disorders of the upper GI tract 1 W7

Question 1

common oesophageal disorders?

Answer 1

GORD (oesophagitis, Barrett’s oesophagus, benign oesophageal stricture)
oesophageal motility disorders (eg achalasia)
eosinophilic oesophagitis
oesophageal cancer

Question 2

oesophagus normal function?

Answer 2

deglutition - striated muscle
UOS relaxes
food enters oesophagus
primary peristaltic wave triggered
LOS relaxes as soon as swallow initiated
food into stomach

Question 3

common symptoms of oesophageal disease?

Answer 3

dysphagia
odynophagia
heartburn
acid regurgitation
waterbrash
dental erosions

Question 4

what is odynophagia?

Answer 4

painful swallowing

Question 5

what is waterbrash

Answer 5

hypersalivation secondary to gastro-oesophageal reflux

Question 6

less common symptoms of oesophageal disease?

Answer 6

chest pain
food regurgitation
food bolus obstruction
globus
cough
dysphonia

Question 7

what is globus

Answer 7

sensation of something in your throat

Question 8

what is dysphonia

Answer 8

altered voice

Question 9

what is dysphagia

Answer 9

difficulty swallowing solids/liquids

Question 10

why is dysphagia an important symptom

Answer 10

alarm symptom, may be indicative of serious disease

Question 11

classifications of dysphagia?

Answer 11

oropharyngeal - neuromuscular
oesophageal - mechanical

Question 12

oesophageal dysphagia features?

Answer 12

discoordination of movement of bolus in oesophagus.
motility disorders.
diabetes, alcoholism, gastroesophageal reflux.

Question 13

oropharyngeal dysphagia features?

Answer 13

difficulty bringing bolus from mouth to oesophagus
commonly neuro cause - often stroke.
decreased saliva, Alzheimer’s, depression

Question 14

hints for dysphagia diagnosis - different patient groups?

Answer 14

elderly = neuro causes if long standing. cancer if new and progressive with regurgitation and weight loss.

younger = dysmotility (achalasia or secondary to acid reflux)

young patients with food bolus obstruction = oesophagitis

Question 15

hints for dysphagia diagnosis - different symptoms?

Answer 15

oesophageal Ca = progressive dysphagia for solids then liquids

dysmotility = dysphagia for liquids as bad as solids

hoarse voice = ENT causes (ear/nose/throat)

regurgitation of food = pharyngeal pouch

Question 16

investigations in oesophageal disease?

Answer 16

endoscopy and biopsy
barium swallow
oesophageal function tests (manometry, pH, impendence monitoring)

Question 17

manometry?

Answer 17

measures pressure in the oesphagus

Question 18

what does GORD stand for?

Answer 18

gastro-oesophageal reflux disease

Question 19

GORD types?

Answer 19

reflux with transient lower oesophageal relaxations

reflux with low lower oesophageal sphincter pressures

Question 20

GORD - reflux with transient lower oesophageal relaxations - features?

Answer 20

more common (can happen in anyone)
daytime reflux
small or no HH (hiatus hernia)
often no oesophagitis

Question 21

GORD - reflux with low lower oesophageal sphincter pressures - features?

Answer 21

less common (20%)
nocturnal reflux
often large hiatus hernia
more severe oesophagitis
Barrett’s

Question 22

typical symptoms of GORD?

Answer 22

heartburn
acid regurgitation
waterbrash

Question 23

what is heartburn?

Answer 23

burning discomfort behind the breast bone spreading upwards

Question 24

acid regurgitation features?

Answer 24

often meal related
postural

Question 25

GORD endoscopy features?

Answer 25

inflammation and narrowing

Question 26

treatment of GORD?

Answer 26

lifestyle measures (smoking, alcohol, diet, weight reduction)
mechanical (posture, clothing, elevate bed-head)
antacids
acid suppression (PPIs - omeprazole)
surgical - fundoplication

Question 27

fundoplication?

Answer 27

reconstruct lower oesophageal sphincter and correct hiatus hernia if present

Question 28

complications of GORD?

Answer 28

oesophagitis
-> oesophageal stricture (narrowing)
-> Barrett’s oesophagus
->adenocarcinoma

Question 29

explanation of lifestyle changes for GORD?

Answer 29

small meals = less reflux
caffeine = irritant, affects acid secretion
carbonated drinks = gastric distension, TLOSRs
smoking = affects LOS pressure
alcohol = irritant
weight reduction = less reflux