Diseases of the Upper GI System

Question 1

Define Barrett’s Oesophagus

Answer 1

Asymptomatic of normal squamous epithelia of the oesophagus by metaplastic columnar epithelium

Question 2

Barret’s oesophagus is a precursor for what other condition?

Answer 2

Oesophageal adenocarcinoma

Question 3

What is the strongest known risk factor for Barrett’s oesophagus?

Answer 3

GORD

Question 4

Name 4 medical conditions that have an association with Barrett’s oesophagus

Answer 4

1. Chronic GORD
2. Hiatus hernia
3. Smoking
4. Obesity

Question 5

What is the clinical test used to detect dysplasia in the investigation of Barrett’s oesophagus?

Answer 5

High resolution white light endoscopy with biopsies

Question 6

Name a form of anti-reflux surgery

Answer 6

Nissen’s fundoplication

Question 7

Name 4 important differentials of progressive dysphagia to solids i.e. a mechanical obstruction or stricture

Answer 7

1. Barrett’s oesophagus
2. Oesophageal cancer
3. Peptic stricture
4. Extrinsic compression of the oesophagus

Question 8

In patients aged over 55 with weight loss, those with any of which 3 factors should be referred for urgent direct access upper GI endoscopy?

Answer 8

1. Upper abdominal pain
2. Reflux
3. Dyspepsia

Question 9

On average, for patients that undergo endoscopy for dysphagia, what is the % breakdown of resulting diagnoses?

Answer 9

~ 40% have functional/ non ulcer dyspepsia 
40 % GORD
13% gastric or duodenal ulcers
2% gastric cancer 
1% oesophageal cancer

Question 10

Suggest 4 important potential differentials for peptic ulceration

Answer 10

1. Gastritis
2. Non-ulcer dyspepsia
3. Pancreatitis
4. Cholecystitis

Question 11

What are the 2 most common causes of peptic ulcer disease?

Answer 11

1. H. Pylori infection

2. NSAIDS

Question 12

What are the 3 methods of testing for a H Pylori infection?

Answer 12

1. Urea breath test
2. Stool antigen test
3. Blood test for antibodies to the bacteria

Question 13

Outline the 3 mechanisms by which NSAIDS lead to gastric ulceration

Answer 13

1. Inhibition of COX 1 - decrease blood flow
2. Topical irritation - Epithelial damage
3. Inhibition COX 2 - Neutrophil adherence

Question 14

Suggest 5 risk factors for the development of peptic ulcer disease

Answer 14

1. Smoking
2. Alcohol excess
3. Family history of peptic ulcer disease
4. Physical stress
5. Hyperesecretory syndromes of stomach acid e.g. Zollinger- Ellison syndrome.

Question 15

Name 3 potential complications of peptic ulcer disease

Answer 15

1. Internal bleeding
2. Perforation
3. Gastric outlet syndrome

Question 16

What are the 2 main clinical characteristics of gastric outlet syndrome?

Answer 16

1. Epigastric abdominal pain

2. Postprandial vomiting due to mechanical obstruction

Question 17

What is the most common cause of gastric outlet syndrome?

Answer 17

Pancreatic cancer

Question 18

Which Rockall score cut off is associated with good prognosis for patients with upper GI bleeding?

Answer 18

Less than 3

Question 19

Name 6 medications which may lead to the formation of a peptic ulcer

Answer 19

1. Potassium channel activators e.g. Nicorandil
2. Corticosteriods
3. NSAIDS
4. SSRIs
5. Anticoagulants
6. Antiplatelets

Question 20

Dysphagia combined with any of which 4 symptoms is sufficient indication for an urgent 2 week referral?

Answer 20

1. Weight loss
2. Anemia
3. Anorexia
4. Persistant vomiting

Question 21

Name the enzyme secreted by the chief cells of the stomach

Answer 21

Pepsinogen

Question 22

Name the cell type that releases HCl into the stomach

Answer 22

Parietal cells

Question 23

ECl cells of the stomach produce what substance?

Answer 23

Histamine

Question 24

Which cell type secretes somatostatin?

Answer 24

Delta cells

Question 25

Describe the the action of somatostatin on acid secretion in the stomach

Answer 25

Down-regulates parasympathetic stimulation of the parietal cells thus reducing volume of acid secretion.

Question 26

In what area of the stomach are G and delta cells found?

Answer 26

Antrum

Question 27

What is the function of the G cell in the stomach?

Answer 27

Secretion of gastrin which in turn stimulates acid production by parietal cells.

Question 28

Name the 3 pathological mechanisms by which NSAIDS lead to the formation or gastric ulcers

Answer 28

1. Mucosal barrier disruption 2. Inhibition of repair mechanism 3. Increased secretion of gastric acid

Question 29

What are the 5 broad categories of causes of haemoptysis?

Answer 29

1. Infective 2. Neoplastic 3. Vascular 4. Autoimmune 5. Drug related