Dysphagia/Nausea/Vomiting/Dyspepsia

Question 1

If the patient says that there was difficulty swallowing solids and liquids from the start, what is this suggestive of?

Answer 1

Motility disorder e.g. achalasia, CNS etc

Question 2

If a patient says that had difficulty swallowing solids and then liquids, what is this suggestive of?

Answer 2

Benign or malignant stricture

Question 3

If the patient says that it is difficult to swallow, especially if the patient coughs on swallowing, what is this suggestive of?

Answer 3

Bulbar palsy

Question 4

What is bulbar palsy?

Answer 4

A problem with the CN nerves that control swallowing

Question 5

What would you suspect if a patient had odynophagia?

Answer 5

Cancer

Oesophageal ulcer

Candida

Spasm

Question 6

If the dysphagia is progressive and worsening, what would you suspect?

Answer 6

A malignant stricture

Question 7

A patient comes in and says that they have had dysphagia. They mention that when they take a drink, their neck bulges. What is this a sign of?

Answer 7

Pharyngeal pouch

Question 8

What tests would you do if a patient complained of dysphagia?

Answer 8

FBC
U&Es
CXR
Upper endoscopy

Question 9

A patient comes in with intermittent dysphagia and chest pain. Their barium swallow showed a corkscrew oesophagus. What do they have?

Answer 9

Oesophageal spasms

Question 10

A patient comes in with dysphagia for fluids and solids. They have been regurgitating anything that they swallow and have had cramps substernally. They have lost weight as they have not been able to eat.

Their CXR shows fluid level in a dilated oesophagus.

What does the patient have and what is the treatment?

Answer 10

Achalasia

Endoscopic balloon dilatation or Heller’s cardiomyopathy and then PPIs

Question 11

What drugs can help to relax a the lower oesophageal sphincter?

Answer 11

Calcium channel blockers

Nitrates

Botulinum toxin injection is a non-invasive method of stopping achalasia

Question 12

What is the difference between regurgitation and vomiting?

Answer 12

Regurgitation requires no effort

Question 13

If a patient has ‘coffee grounds’ in their vomit, what is happening to them?

Answer 13

Some form of GI bleeding

Question 14

What can vomiting do to arterial blood gases?

Answer 14

Metabolic alkalosis with severe vomiting

Question 15

What are cyclizine and cinnarizine?

Answer 15

H2 receptor antagonists used as antiemetics

Question 16

What are metoclopramide and domperidone, and what are they used for?

Answer 16

H2 receptor antagonists

Anti-emetics

Prokinetics

Question 17

What is ondansetron and what is it used for?

Answer 17

5HT3 receptor antagonist

IV antiemetic - e.g. used in chemo

Question 18

WHAT ARE THE ALARM SYMPTOMS????????

Answer 18

Anaemia
Loss of weight
Anorexia
Recent onset/progressive
Melaena/haematemesis
Swallowing difficulty

Question 19

What is more common, a gastric ulcer or a duodenal ulcer?

Answer 19

Duodenal

Question 20

If a patient is over the age of 55 and presents with a recent onset of dyspepsia, what are you going to do?

Answer 20

Refer for an urgent endoscopy

Question 21

How long should a patient be off of antibiotics and omeprazole before having a breath test or upper GI endoscopy?

Answer 21

4 weeks for antibiotics

2 weeks omeprazole

Question 22

What is a non-invasive way of treating achalasia?

Answer 22

Botulinum toxin

Question 23

Rapid correction of hyponatraemia can lead to what?

Answer 23

Bulbar palsy