Gastro #1

Question 1

dysphagia vs odynophagia

Answer 1

dysphagia- difficulty swallowing

odynophagia- painful swallowing (indicates inf process)

Question 2

most common diagnostic modalities for esophageal disroders

Answer 2

barium swallowing (esophagram)

esophagogastroudodenoscopy (EGD/OGD)

Esophageal manometry

24h pH monitoring

Question 3

GERD facts + what is it due to

Answer 3

1st identifiable cause for epigastric pain (10-20% of people in the West)

due to excessive relaxation of lower esophageal sphincter (LES)

Question 4

risk factors for GERD

Answer 4

obesity, old age, hiatus hernia, family hx, meds (Ca2+ channel blockers)

Question 5

investigations for GERD if chest pain? (4)

Answer 5

• EKG to exclude heart
• Clinical dx using proton pump inhibitors
• gastroscopy
• espphageal manometry

Question 6

S&S of GERD

Answer 6

heart burn, chest pain, dysphagia, odynophagia

chest pain, chronic cough, wheezes (THIS COULD BE HEART CONDITION)

Question 7

GERD treatment

Answer 7

proton pump inhibitors (PPIs), H2-antaognists

avoid certain foods and weight loss (and raise head in bed)

Question 8

Big complication from GERD

Answer 8

Barrett’s esophagus + esophageal adenocarcinoma

can also have esophagitis, ulcer, bleeding, esophageal stricutre disease

Question 9

what is barrels epophagus and what is it due to

Answer 9

Metaplasia of normal squamous esophageal epithelium to abnormal columnar epithelium

Due to long standing GERD

Question 10

what does barrett’s esophagus predispose to?

Answer 10

adenocarcinoma

Question 11

Esophageal Motor Disroders (3)

Answer 11

1. Achalasia
2. Scleroderma
3. Diffuse Esophageal spasm

Question 12

What is Achalasia and what is it due to

Answer 12

Failure of smooth muscle relaxation at LES (incomplete relaxation of the lower esophageal sphincter)

increased LES pressure
progressive loss of peristaltic function

due to malignancy, idiopathic or chagas disease

Question 13

investigations for achalasia and best test (4)

Answer 13

Chest x ray
Barium studies (birds beak at end of esophagus)- best initial test
endoscopy
manometry- most accurate test

Question 14

most accurate test for scleroderma

Answer 14

manometry

Question 15

Tx for scleroderma

Answer 15

Agressive GERD therapy with PPIs

Question 16

Diffuse Esophageal Spasm (chest pain)- what is it and symptoms

Answer 16

Disorder in neural conduction of resulting in esophageal spasm.

Presents as intermittent pain that has no relation with swallowing

Question 17

test to differential diffuse esophageal spasm

Answer 17

EKG and cardiac enzymes to rule out cardiac diseases

Question 18

diffuse esophageal spasm investigation finding

Answer 18

barium x-ray: corkscrew pattern

Question 19

treatment for DIffuse Esophageal Spasm

Answer 19

Clacium channel blockers

Question 20

Esophageal Diverticula def and 3 types

Answer 20

Outpouchings of one or more layers of the esophageal tract

1. Pharyngoesophageal diverticulum
2. Mid esophageal
3. Just prox to LES

Question 21

Pharyngoesophageal (Zenker’s) Divertiuculum (Esophageal Diverticula)

Answer 21

Most common! - Posterior outpouching

collects food which will rot causing severe HALITOSIS(bad breath) RED

Question 22

Peptic Structure - What be + investigations

Answer 22

Presents as dysphagia alongside a long history of reflux symptoms, but reflux symptoms may disappear as stricture develops.

• Endocopy
• barium study

Question 23

two conditions that can cause chest pain

Answer 23

GERD and diffuse esophageal Spasm

Question 24

Esophagitis def + mc causation

Answer 24

Can be due to infection (viral or fungal) or irritation (chemical or pills) - MOST COMMONLY Candida

Infection is rare in immunocompetent persons

Question 25

HALLMARK symptom of esophagitis RED

Answer 25

odynophagia

Question 26

Esophageal carcinoma mc type world wide and western world

Answer 26

world- Squamous cell carcinoma in upper 2/3 esophagus western- adenocarcinoma in distal 1/3 of esophagus

Question 27

Risk factors for Squamous Cell Carcinoma (Esophageal carcinoma --> upper 2/3rds of esopahgus (6 s’s)

Answer 27

``` Smoking Spirits (alcohol) Seeds Scalding (hot liquid) Strictures Sack (diverticula) ```

Question 28

Risk factors for adenocarcinoma

Answer 28

barret's esophagus (MOST IMPORTANT) Obesity Gerd Caucasians

Question 29

red risk factors for adenocarcinoma of esophagus

Answer 29

Long standing GERD | Distal 1/3

Question 30

most important investigation for esophageal carcinoma

Answer 30

Endoscopic biopsy (EGD with biopsy)

Question 31

Dysphagia + weight loss = ?

Answer 31

esophageal pathology

Question 32

Dysphasia + weifht loss + heme +ve stool/Anemia = ?

Answer 32

cancer

Question 33

Major sign of esophageal perfortation

Answer 33

Boerhaave's syndrome - repeated, froceful vomiting

Question 34

Esophageal perforation conditions BOTH associated with forceful emesis(vomiting)

Answer 34

Boerhave's syndrome (transmural esophageal perfortation) MAllory-Weiis tear (Non-transmural esophageal tear - partial thickness)

Question 35

Hiatal Hernia - Sliding hiatus hernia type 1

Answer 35

90% of esophageal hernias Herniation of both the stomach and the gastroesophageal (GE) junction into thorax

Question 36

Paraesophageal hiatus hernia (type 2)

Answer 36

Herniation of all or part of the stomach through the esophageal hiatus into the thorax with an !!!!! undisplaced GE junction !!!!!!!

Question 37

what is a type 3 (mixed hiatus hernia) and type 4 hernia

Answer 37

type 3- Combo of typw 2 + 3 Type 4- Herniation of the stimach and organs into the thorax