Difficulty Gastro Questions

Question 1

What are the two main locations where dysphagia can occur in?

Answer 1

Cricopharyngeal sphincter

Distal oesophagus

Question 2

What are the two main types of regurgitation?

Answer 2

Functional

Mechanical

Question 3

What is the difference between reflux and regurgitation?

Answer 3

Regurgitation is return of oesophageal contents whereas reflux is passive return of gastroduodenal contents

Question 4

What is the physiological cause of achlasia?

Answer 4

Due to loss of ganglion cells in Aurebach’s myenteric plexus which innervate the LOS wall leading to a decrease in activity of the NCNA neurones.

Question 5

What are the two main pathological causes for the diagnosis of a functional oesophageal disorder?

Answer 5

Abnormal oesophageal contractions

Failure of protective mechanisms for reflux

Question 6

What is a Heller’s Myotomy?

Answer 6

A continuous myotomy performed for 6 cm on the oesophagus & 3 cm onto the stomach

Question 7

What is a Dor Fundipulation?

Answer 7

Procedure where anterior fundus folded over oesophagus and sutured to right side of myotomy

Question 8

How does sclerodoma lead to GERD?

Answer 8

Sclerodoma is autoimmune condition which leads to atrophy of smooth muscle in the oesophagus.

Peristalsis in the distal portions of the oesophagus ceases over time, leading to decrease in resting pressure in the LOS.

Low pressure leads to acid reflux and development of GERD over time.

Question 9

Malignant causes of oesophageal perforation often have a poor prognosis. Give 4 examples of some malignant causes

Answer 9

Advanced cancers

Radiotherapy

Dilatation

Stenting

Question 10

List 6 factors that can increase pressure within the LOS to inhibit acid reflux.

Answer 10

High intra-abdominal pressure

Acetylcholine (eggs, meats, fish)

Hormones

Histamine

Protein rich food

alpha-adrenergic agonists (hypertension)

Question 11

List 6 factors that can deceasae pressure within the LOS to promote acid reflux.

Answer 11

Smoking

Fat

Hormone

Beta-adrenergic agonists (asthma, bradycardia)

Chocolate

Acid gastric juice

Question 12

Give 6 examples of causes for failures in defensive mechanisms against reflux.

Answer 12

Low saliva prodiction (Sleep + Xerostomia (dry mouth)

Decreased buffering capacity of saliva (e.g from smoking)

Abnormal peristalsis

Defective mucosal protective mechanism (e.g. alcohol)

Hiatus hernia

Decrease in sphincter pressure

Question 13

Herniation formed when the stomach and the lower part of the esophagus slide up through the diaphragm

Answer 13

Sliding hiatus hernia

Question 14

A type of herniation where part of the stomach pushes (protrudes) up through the hole in the diaphragm next to the oesophagus

Answer 14

Rolling hiatus hernia

Question 15

Mucosal defense involves which two types of physical barriers? Give 2 examples for each type of physical barrier

Answer 15

Anatomical physical barriers (e.g. epthielial barriers and peristalsis)

Chemical physical barriers (e.g. enzymes and pH)

Question 16

What is the role GALT plays in the active and innate immunological response? (2)

Answer 16

Producing lymphoid cells and antibodies

Question 17

How does follicle associated epithelium (FAE) differ from normal epithelium of the intestinal tract? (3)

Answer 17

No goblet cells

No secretory IgA

No microvilli

Question 18

Briefly explain how dendritic cells play a role in antigen sampling

Answer 18

Dendritic proccesses can pass through the tight junction of the epithilial cells, enabling them to sample antigens present within the lumen.

They the trnasfer the anrtigens sampled and deliver them to mesenteric lymph nodes

Question 19

Explain the role of secretory IgA in the gut lumen

Answer 19

sIgA binds luminal antigen preventing its adhesion and consequent invasion.

Question 20

List 2 parasitic causes of infectious diarrhoea (gastroenteritis)

Answer 20

Giardia lamblia

Entamoeba histolytica

Question 21

What is the main treatment option for a patient infected with campylobacter.

Answer 21

Treatment not usually required (unless extremely unwell)

If so Azithromycin (macrolide) is the standard antibiotic

Question 22

What is the step by step management plan for a patient who has a C.diff infection?

Answer 22

Isolate the patient

Stop current antibiotics

Give Metronidazole or Vancomycin

May consider Faecal Microbiota Transplantation (FMT) (98% cure rate)

Question 23

What is the avergae resting pressure of the lower oesophageal sphincter

Answer 23

20mmHg

Question 24

Give 5 examples of diseases which can lead to secondary causes of achlasia

Answer 24

Chagas’ Disease (parasitic infection)

Protozoa infection

Amyloid

Sarcoma (Cancer)

Eosinophilic Oesophagitis

Question 25

How can a corkscrew oesophagus be diagnosed?

Answer 25

Presentation of dysphagia and chest pain

Barium swallow test shows a corkscrew oesophagus

Upper GI endoscopy

Question 26

What are 4 intraoperative causes of oesophageal perforation?

Answer 26

Hiatus hernia repair

Hellers Cardiomyotomy

Pulmonary surgery

Thyroid surgery

Question 27

After reflux has occured, what 3 mechanisms are there which prevents it from causing any further damage?

Answer 27

Volume clearance - oesophageal peristalsis reflex

pH clearance: saliva

Epithelium: barrier properties

Question 28

Give 3 examples of regions of the oral cavity which contains high amount of lymphoid tissue (MALT)

Answer 28

Paletine tonsil

Lingual tonsil

Pharyngeal tonsil

Question 29

Explain how secretory IgA is secreted into the gut lumen.

Answer 29

Activated plasma cells produce and secrete dimeric IgA in the submucosa

IgA binds to polymeric IgA receptors and is taken into the epithelial cells.

Enzymatic cleavage between the IgA and receptor occurs and secretory IgA is released into the lumen to perform its function

Question 30

Cholera is a acute bacterial disease caused by which bacteria and its serogroups?

Answer 30

Vibrio cholerae serogroups O1 & O139

Question 31

What vertebral level does the oesophagus enter the diaphragm?

Answer 31

T10

Question 32

What is the avergae resting pressure of the lower oesophageal sphincter

Answer 32

20mmHg