Dyspepsia

Question 1

Oropharyngeal dysphagia is usually

related to _______

Answer 1

neuromuscular dysfunction and is

commonly caused by stroke

Question 2

______ is usually due to motor disorders, such as achalasia or diffuse oesophageal spasm, and to peptic oesophageal
strictures often secondary to reflux

Answer 2

Oesophageal dysphagia

Question 3

A _______ usually causes regurgitation

of undigested food and gurgling may be audible over the side of the neck

Answer 3

pharyngeal pouch

Question 4

GORD tends to exclude ______

Answer 4

achalasia

Question 5

Red flag pointers for dysphagia

Answer 5

• Age >50 years
• Recent or sudden onset
• Unexplained weight loss
• Painful swallowing
• Progressive dysphagia
• Dysphagia for solids
• Hiccoughs
• Hoarseness
• Neurological symptoms/signs

Question 6

Gastroenterologists claim that the big three

common causes referred to them are_______

Answer 6

benign

peptic stricture, cancer and achalasia

Question 7

Intermittent dysphagia for both liquids and

solids is characteristic of a motility disorder such

Answer 7

as oesophageal achalasia

Question 8

≈__________ is usually

evident when there is a short history of rapidly progressive dysphagia and significant weight loss.

Answer 8

Malignant oesophageal obstruction i

Question 9

What is a special esophageal obstruction test?

Answer 9

— hand the patient a glass of water and place a stethoscope over the left upper quadrant of abdomen
— measure time between swallowing and
murmur produced by bolus passing the cardia (normal: 7–10 seconds)

Question 10

The primary investigation in suspected
_______ is a video barium swallow
while endoscopy is generally the first investigation in cases of suspected _________

Answer 10

pharyngeal dysphagia

oesophageal dysphagia

Question 11

What is the dx?

• Fibrous stricture of lower third oesophagus (can be higher)
• Follows years of reflux oesophagitis
• Usually older patients

Answer 11

Benign peptic stricture

Question 12

Benign peptic stricture

• Dysphagia with ______
• Diagnosis confirmed by ____ and ____

Answer 12

solid food

endoscopy and barium
swallow

Question 13

Benign peptic stricture Tx

Answer 13

• Dilate the stricture

* Treat reflux vigorously

Question 14

Association with esophageal CA

Answer 14

GORD, tobacco, Barrett oesophagus

Question 15

MC esophageal CA

Answer 15

SCC (commonest) and adenocarcinoma

Question 16

________ associated with Barrett mucosa

Answer 16

Adenocarcinoma

Question 17

What is the dx?

• A disorder of oesophageal motility
• Widely dilated oesophagus
• Empties poorly through a smoothly tapered
lower end

Answer 17

Achalasia

Question 18

Achalasia

________is the only way to diagnose with
certainty

Answer 18

Manometry

Question 19

Conservative tx of achalasia

Answer 19

Conservative in the elderly (e.g. nifedipine/or
endoscopic botulinum toxin injection into the
sphincter

Question 20

Surgical Mx of achalasia

Answer 20

Pneumatic dilatation of lower oesophageal

sphincter or surgical myotomy

Question 21

______have no place in treatment of achalasia

Answer 21

Prokinetic drugs

Question 22

_______, can cause

painful esophageal ulceration in all age groups

Answer 22

Tetracycline, especially doxycycline

Question 23

Also referred to as ‘_________’ or ‘lump in the throat’, it is the subjective sensation of a lump in the throat.

Answer 23

globus hystericus

Question 24

Cause of globus hystericus

Answer 24

Suppression of sadness is most often implicated. No specific aetiology or physiological mechanism has
been established

Question 25

___________is increasingly beingrecognised as a cause of dysphagia, gastro-oesophagealreflux and acute food bolus obstruction in both children (particularly) and adults.

Answer 25

Eosinophilic oesophagitis

Question 26

Associations of Eosinophilic oesophagitis

Answer 26

It is associated with allergic disorders such as hay fever,

cow’s milk allergy and asthma

Question 27

Ab associated with Eosinophilic oesophagitis

Answer 27

IgE

Question 28

Gastroscopy findings in Eosinophilic oesophagitis

Answer 28

eosinophilic

infiltrates in the oesophagus on mucosal biopsies

Question 29

Mx of Eosinophilic oesophagitis

Answer 29

A six-food elimination diet (cow’s milk protein, wheat, soy, eggs, seafood
and peanuts) has been shown to reduce symptoms in up to 90%

Question 30

Tx of acute attach of Eosinophilic oesophagitis

Answer 30

Treatment of the acute attack includes

IM buscopan and a swallowed topical corticosteroid aerosol e.g. fluticasone twice daily for 8 weeks.

Question 31

Mechanical dysphagia represents _____ until

proved otherwise

Answer 31

cancer

Question 32

Cancer-induced achalasia occurs with tumours at the _____ usually due to
______ of the stomach

Answer 32

gastro-oesophageal junction

adenocarcinoma

Question 33

A prominent hard lymph node in the left

supraclavicular fossa_______ is suggestive of cancer of the stomach

Answer 33

(Troisier sign)

Question 34

Dysphagia can be caused by a_____ and can be diagnosed by manometry or barium
swallow.

Answer 34

tight fundoplication