 23

How is a upper GI blled different to normal haemorrhage

Answer 23

transfusion worsens outcomes (unless Pt shocked)

Question 24

Mx of upper GI bleed

Answer 24

terlipressin and PPIs instead.

Question 25

DDx gastritis

Answer 25

autoimmune (pernicious anaemia), H Pylori, NSAIDs, radiotherapy

Question 26

Mx of gastritis

Answer 26

Lifestyle changes, treat underlying disease.
H2, PPIs,
antacids are mainstay of symptom reduction