CC- Oesophagus, Stomach and SI

Question 1

Define GORD/ reflux oesophagitis

Answer 1

Symptomatic passage of gastric content into the lower oesophagus

Question 2

What are the 3 Key risk factors of GORD?

Answer 2

1) Decreased LOS tone: caffeine, fatty foods, hiatal hernia
2) Impaired mucosal defences: smoking, alcohol
3) Increased IA pressure: pregnancy, obesity, ascites, lifting and bending

Question 3

What is the difference between a rolling and a sliding hernia?

Answer 3

Sliding: Stomach protrudes in and out of herniation
Rolling: Whole portion of the stomach has herniated and stayed out of the abdominal cavity

Question 4

How does the epithelium change in Baretts Mucosa?

Answer 4

from stratified squamous epithelium to simple columnar epithelium

Question 5

What are some of the complications of GORD?

Answer 5

Chronically Low pH causing:

• Healing with fibrosis (obstruction, dysphagia)
• Blood loss –> iron deficiency anaemia
• Oesophageal ulceration
• Metaplasia –> Barettes Mucosa

Question 6

What are some clinical features of GORD?

Answer 6

• Heart burn
• Dyspepsia
• Dysphagia, Odonophagia

Question 7

What is acute gastritis?

Answer 7

Acute inflammation of the gastric lining

Question 8

What are the potential causes of acute gastritis?

Answer 8

• Damage to the lining: alcohol, NSAID’s
• Infective causes: E.coli & salmonella
• Mucosal suppressants: chemotherapy, radiotherapy

Question 9

What is autoimmune gastritis?

Answer 9

Another name: Pernicious Gastritis

• When you produce antibodies against your own parietal cells and intrinsic factor
• Leads to Vitamin B12 deficiency and megaloblastic anaemia
• Can lead to Vic B12 neuropathy

Question 10

What are peptic ulcers?

Answer 10

An Ulcer in any part of the GIT that is exposed to gastric secretions
common D1 of duodenum (70%) and lesser curvature of the stomach (30%)

Question 11

What are some risk factors for Peptic Ulcers?

Answer 11

• H. Pylori infection (most common)
• NSAID’s
• Smoking
• Genetics

Question 12

What are the 4 mechanisms used by H. Pylori Antibiotics?

Answer 12

4 Mechanisms:

1) Inhibit protein synthesis
2) Inhibition of cell wall synthesis
3) Disruption of the cell membrane
4) Interference of metabolic processes

Question 13

What is Coeliac Disease?

Answer 13

Genetically-determined, abnormal, hypersensitivity reaction to gluten or its peptide derivative, gliadin

Question 14

What part of the bowel is most affected?

Answer 14

proximal bowel, especially duodenal-jejunal junction

Question 15

Pathophysiological steps of Coeliac disease

Answer 15

1) Type 4 (cell- mediated) hypersensitivity reaction
2) Immune cells infiltrate lamina propria
3) T-lymphocytes release inflammatory cytokines & Plasma cells produce IgA antibodies
4) Damage to mucosa and atrophy of vili
5) Impaired intracellular metabolism

Question 16

What are the risk factors for Oesophageal Cancer?

Answer 16

• Smoking
• Alcohol intake
• Barettes Mucosa

Question 17

What is the classic triad of Oesophageal Cancer?

Answer 17

1) Dysphagia
2) Odonophagia
3) Weight loss

Other not so common:

• haematamesis
• anemia
• symptoms of secondary spread

Question 18

What are some of the risk factors for Stomach Cancer?

Answer 18

• H. Pylori (indirect carcinogen)
• Chronic/Autoimmune gastritis (epithelial damage/ replacement)
• Diets high in salt

Question 19

95% of gastric cancers are

a) Carcinoma
b) Adenocarcinoma
c) Squamous cell carcinoma
d) None of the above

Answer 19

b) Adenocarcinoma

Question 20

Name some clinical features of Stomach Cancer

Answer 20

Often mimic gastric ulcer & are diagnosed late

1) Anorexia
2) Haematamesis
3) Nausea
4) Dyspepsia
5) Sometime presenting factors are due to spread