Gastroenterology

Question 1

What is Achalasia?

Answer 1

Neuromuscualr disorder of failed peristalsis and inability to relax LOS

Question 2

Symptoms of achalasia?

Answer 2

Dysphagia to liquids and solids
Variability
Regurgitation

Question 3

Investigation of achalsia?

Answer 3

• Oesophageal mamometry
• Barium swallow
• CXR widened mediastinum

Question 4

Barium swallow in achalsia?

Answer 4

Birds beak

Question 5

Management of achalasia?

Answer 5

• Oesophageal dilatation endoscopically
• Heller myotomy- recurrence or persistent
• If can’t have surgical intervention: botulinum toxin injections, then CCB/nitrates

Question 6

What is Plummer-Vinson syndrome?

Answer 6

Dysphagia with IDA due to upper oesophageal web

Question 7

What is a pharyngeal pouch?

Answer 7

Herniation of pharyngeal mucosa

Question 8

Presentation of pharyngeal pouch?

Answer 8

Regurgitation
Bulging neck with gurgling
Halitosis

Question 9

Investigation of pharyngeal pouch?

Answer 9

Barium swallow with dynamic video fluoroscopy

Question 10

Management of pharyngeal pouch?

Answer 10

Observation
Surgery

Question 11

What is Barretts oesophagus?

Answer 11

Metaplasia of the lower oesophagus with epithelium changing from squamous cell to columnar

Question 12

What can Barretts oesophagus progress to?

Answer 12

Adenocarcinoma

Question 13

Management of Barretts oesophagus?

Answer 13

Metaplasia- OGD 3-5 years, high dose PPI

Dysplasia- radio frequency ablation

Question 14

Diffuse oesophageal spasm of barium swallow?

Answer 14

Corkscrew appearance

Question 15

What is eosinophillic oesophagitis?

Answer 15

Allergic inflammatory infiltration of the oeophagus causing dysphgia and dyspepsia on background of atopy

Question 16

Diagnosis of eosinophillic oesophagitis?

Answer 16

OGD with eosinophils ?5 per high powered field

Question 17

Management of eosinophilic oesophagitis?

Answer 17

Stop food triggers
Topical steroids
Oesophageal dilation

Question 18

Management of pyloric stenosis?

Answer 18

Ramstedt pyloromyotomy

Question 19

Most common oesophageal cancer?

Answer 19

Adenocarcinoma

Question 20

Adenocarcinoma of the oesophagus risk factors and location?

Answer 20

GORD
Barrett’s
Smoking
Obesity

Lower 1.3rd by GOJ

Question 21

Squamous cell carcinoma of oesophagus risk factors and lcoation?

Answer 21

Alcohol
Smoking
Achalasia
Plummer-Vinson syndrome

Upper 2/3rd oesophagus

Question 22

Associations of H. pylori?

Answer 22

PUD
Gastric cancer
MALT lymphoma
Atrophic gastritis

Question 23

Management of H. pylori?

Answer 23

7 days

PPI + amoxicillin + clarithromycin

2nd line- PPI + amoxicillin + metronidazole

Pen allergy PPI + clarithromcyin + metronidazole

Question 24

What is Boerhaaves syndrome?

Answer 24

oesophgeal perforation after significant vomiting

Question 25

Investigation of Boerhaaves syndrome?

Answer 25

Oesophagogram with gastrograffin CT thorax

Question 26

Risk factors for PUD?

Answer 26

Smoking NSAIDs H. pylori Steroids SSRIs

Question 27

Most common PUD?

Answer 27

Duodenal

Question 28

What is Zollinger-Ellison syndrome?

Answer 28

Gastrin secreting tumour seen with multiple ulcers

Question 29

Association with Zollinger-ellison syndrome?

Answer 29

MEN-1

Question 30

Screening for zollinger ellison syndrome?

Answer 30

fasting gastrin levels

Question 31

Diagnosis of zollinger-ellison syndrome?

Answer 31

Secretin stimulation test

Question 32

Management of zollinger-ellison syndrome?

Answer 32

High dose PPI + resection of tumour

Question 33

Location of zollinger-ellison syndrome?

Answer 33

Duodenum Pancreas