Disorders of Upper GI Tract

Question 1

what is deglutition

Answer 1

swallowing

Question 2

when does the lower oesophageal sphincter relax

Answer 2

as soon as swallow is initiated

Question 3

common oeosphageal disorder

Answer 3

GORD
oesophageal motility disorders
eosinophilic oesophagitis
oesophageal cancer

Question 4

common symptoms of oesophageal disease

Answer 4

dysphagia
odynophagia (painful swallowing)
heartburn
acid regurgitation
water brash

Question 5

what is odynophagia

Question 6

what is water brash

Answer 6

increased salivation

Question 7

name for difficulty swallowing

Answer 7

dysphagia

Question 8

less common symptoms of oesophageal disease

Answer 8

chest pain
food regurgitation
food bolus obstruction
globus
cough
dysphonia

Question 9

what is globus

Answer 9

unusual sensation that something is stuck in oesophagus but isn’t

Question 10

what is dysphonia and what is a cause

Answer 10

altered voice due to acid causing irritation of vocal cords

Question 11

when does oeosphageal cancer tend to present

Answer 11

late
asymptomatic until late stage

Question 12

how is dysphagia classified

Answer 12

oropharyngeal or oesophageal

Question 13

learn difference between oropharyngeal and oesophageal dysphagia

Question 14

signs of oesophageal disease

Answer 14

dental erosion
weight loss
anaemia
lymphadenopathy

Question 15

which is more common
reflux with transient lower oesophageal relaxations
or
reflux with low lower oesophageal sphincter pressures

Answer 15

reflux with transient lower oesophageal relaxations

Question 16

which is more severe
reflux with transient lower oesophageal relaxations
or
reflux with low lower oesophageal sphincter pressures

Answer 16

reflux with low lower oesophageal sphincter pressures

Question 17

cause of daytime reflux

Answer 17

reflux with transient lower oesophageal relaxations

Question 18

cause of nocturnal reflux

Answer 18

reflux with low lower oesophageal sphincter pressures

Question 19

someone has daytime reflux, no hiatus hernia and no oesophagitis
what is the cause of their reflux

Answer 19

transient lower oesophageal relaxtions

Question 20

someone has nocturnal reflux, a large hiatus hernia and severe oeosphagitis
what is the cause of their reflux

Answer 20

low lower oesophageal sphincter pressures

Question 21

what type of reflux causes Barrett’s

Answer 21

low lower oeosphageal sphincter pressures

Question 22

investigations in oesophageal disease

Answer 22

endoscopy and biopsy
barium swallow and x-ray
oesophageal function tests

Question 23

what can be used to determine if the reflux material is acidic or not

Answer 23

oeosphageal function tests (e.g. pH and impedence monitoring)

Question 24

if oesophageal cancer is suspected what is required

Answer 24

urgent upper GI endoscopy and biopsy
CT
endoscopic ultrasound

Question 25

what is barrett's oesophagus

Answer 25

where the squamous epithelium lining the oesophagus is replaced by columnar epithelium

Question 26

who gets barrett's most

Answer 26

men >50 obese

Question 27

relationship with barrett's and cancer

Answer 27

barrett's is premalignant so can progress to adenocarcinoma most adenocarcinomas arise from barrett's

Question 28

treatment of Barrett's

Answer 28

long term proton pump inhibitor

Question 29

treatment of GORD

Answer 29

lifestyle (smoking, alcohol, diet, weight reduction) mechanical (posture, loose clothing, elevate bed-head) antacids acid suppression (PPIs, H2RA) surgical (fundoplication)

Question 30

example of PPI

Answer 30

omeprazole

Question 31

example of H2RA

Answer 31

ranitidine

Question 32

what is oesophageal achalasia

Answer 32

failure the lower oeosphageal sphincter to relax and absence of peristalsis

Question 33

presentation of achalasia

Answer 33

dysphagia to liquids and solids weight loss chest pain

Question 34

complications of achalasia

Answer 34

oesophageal dilation respiratory complications

Question 35

what does endoscopy show in achalasia

Answer 35

usually normal

Question 36

cause of achalasia

Answer 36

degenerative lesion of oesophageal innervation

Question 37

treatment of achalsia

Answer 37

botox - paralyse LOS endoscopic dilation surgical myotomy POEM

Question 38

what is the down side of botox as treatment for achalasia

Answer 38

it is not long lasting

Question 39

why is dilated oesophagus a complication of achalsia

Answer 39

due to absence of peristalsis and tighter sphincter so food gets stuck in oesophagus for longer

Question 40

food bolus obstruction and dysphagia is a common presentation of

Answer 40

eosinophilic oesophagitis

Question 41

risk factors for eosinophilic oesophagitis

Answer 41

younger age male history of atopy (hayfever and asthma)

Question 42

diagnosis of eosinophilic oeosphagitis

Answer 42

>15 eosinophils/pof on biopsy

Question 43

eosinophilic oesophagitis association with cancer

Answer 43

no association

Question 44

what is eosinophilic oesophagitis

Answer 44

build up of eosinophils (WBCs) in the lining of the oesophagus in response to food or acid leads to difficulty swallowing and eventually narrowing of the oeosphagus

Question 45

what can be seen on endoscopy in eosinophilic oesophagitis

Answer 45

lumps (strictures, rings, exudates, furrows)

Question 46

treatment of eosinophilic oesophagitis

Answer 46

diet (elimination of trigger foods) drugs (PPIs, topical steroids) dilation (of strictures)

Question 47

causes of oesophageal strictures

Answer 47

benign - GORD, barrett's, extrinsic compression, post radiotherapy, post surgery, toxic substance injestion malignant - cancer

Question 48

treatment of benign oesophageal sphincter

Answer 48

PPIs dilation

Question 49

what types of cancer can occur in oesophagus

Answer 49

adenocarcinoma squamous cell carcinoma

Question 50

which part of oesophagus do squamous cell carcinomas occur

Answer 50

upper/mid

Question 51

which part of oesophagus do adenocarcinomas occur

Answer 51

lower

Question 52

who gets adenocarcinomas

Answer 52

60s-70s Barrett's obesity

Question 53

who gets squamous cell carcinomas

Answer 53

80s-90s smokers alcohol

Question 54

what is intermittent dysphagia for liquids and solids suggestive of

Answer 54

motility problem (e.g. achalasia)

Question 55

intermittent tarry stool is suggestive of

Answer 55

chronic blood loss from upper GI tract

Question 56

h.pylori treatment

Answer 56

Abx and PPI for 1 week