Oesophageal Reflux, Cancer and Gastritis

Question 1

What is the most common symptom associated with upper GI pathology?

Answer 1

Upper abdominal pain /Retrosternal pain/indigestion

Question 2

What are the potential consequences of oesophageal reflux? (3)

Answer 2

Thickening of squamous epithelium
Ulceration of oesophagus in severe reflux
Barret’s oesophagus

Question 3

If the damage done by oesophageal reflux heals by fibrosis, what can occur? (3)

Answer 3

Stricture formation
Impaired oesophageal motility
Oesophageal obstruction

Question 4

What is Barrett’s oesophagus? (3)

Answer 4

A type of metaplasia
Change from squamous to glandular epithelium in the oesophagus
A pre-malignant condition

Question 5

What are the two main histological types of oesophageal cancer?

Answer 5

Squamous carcinoma

Adenocarcinoma

Question 6

What are the risk factors for squamous oesophageal cancer? (3)

Answer 6

Smoking
Alcohol
Dietary carcinogens

Question 7

What are the risk factors for adenocarcinoma oesophageal cancer? (2)

Answer 7

Barrett’s metaplasia (oesophageal reflux)

Obesity

Question 8

What are the local effects of oesophageal cancer? (3)

Answer 8

Obstruction
Ulceration
Perforation

Question 9

Where may oesophageal cancer spread to? (3)

Answer 9

Invasion of local structures
Regional lymph nodes
Liver through bloodstream

Question 10

What are the three types of gastritis?

Answer 10

Autoimmune
Bacterial
Chemical

Question 11

What autoantibodies are produced in type A gastritis?

Answer 11

Against parietal cells and intrinsic factor

Question 12

What are the consequences of type A gastritis? (2)

Answer 12

Decreased acid secretion

Loss of intrinsic factor (Vit. B12 deficiency)

Question 13

Which bacteria is most commonly involved in type B gastritis?

Answer 13

H. pylori

Question 14

Which chemicals are commonly involved in type C gastritis? (3)

Answer 14

Drugs (esp. NSAIDs)
Bile
Alcohol

Question 15

What is gastritis?

Answer 15

Inflammation of the gastric mucosa

Question 16

What vertebral level does the oesophagus start?

Answer 16

C6

Question 17

What vertebral level is the oesophageal hiatus?

Answer 17

T10

Question 18

What cranial nerve mediates contraction of the oesophagus and opening of the LOS?

Answer 18

Vagus

Question 19

What investigations may be performed for oesophageal disorders? (5)

Answer 19

UGIE
Oesophago-gastro-duodenoscopy (OGD)
Barium swallow
Oesophageal pH (reflux)
Manometry

Question 20

What are common associated symptoms of heartburn? (2)

Answer 20

Cough

Waterbrash

Question 21

What food and drugs can lead to reflux? (3)

Answer 21

Alcohol
Nicotine
Dietary Xanthine

Question 22

What should you ask about in a history of dysphagia? (4)

Answer 22

Type of foods solid or liquid)
Pattern (progressive or intermittent)
Associated Symptoms (weight loss, regurgitation, cough)
Location (oropharyngealor oesophageal)

Question 23

Describe a hypermotile oesophagus during barium swalllow

Answer 23

Corkscrew like appearance

Question 24

What is the treatment for a hypermotile oesophagus

Answer 24

Smooth muscle relaxants

Question 25

What diseases are associated with a hypomotile oesophagus (3)

Answer 25

Connective tissue disease Diabetes Neuropathy

Question 26

What is achalasia? (2)

Answer 26

Functional loss of myenteric plexus ganglion cells i the distal oesophagus and LOS Absence of useful peristaltic contractions in the lower oesophagus

Question 27

What are the symptoms of achalasia? (4)

Answer 27

Progressive dysphagia Weight loss Chest pain Regurgitation and chest infection

Question 28

What are the complications of achalasia?

Answer 28

Aspiration pneumonia Lung disease Increased risk of squamous cell oesophageal carcinoma

Question 29

What are the pharmacological treatments for achalasia? (2)

Answer 29

Nitrates | Calcium channel blockers

Question 30

What are the endoscopic treatments for achalasia? (2)

Answer 30

Botulin toxin | Pneumatic balloon dilation

Question 31

What is the surgical treatment for achalasia?

Answer 31

Myotomy