Approach to upper GI symptoms 2

Question 1

classic cause of esoph. motor dysphagia?

Answer 1

achalasia

Question 2

achalasia: pathophysl?

Answer 2

hypertrophy of LES muscle. degeneration of neuronal bodies and ganglion cells in myenteric plexus, esp. VIP/NO nerves –> LES doesn’t open, peristalsis not coordinated

Question 3

symptoms of achalasia

Answer 3

slowly progressive dysphagia for liquids + solids. regurgitation of undigested food esp. at night/when bending over. chest pain. weight loss.

Question 4

causes of mechanical dysphagia

Answer 4

benign strictures (Webs, rings). schatzke’s ring (ring of mucosal or muscular tissue = narrows LES). esophageal cancer. eosinophilic esophagitis

Question 5

odynophagia: meaning? causes?

Answer 5

painful swallowing. pharyngeal infections/inflammation. pill esophagitis. infectious esophagitis: candida, CMV, herpes. caustic injury. radiation esophagitis.

Question 6

odynophagia: how to figure out cause

Answer 6

usually requires endoscopy

Question 7

common causes of dyspepsia (epigastric pain)

Answer 7

gastric/duodenal ulcer disease. non ulcer dyspepsia. pancreatitis. gall stone disease. causes above diaphragm like MI

Question 8

how to test for H. pylori

Answer 8

serology (blood sample). mucosal gastric biospy during endoscopy. C13 breath testing.

Question 9

2 main causes of peptic ulcers

Answer 9

H. pylori + NSAIDs

Question 10

pathogenesis of NSAID induced ulcers (2)

Answer 10

prostaglandin mediated: inhibit PG which normally stimulate cell turnover/bicarb. direct effect: microvascular injury b/c of increased neutrophil adherence + formation of white clots that result in ischemia

Question 11

non ulcer dyspepsia: def

Answer 11

symptoms of epigastric pain or discomfort from upper GI tract but not caused by ulcer disease –> nausea, feeling of abnormal/slow digestion, feeling of early satiety

Question 12

causes of NUD

Answer 12

dietary, lifestyle, stress. med related: antibiotics, aspirin, hormones, narcotics. H pylori infection. motor disorder?

Question 13

management for dyspepsia

Answer 13

test + treat for HP. investigate with endoscopy if alarm symptoms. treat ulcers: for HP, or with H2 blockers/PPIs

Question 14

choosing wisely (3)

Answer 14

reassess PPI use at least once a year. avoid UGI series to investigate dyspepsia. avoid endoscopy <55yo unless alarm symptoms