GI conditions: gastric/ oesophageal

Question 1

Differentials for

• difficulty swallowing solids vs
• difficulty swallowing both solids and liquids

Answer 1

Difficulty with solids only: strictures

Difficulty with both: achalasia (LES not relaxing)/ neuro problem eg Myasthenia Gravis

Question 2

How long must someone be off PPIs before undergoing an H Pylori test

Answer 2

2 weeks

Question 3

What would make you suspect an oesophageal stricture is malignant

Answer 3

Abrupt,
Asymmetrical,
Irregular nodular mucosa

(benign would taper smoothly)

Question 4

2ww criteria for upper GI cancer

Answer 4

1. Dysphagia
2. Upper abdo mass consistent with cancer
3. > 55 + weight loss + dyspepsia/ reflux/ upper abdo pain

Question 5

What test is used to check if H pylori eradication therapy worked

Answer 5

Urea breath test

Question 6

What type of oesophageal cancer is associated with

• Barrett’s oesophagus
• Achalasia

Answer 6

• Barrett’s oesophagus: adenocarcinoma

- Achalasia: squamous cell cancer

Question 7

What is the best long term feeding option for someone with an unsafe swallow

Answer 7

PEG tube

Question 8

Likely cause of odynophagia in immunocompromised patient (HIV/ Hep C) with diarrhoea and weight loss

Answer 8

Oesophageal candidiasis

Question 9

Risk factors for oesophageal strictures

Answer 9

Hiatus hernia

Question 10

Management of oesophageal strictures (benign, malignant, palliative)

Answer 10

Oesophageal strictures

Benign: balloon dilation

Malignant: treat underlying cause

Palliative: stent, internal radiation

Question 11

Imaging/ special test investigations (and findings) for achalasia

Which one is diagnostic

Answer 11

(DIAGNOSTIC) Manometry: failures of LES relaxation

Barium swallow: birds beak oesophageal (dilation then tapering)

Biopsy: absent nerve cells in myenteric plexus

Question 12

Medical/ interventional/ surgical treatment of achalasia

Answer 12

Medical: CCB, GTN (reduce LES pressure)

Botox: paralyse muscles than hold LES shut
Balloon dilation

Surgery: Hellers cardiomyotomy

Question 13

Risk factors for oesophageal cancer: squamous cell cancer vs adenocarcinoma

Answer 13

OESOPHAGEAL CANCER

squamous cell cancer: achalasia

adenocarcinoma: GORD, Barret’ts

Question 14

Management of pharyngeal pouch

Answer 14

Only fixed by surgery

Question 15

What do the following signs/symptoms suggest

Reflux
Chronic cough
Difficult intubation
Halitosis

Answer 15

Pharyngeal pouch

Question 16

What do the following signs/symptoms suggest

Central crushing chest pain
Weight loss
Trouble swallowing both solids and liquids

Answer 16

Achalasia

Question 17

What’s the Rockall score used for? What are the components

Answer 17

Risk of adverse outcome after acute upper GI bleed

Age
BP fall
Co-morbidities
Diagnosis after endoscopy
Evidence of bleeding

Question 18

What is used as prophylaxis against oesophageal varices bleeding

Answer 18

• Propanolol

- Variceal band ligation

Question 19

What is used to treat oesophageal varices bleeding

Answer 19

1. Terlipressin
2. Pipercillin/tazobactam for 3 days
3. Variceal band ligation
4. TIPPS

Question 20

Why should PPI not be given to patients with upper GI bleed before endoscopy

Answer 20

PPI would mask the site of bleeding