Gastroenterology: Upper GIT diseases

Question 1

What is Dysphagia?

Answer 1

Difficulty in swallowing

Question 2

Why does Dysphagia always need urgent investigation?

Answer 2

To rule out malignancy

Question 3

If patient is finding swallowing painful, this can suggest? (4)

Answer 3

• Oesophageal cancer
• Ulcer
• Spasm
• Candidiasis

Question 4

If patient finds it difficult to make a swallowing movement, this can suggest?

Answer 4

Suspect bulbar palsy

esp if swallowing causes coughing

Question 5

If patient has always found it difficult to swallow solids and liquids, this can suggest? (2)

Answer 5

• Motility disorder

- Pharyngeal cause

Question 6

Intermittent dysphagia can suggest?

Answer 6

Oesophageal spasm

Question 7

Constant/worsening dysphagia can suggest?

Answer 7

Malignant structure

Question 8

If patients neck bulges or gurgles upon swallowing this can suggest?

Answer 8

Pharyngeal pouch

Question 9

What needs to be examined in a patient showing dysphagia? (5)

Answer 9

• Cachexia
• Anaemia
• Oral examination
• Virchow’s node
• Other signs of systemic disease

Question 10

What are the 2 main causes of dysphagia?

Answer 10

• Mechanical block

- Motility disorders

Question 11

Name 4 types of mechanical blocks that cause dysphagia

Answer 11

• Malignant structure
• Benign structure
• Extrinsic pressure
• Pharyngeal pouch

Question 12

Name some motility disorders that cause dysphagia (5)

Answer 12

• Achalasia
• Diffuse oesophageal spasm
• Systemic sclerosis
• Myasthenia gravis
• Bulbar palsy

Question 13

What is Myasthenia gravis?

Answer 13

Autoimmune condition involving antibodies to ACh receptors

Question 14

What are some clinical features of someone with MG? (3)

Answer 14

• Ptosis (eye drooping)
• Myasthenic snarl on smiling
• Whilst counting to 50 voice deteriorates

Question 15

What is bulbar palsy?

Answer 15

Presentation of diseases involving cranial nuclei of IX-XII

Question 16

What structures in the head and neck does bulbar palsy affect?

Answer 16

LMN lesion of tongue and muscles of talking and swallowing

Question 17

What are some of the causes of bulbar palsy? (3)

Answer 17

• Motor neurone disease
• MG
• Syringobulbia

Question 18

What is Achalasia?

Answer 18

Lower oesophageal sphincter fails to relax

regurgitation

Question 19

What is Gastro-oesophageal reflux (GORD)?

Answer 19

Reflux of stomach contents causing troublesome symptoms with at least two heartburn episodes each week

Question 20

GORD is related to the dysfunction of what?

Answer 20

Lower oesophageal sphincter

Question 21

Name some predisposing factors for GORD

Answer 21

• Smoking
• Alcohol
• Pregnancy
• Overeating
• Obesity
• Hiatus hernia
• Oesophageal problems

Question 22

What are some Oesophageal GORD symptoms? (4)

Answer 22

• Heart burn
• Belching
• Acid brash/Water brash
• Odynophagia (painful swallowing)

Question 23

What some Extra-Oesophageal GORD symptoms? (4)

Answer 23

• Nocturnal asthma
• Chronic cough
• Laryngitis
• Sinusitis

Question 24

What are some complications of GORD?

Answer 24

• Oesophagitis
• Ulcers
• Benign stricture
• Barrett’s oesophagus
• Oesophageal adenocarcinoma
• Iron deficiency anaemia

Question 25

What lifestyle advice would be given to someone with GORD? (5)

Answer 25

- Weight loss - Smoking cessation - Raise bedhead - Small regular meals - Avoid hot/spicy/caffeinated food before bed

Question 26

What medication can be given to someone with GORD? (2)

Answer 26

- Antacids (gaviscon) | - Proton pump inhibitors (lansoprazole)

Question 27

What is the dental relevance of GORD?

Answer 27

- Unpleasant taste - Enamel erosion - Worsened by NSAIDs

Question 28

What are the two types of Hiatus hernia?

Answer 28

- Sliding (80%) | - Rolling

Question 29

What is sliding hiatus hernia?

Answer 29

Gastro-oesophageal junction slides into chest

Question 30

What is rolling hiatus hernia?

Answer 30

Bulge of stomach herniates into chest alongside oesophagus

Question 31

In which type of hiatus hernia does an acid reflux occur?

Answer 31

Sliding

Question 32

How is hiatus hernia treated?

Answer 32

- Lose weight - Reflux symptoms treated - Surgical repair if serious

Question 33

What is Barret's Oesophagus?

Answer 33

Chronic reflux oesophagitis

Question 34

In terms of malignancy what type of lesion is Barret's Oesophagus?

Answer 34

Premalignant lesion so need to be checked immediately

Question 35

Oesophageal carcinoma; UK death/year? M:F?

Answer 35

- 6000 deaths/year | - 5:1

Question 36

What are some risk factors of Oesophageal carcinoma?

Answer 36

- Smoking - Alcohol abuse - Achalasia - Obesity - Low vitamin A/C - GORD - Barret's

Question 37

Symptoms of Oesophageal carcinoma (5)

Answer 37

- Hoarse cough - Dysphagia - Weight loss - Chest pain - Lymphadenopathy

Question 38

What are the percentages of Oesophageal carcinoma for each site and what type of carcinoma? - Upper third? - Middle third? - Lower third?

Answer 38

- 20% squamous cell carcinoma - 50% squamous cell carcinoma - 30% adenocarcinoma

Question 39

What is Dyspepsia?

Answer 39

Nonspecific group of symptoms related to upper GI tract | Synonym to indigestion

Question 40

What does the ALARMS acronym to remember dyspepsia symptoms stand for?

Answer 40

- Anaemia - Loss of weight - Anorexia - Recent onset with progressive symptoms - Melaena or haematemesis - Swallowing difficulty

Question 41

What is melaena?

Answer 41

Producing sticky faeces which may contain blood

Question 42

What is peptic ulcer disease (PUD)?

Answer 42

A break in the inner lining of the stomach

Question 43

What are some risk factors for peptic ulcers?

Answer 43

- H. pylori - Drugs (E.g NSAIDs) - Smoking - Stress (maybe)

Question 44

What are the two types of ulceration?

Answer 44

- Gastric ulceration | - Duodenal ulceration

Question 45

Gastric ulceration; Vulnerable group? Symptoms? Pain? Relief?

Answer 45

- Mainly elderly - Asymptomatic (maybe weight loss) - Epigastric pain - Antacids

Question 46

Duodenal ulceration; Likelihood? Symptoms? Pain? Relief?

Answer 46

- 4 times more common that gastric - Maybe asymptomatic - Epigastric - Drinking milk

Question 47

What are adenocarcinomas?

Answer 47

A malignant tumor formed from glandular structures in epithelial tissue.

Question 48

What is the most common type of gastric cancer?

Answer 48

Gastric adenocarcinomas (more than 90%)

Question 49

Gastric cancer; - M:F - Peak incidence age - Vulnerable groups

Answer 49

- 2:1 - 60-84 - Eastern Asia/Europe and South America

Question 50

What are some risk factors of Gastric cancer? (6)

Answer 50

- H. pylori infection - Smoking - Alcohol - Not enough fruit/veg - Excess salt diet - Pernicious anaemia

Question 51

Clinical representations of gastric cancer? (5)

Answer 51

- Nausea - Melaena - Anaemia - Virchows node - Sister Mary Josephs nodule

Question 52

List some alarming features that suggest gastric cancer

Answer 52

- New onset dyspepsia in patients > 55 years - FH upper GIT cancer - Unintended weight loss - Upper or lower GI bleeding - Progressive dysphagia - Odynophagia - Unexplained iron deficiency anaemia - Persistent vomiting - Palpable mass or lymphadenopathy - Jaundice

Question 53

How would you investigate gastric cancer?

Answer 53

- Endoscopy | - Biopsy

Question 54

What is a Biopsy?

Answer 54

An examination of tissue removed from a living body to discover the presence, cause, or extent of a disease.

Question 55

What is Haematemesis?

Answer 55

Vomiting of blood

Question 56

What are some common causes of Haematemesis?

Answer 56

- Gastric erosion - Duodenitis - Oesophagitis - Peptic ulcers - Drugs (ie NSAIDs) - Malignancy

Question 57

What are some rare causes of Haematemesis?

Answer 57

- Bleeding disorders - Peutz-Jeghers syndrome - Portal hypertensive gastropathy