Signs and Symptoms linked to conditions

Question 1

What type of lesions are seen in Diabetes Mellitus?

Answer 1

Kimmelstiel-Wilson lesions in the kidneys (glomerulosclerosis)

Question 2

What are the 5 key questions asked regarding dysphagia?

Answer 2

1. Was there difficulty swallowing solids and liquids from the start?
2. Is it difficult to make the swallowing movement?
3. Is swallowing painful (odynophagia)?
4. Is the dysphagia intermittent or is it constant and getting worse?
5. Does the neck bulge or gurgle on drinking?

Question 3

What is suspected if there is difficulty swallowing solids and liquids at the very beginning?
What is suspected if there is difficulty swallowing solids first, followed by liquids?

Answer 3

Difficulty swallowing solids and liquids from the start: suspect motility disorders (especially if non-progressive, eg achalasia, CNS, or pharyngeal causes).

If it is difficult to swallow solids first followed by liquids, suspect a stricture.

Question 4

What is suspected if there is difficulty making the swallowing movement?

Answer 4

Suspect bulbar palsy, especially if patient coughs on swallowing.

Question 5

What is odynophagia?

Answer 5

Painful swallowing

Question 6

What is suspected if the neck bulge or gurgle on drinking?

Answer 6

Suspect a pharyngeal pouch if the neck bulge or gurgle on drinking.

Question 7

What is achalasia?

Answer 7

It is a motility disorder where the degeneration of the myenteric plexus leads to the smooth muscle’s failure to relax. In oesophageal achalasia, the lower sphinter fails to relax, causing dysphagia, regurgitation, substernal cramps, and decrease weight.

Question 8

What is the treatment for Achalasia?

Answer 8

Endoscopic balloon dilatation or Heller’s cardiomyotomy (a surgical procedure where cardiac sphincter muscles are cut).
Calcium channel blockers and nitrates also relaxes the sphincter.

Question 9

What is the difference between regurgitation and vomiting?

Answer 9

Regurgitation is effortless and unassociated with nausea.

Question 10

What are the different types of vomit and what do each of them indicate?

Answer 10

1. “Coffee grounds” - GI bleeding
2. Recognizable food - gastric stasis
3. Feculent - small bowel obstruction or bacterial overgrowth

Question 11

What are the possible reasons for odynophagia?

Answer 11

Cancer, oesophageal ulcer (benign or malignant), Candida (immunocompromised or poor steroid inhaler technique) or spasm.

Question 12

How is severe vomiting reflected in the blood test?

Answer 12

There is metabolic alkalosis and hypochloraemia.

Question 13

What is dyspepsia?

Answer 13

Indigestion

Question 14

What are the red flags of dyspepsia?

Presence of these red flag symptoms necessitates what actions?

Answer 14

ALARM Symptoms:
A - Anaemia
L - Loss of weight
A - Anorexia
R - Recent onset/progressive symptoms
M - Melaena/ Haematemesis
S - Swallowing difficulty

If ALARM Symptoms are present, or >55yo, do upper GI endoscopy

Question 15

Which drugs can cause dyspepsia?

Answer 15

NSAIDs

Question 16

What should be done for patients who came in with the ALARM Symptoms?

Answer 16

Conduct urgent endoscopy

Question 17

What are the symptoms of duodenal ulcer?

Answer 17

Epigastric pain typically before meals or at night, relieved by eating or drinking milk.

Question 18

What are the symptoms of gastric ulcer?

Answer 18

Asymptomatic or epigastric pain related to meals. Sometimes relieved by antacids, and sometimes may have weight loss.

Question 19

Which drugs can cause duodenal ulcer?

Answer 19

NSAIDs, steroids and SSRI

Question 20

What does Calcium channel blockers do to the lower oesophageal sphincter?

Answer 20

Calcium channel blockers relaxes the lower oesophageal sphincter

Question 21

What are the 2 types of hiatus hernia? Which is more common?

Answer 21

Sliding hiatus hernia and rolling hiatus hernia.

Sliding hiatus hernia is more common.