clinical overview gastro-oesophageal disease

Question 1

what are the three physiological constrictions of the oesophagus ?

Answer 1

cricopharynxgeus
aortic arch
hiatus

Question 2

what is the lining of the oesophagus ?

Answer 2

stratified squamous epithelium

Question 3

what is the general clinical presentation of oesophageal disorders ?

Answer 3

dysphagia with or without pain n
regurgitation/ drooling
malnutrition

Question 4

what are the investigations for oesophageal disorders?

Answer 4

contrast radiology 
endoscopy 
and special tests such as:
pH meter (GERD) 
Motility study (Achalasia)

Question 5

what is the nature of the stricture of post corrosive oesophageal stricture ?

Answer 5

tight
long segment
multiple ( esoph, stomach)
marked proximal dilatation

Question 6

what are the most common cases associated with PCOS ?

Answer 6

mostly children , with adults its mainly a suicidal attempt or a psychotic patient

Question 7

what is the management for PCOS?

Answer 7

endoscopy after 2 weeks of insult then :

dilatation or resection

Question 8

when do we perform a resection on a PCOS patient ?

Answer 8

if the dilatation failed
if there is a tight stricture
if there is a malignancy

Question 9

when can we start considering a carcinoma with PCOS ?

Answer 9

if we performed dilatation and the patient still has dysphagia

Question 10

what is achalasia ?

Answer 10

a motility disorder characterized by failure of relaxation of the lower oesophageal sphincter

Question 11

what is the nature of the stricture in achalasia ?

Answer 11

distal ( less than LES)
short ( less than 5 cm)
smooth mucosa
centric lumen

Question 12

what does the body of the oesophagus look like in achalasia ?

Answer 12

• enormous proximal dilatation with oesophageal fluid/air trap
• a-peristaltic
• absent gastric air bubble

Question 13

what are the manometry results in achalasia ?

Answer 13

hypertesive and long LES

and no peristalsis

Question 14

what does the position of the stricture indicate in achalasia ?

Answer 14

if its below the cupula of the diaphragm - most likely not carcinoma
above the cupula of the diaphragm- rat tail appearance (carcinoma)

Question 15

what is the radiological finding with long standing achalasia ?

Answer 15

bird beak appearance (elongation and dilation)

Question 16

what are the three types of diverticula formation ?

Answer 16

• pharyngeoesophgeal
• mid-esophgeal
• epiphrenic

Question 17

what is Zinker’s diverticulum ?

Answer 17

a pharyngeooesphgeal diverticula characterized by the incoordination between the cricopharyngeus muscle contraction and upper eosophgeal relaxation inducing luminal hypertension

Question 18

how do we treat and managed Zinker’s diverticulum ?

Answer 18

diverteculetomy then

treat the spasm with a transverse myotomy

Question 19

where are pharyngoesophgeal diverticulum more common in?

Answer 19

more in males
in elderly
in the left posterior triangle usually

Question 20

what are the three types of hiatal hernias ?

Answer 20

sliding cardia (type I)
rolling fundus (type II)
combined (type III)

Question 21

what is the initiating process in sliding hernias?

Answer 21

in type 1 HH :

GERD

Question 22

what is the presentation of rolling hernias?

Answer 22

3D syndrome :
dysphagia
dyspepsia
dyspnea

Question 23

when can we suspect Barrets oesophagus on endoscopy?

Answer 23

disturbed z-line

Question 24

what does metaplasia predispose to ?

Answer 24

adenocarcinoma

Question 25

what is a leimyoma ?

Answer 25

benign smooth muscle tumor

Question 26

what are the features of a leimyoma ?

Answer 26

may be large regular contour intact mucosa 60% distal third

Question 27

what radiological feature is specific to carcinomas?

Answer 27

mural thickening

Question 28

what differentiates a carcinoma from a leiomyoma ?

Answer 28

``` mural thickening eccentric lumen wide prevertebral space shouldering mucosal irregularity ```

Question 29

what are the types of gastric outlet obstruction ?

Answer 29

lumenal mural extrinsic

Question 30

what is bouveret syndrome ?

Answer 30

gall stone obstruction in the lumen of the stomach

Question 31

what are the two types of volvulus ?

Answer 31

organo-axial : joining of the cardia along with the pylorus | mesenterico-axial: joining the lesser and greater omentum together

Question 32

what is the clinical presentation of organo-axial volvulus ?

Answer 32

acute abdominal pain vomiting abdominal distention shock

Question 33

what is the cause of GIST ?

Answer 33

mutation in PDGFRA and KIT genes

Question 34

what is the treatment for GIST ?

Answer 34

in resectable regions: | and tyrosine kinase inhibitors after the resection

Question 35

what is the lesion is non resectable in GIST ?

Answer 35

use TKI drugs until it becomes resectable

Question 36

what is an example of a TKI ?

Answer 36

imatinib