GI - dysphagia

Question 1

How does solids/liquids help in DDx of dysphagia?

Answer 1

Solids = mechanical obstruction

Solids + liquids = motility dysfunction

Question 2

Px of GORD

Answer 2

• heartburn, acid regurgitation
• positional cough (e.g. nocturnal cough)
• waterbrash (increased salivary secretion due to acid at the back of throat)
• altered taste sensation
• morning nausea
• laryingitis/hoarse voice

Question 3

Distance from mouth to upper & lower esophageal sphincters (E.g. when doing endoscope)

Answer 3

UES (upper esophageal sphincter) at 22cm

LES (lower esophageal sphincter) at 40cm

Question 4

What is hiatus hernia? What are the common types?

Answer 4

Part of stomach being above the diaphragm

• sliding hernia: part of stomach up through diaphragm along esophagus. Commonest type
• paraesophageal hernia: hernia of stomach next to esophagus through diaphragm. It may compress esophagus from the side

Question 5

Diet advice for GORD

Answer 5

• low fat diet
• low cigarette
• low caffeine
• eat earlier to avoid nocturnal reflux
• not excessive anticholinergic drugs (TCA) + ventolin

Question 6

How can you confirm the eradication of H. pylori? When can you get false negatives & false positives?

Answer 6

Check eradication 6 weeks post with faecal H. pylori antigen test or with H2 breath test

False negatives: due to PPIs

False positives: urease still present during 2-4 weeks post eradication of H. pylori

Question 7

What classes are Zantac & Somac?

Answer 7

Zantac: H2 receptor blocker for GORD

Somac: Pantoprazole (PPI) for GORD

Question 8

What (2) medications can give you oesophageal ulceration?

Answer 8

Slow K+ & doxycycline

Question 9

(2) findings in Pathology of peptic esophagitis

Answer 9

• long lamina propria papillae

- Smooth muscle hypertrophy

Question 10

What defines a Z line in the stomach/esophagus?

Answer 10

Where Columnar epithelium joins sqamous epithelium. Z line may be in the esophagus in cases of Barrett’s esophagus or hiatus hernia

Question 11

Significance of presence of Goblet cells in esophagus

Answer 11

Intestinal metaplasia within the Barrett’s mucosa

Goblet cells are NOT present in esophagus or stomach. Only present in duodenum/small intestine.

Question 12

A 54 yo male with long Hx of heartburn who Px with a 3 month Hx of progressive dysphagia from solids to liquids. DDx?

Answer 12

• Oesophageal cancer