Pathologies

Question 1

Upper GI pathologies

Answer 1

Achalasia, megaoesophagus, GORD, peptic ulcers, oesophageal cancer, gastric cancer

Question 2

Xerostomia

Answer 2

Dry mouth with ↓ production of saliva affecting taste, chewing, swallowing, speech, dental issues

Question 3

Dysphagia

Answer 3

Difficulty swallowing either from mouth to oesophagus (oropharyngeal dysphagia) or from oesophagus to stomach (oesophageal dysphagia)

Question 4

Achalasia

Answer 4

Uncommon condition where LOS fails to relax during swallowing so food cannot pass into the stomach, causing distention of the oesophagus

Question 5

Symptoms of Achalasia

Answer 5

Dysphagia
Chest pain and discomfort
Regurgitation of undigested food and saliva
Coughing
Choking
Weight loss
Heartburn

Question 6

Achalasia subtypes

Answer 6

Type I - near total loss of peristalsis and oesophageal pressurisation, incomplete relaxation of LOS, severe dysphagia and regurgitation
Type II - oesophageal compression, partial preservation of muscle tone, incomplete relaxation of LOS
Type III - spastic, uncoordinated contractions of distal oesophagus, incomplete relaxation of LOS

Question 7

GORD

Answer 7

Reflux of acidic gastric contents into oesophagus as LOS opens inappropriately causing heartburn, cough, sore throat
Can lead to oesophageal stricture/Barrett’s oesophagus/adenocarcinoma

Question 8

GI Obstruction

Answer 8

Obstruction at any point along GI tract caused by tumour/fibrosis/spasm/paralysis

Question 9

Oesophageal obstructions

Answer 9

Barrett’s Oesophagus - normal oesophageal squamous epithelium is replaced by columnar mucosa similar to gastric lining. Can be due to GORD and leads to oesophageal adenocarcinoma. Causes narrowing and ulcers.
Oesophagitis - inflammation that can lead to irritation, narrowing, ulcers, Barrett’s

Question 10

Gastritis

Answer 10

Inflammation of gastric mucosa due to bacterial infection or irritants (aspirin and alcohol), causes ↑ permeability and gastric ulcers

Question 11

Hypochlorhydria / Achlorhydria

Answer 11

Loss / diminished HCl secretion and so pepsin is not activated

Question 12

Peptic Ulcers

Answer 12

Excoriated area (removal of surface) in stomach/intestinal mucosa due to either:
1. Excess secretion of acid/pepsin (gastric juices)
2. Lack of of protective mucosa or bicarbonate
3. Dysfunction of pancreatic or hepatic alkaline secretions
4. smoking/alcohol/aspirin/NSAIDs
Occurs in pyloric sphincter/lower oesophagus

Question 13

Gastrinoma/Zollinger-Ellison Syndrome

Answer 13

Peptic ulcers and diarrhoea due to high gastric acid secretion from high gastrin secretion from tumours in the pancreas and duodenum

Question 14

Gastroparesis

Answer 14

Delayed gastric emptying can be caused peptic ulcers, GORD, cancers, etc.

Question 15

Rumination syndrome

Answer 15

Regurgitation of undigested/partially digested food from stomach without effort and within minutes of eating

Question 16

Dyspepsia

Answer 16

Indigestion with discomfort and pain in the upper abdomen
Non-specific symptom of various conditions or may not have any clinical reasoning (functional)

Question 16

Gastric Obstructions

Answer 16

Gastric adenocarcinoma - tumour in stomach lining that develops over years, associated with chronic inflammation.
Gastric polyps - abnormal growths developing on gastric lining, mainly benign and often found incidentally

Question 17

Lower GI pathologies

Answer 17

Functional bowel disorders, IBD, diarrhoea, colorectal cancer, diverticulitis

Question 18

Hirschsprung disease