upper GI conditions

Question 1

What is achalasia?

Answer 1

condition whereby the lower oesophageal sphincter fails to relax

Question 2

What are the symptoms of achalasia?

Answer 2

1. gradual onset of dysphagia
2. regurgitation of undigested food
3. aspiration
4. weight loss (often mild)

Question 3

What is the sign of achalasia seen in barium swallow called?

Answer 3

“birds beak appearance”

Question 4

What does endoscopy in achalasia show?

Answer 4

dilated oesophagus

contains residual material e.g. food regurgitations

Question 5

How is achalasia managed?

Answer 5

botox injections
calcium channel blockers
surgical cleavage of the muscle, called Heller’s Myotomy

Question 6

What is Barrett’s oesophagus?

Answer 6

a condition that patients with long term gastro-oesophageal reflux get.

It is caused by chronic acid exposure leading to squamous epithelium becoming metaplastic columnar epithelium

Question 7

What is the biggest complication of Barrett’s oesophagus?

Answer 7

oesophageal adenocarcinoma

Question 8

What is the management for patients who have low grade dysplasia barrett’s?

Answer 8

high dose PPI

endoscopic surveillance

Question 9

What is the management for patients who have high grade dysplasia barrett’s?

Answer 9

endoscopic resection of the abnormal areas e.g. ablation and if fit for surgery can have an oesophagectomy

Question 10

What is pharyngeal pouch?

Answer 10

herniation of the pharyngeal mucosa through a weakness between the thyropharyngeus and the cricopharyngeus muscles of the pharynx

Question 11

How does pharyngeal pouch present?

Answer 11

1. dysphagia
2. regurgitation of undigested food
3. aspiration
4. chronic cough
5. weight loss

Question 12

Why is endoscopy avoided if suspected pharyngeal pouch

Answer 12

there is a risk of perforation to the lesion

Question 13

What is seen in barium swallow of pharyngeal pouch?

Answer 13

a residual pool of contrast within the pouch

Question 14

How is pharyngeal pouch managed?

Answer 14

if small and asymptomatic, no tx

resection of the diverticulum or incision of cricopharyngeus muscle can be performed

Question 15

What are the main symptoms of peptic ulcers?

Answer 15

1. epigastric pain
2. fullness
3. bloating
4. nausea
5. intolerance to fatty foods

Question 16

What is GORD?

Answer 16

reflux of gastric contents into the oesophagus caused by a defective lower oesophageal sphincter

Question 17

what are the MAIN symptoms of GORD?

Answer 17

“heart burn” - dyspepsia

sensation of acid regurgitation

Question 18

What are the associated symptoms of GORD which are less common?

Answer 18

epigastric pain
bloating
belching
tooth erosion

Question 19

What are the risk factors of GORD?

Answer 19

obesity, smoking, alcohol and trigger foods e.g. spicy, coffee, citrus fruits

Question 20

What are the 3 main investigations of GORD?

Answer 20

PPI trial

oesophagogastroduodenoscopy if patient has relapsing symptoms

oesophageal manometry

Question 21

Management of GORD

Answer 21

1. weight loss, change in diet
2. PPI for 8 weeks
3. antiacids for relief
4. anti reflux surgery if needed

Question 22

name the 4 complications of GORD

Answer 22

1. oesophageal ulcer
2. barrett’s oesophagus
3. oesophageal stricture
4. adenocarcinoma of the oesophagus

Question 23

RED FLAG symptoms for GORD associated with oesophageal adenocarcinoma

Answer 23

weight loss
anaemia
dysphagia
melaena
persistent vomiting

Question 24

What is a hiatus hernia?

Answer 24

abdominal contents protrude through an enlarged oesophageal hiatus in the diaphragm

Question 25

Sliding hiatial hernia

Answer 25

most common type
slides up into the chest
less competent sphincter results in acid reflux
treatment is similar for GORD

Question 26

rolling hiatial hernia

Answer 26

the gastro-oesophageal junction remains in the abdomen

part of the stomach protrudes into the chest

can result in necrosis

Question 27

risk factors for hiatus hernia

Answer 27

obesity

previous hiatial surgery

increased intra-abdominal pressure

Question 28

Clinical features of hiatus hernia

Answer 28

a. heart burn
b. dysphagia
c. SOB
d. chronic cough
e. chest pain

Question 29

How are hiatus hernias diagnosed?

Answer 29

barium swallows

Question 30

how is hiatus hernia managed conservatively?

Answer 30

• weight loss
• elevation of head off the bed
• avoid eating at night
• avoiding alcohol and acidic foods
• avoiding nicotine

Question 31

medical management of hiatus hernia

Answer 31

PPI use for 4-8 weeks then looking at response

Nissen’s fundolication = closing the defect by tightening and wrapping fundus around oesophageal sphincter

Question 32

what are possible causes of candida infection?

Answer 32

• old age
• DM
• immunosuppression
• long term corticosteroids
• malignancy
• antibiotics

Question 33

Treatment of candida

Answer 33

fluconazole

Question 34

What causes hairy leukoplakia?

Answer 34

epstein-barr virus

suggestive of HIV infection

Question 35

What do apthous oral ulcers suggest?

Answer 35

iron, b12 and folate deficiencies

crohn’s disease

Question 36

cause(s) of glossitis

Answer 36

iron deficiency

Question 37

What is oesophageal variceal bleeding?

Answer 37

varices are enlarged blood vessels due to portal hypertension.
this condition is when they bleed and this carries a high mortality risk.

Question 38

Management of variceal bleeding via ABCDE approach

Answer 38

• blood transfusions if lost a large amount of blood
• Terlipressin is a vasopressin used to cause vascoconstriction
• Broad spectrum abx are used to reduce risk of bacterial peritonitis