Gastro

Question 1

Features of Achalasia

Answer 1

Dysphagia of liquids and solids
Variation in severity
Heartburn
Regurg of food
Malignant Changes in small numbers

Question 2

Investigations into achalasia

Answer 2

Oesophageal manometry - excessive LOS tone which doesn’t relax

Barium swallow - grossly expanded oesophagus, bird beak appearance

Cxr - wide mediastinum

Question 3

Treatment of achalasia

Answer 3

Pneumatic balloon dilation

Surgery - heller cardiomyotomy
Intra-sphincteric injection of botulinum toxin
Drug therapy limited - nitrates, ccb

Question 4

Most important electrolyte disturbances in refeeding syndrome

Answer 4

Hypophosphataemia - main one
Hypokalaemia
Hypomagnasaemia - may predispose to torsades

Question 5

Clinical presentations in refeeding syndrome

Answer 5

Hypoglycaemia
Confusion
Peripheral oedema
Nausea/vomiting
Lethargy/malaise
Cardiac arrhythmia
Severe weight loss
Hypertension

Question 6

Clinical consequences of hypophosphataemia

Answer 6

Cardiac dysfunction - HF or arrhythmia
Resp Failure
Neurological - confusion & seizures
Haem - tissue hypoxia & hemolysis
Rhabdo- muscle break down

Mainly all because of ATP

Question 7

Features of patients at high risk of refeeding syndrome

Answer 7

BMI <16
Unintentional weight loss >15% over 3-6months
Little nutritional intake >10 days
Hypokal, hypophos, hypomag before feeding

Question 8

Management of refeeding

Answer 8

Slow introduction feeding
Regular monitoring & correction of electrolytes
Fluid balance
Monitor cardiac rhythm

Question 9

Which drug is best used for itching associated with liver failure?

Answer 9

Cholestyramine