Upper Gastrointestinal

Question 1

GORD definition

Answer 1

Reflux of acidic stomach contents into the oesophagus due to inappropriate transient or permanent relaxation of the lower oesophageal sphincter

Question 2

GORD can be classified into:

Answer 2

Erosive and non-erosive

Question 3

__-__% of patients with GORD have the non-erosive subtype

Answer 3

50-70%

Question 4

__-__% of patients with GORD have the erosive subtype

Answer 4

30-50%

Question 5

Risk factors for GORD include:

Answer 5

Smoking, alcohol, stress, obesity, pregnancy, scleroderma

Question 6

Clinical features of GORD include:

Answer 6

Retrosternal burning pain exacerbated with lying down, postprandially and triggered by certain foods/beverages. Regurgitation. Dysphagia. Bloating. Non-productive cough.

Question 7

Diagnosis of GORD is made:

Answer 7

Clinically

Question 8

Histopathological features of GORD include:

Answer 8

Superficial coagulative necrosis, basal cell thickening, elongation of papillae in lamina propria, inflammatory cell, squamous to columnar transformation

Question 9

Lifestyle changes indicated in the management of GORD include:

Answer 9

Weight loss, exercise and avoidance of triggers

Question 10

The first-line pharmacological treatment for GORD is:

Answer 10

Proton pump inhibitors

Question 11

Surgical management of GORD includes:

Answer 11

Fundoplication

Question 12

Fundoplication is only indicated in GORD which:

Answer 12

Is pharmacologically resistant to treatment

Question 13

Squamous cell carcinoma is most commonly found in which portion of the oesophagus?

Answer 13

The upper 2/3

Question 14

The most common subtype of oesophageal malignancy is:

Answer 14

Squamous cell carcinoma

Question 15

Adenocarcinoma is most commonly found in which portion of the oesophagus?

Answer 15

The lower 1/3

Question 16

Oesophageal malignancy can be classified by position according to:

Answer 16

The Siewert classification

Question 17

Risk factors for development of oesophageal carcinoma include:

Answer 17

Male sex, age 60-70yo, smoking, alcohol, past medical history of GORD/Barrett’s oesophagus

Question 18

The overall five year survival rate of oesophageal malignancy is:

Answer 18

20%

Question 19

Symptoms consistent with oesophageal carcinoma include:

Answer 19

Progressive dysphagia from solids to liquids, constitutional symptoms, dyspepsia, dyspnoea, retrosternal chest or back pain, persistent cough

Question 20

Signs of oesophageal carcinoma on physical examination include:

Answer 20

Vocal hoarseness, pallor, Horner’s syndrome, cervical lymphadenopathy

Question 21

Histopathological findings consistent with oesophageal adenocarcinoma include:

Answer 21

Metaplasia of oesophageal epithelium to columnar epithelium with goblet cells

Question 22

Histopathological findings consistent with oesophageal squamous cell carcinoma include:

Answer 22

Lymphocytic infiltration between carcinoma clusters

Question 23

Neoadjuvant chemoradiotherapy is indicated in oesophageal carcinoma in the following:

Answer 23

Locally invasive disease and Barrett syndrome high grade metaplasia

Question 24

Chemotherapy is indicated for oesophageal carcinoma in:

Answer 24

Advanced disease

Question 25

Operative treatment of oesophageal carcinoma includes:

Answer 25

Endoscopic submucosal resection

Question 26

Operative management of oesophageal carcinoma is indicated in:

Answer 26

Superficial epithelial lesions

Question 27

Barrett’s oesophagus definition

Answer 27

Intestinal metaplasia of the oesophageal mucosa where squamous epithelium transforms to columnar epithelium

Question 28

Barrett’s oesophagus is induced by:

Answer 28

Chronic reflux of gastric contents

Question 29

Risk factors for Barrett’s oesophagus include:

Answer 29

Male sex, age>50yo, obesity, GORD for >5years

Question 30

Barrett’s oesophagus can be confirmed on:

Answer 30

Endoscopy

Question 31

Conservative management of Barrett’s oesophagus includes:

Answer 31

Regular endoscopic monitoring

Question 32

Pharmacological management of Barrett’s oesophagus includes:

Answer 32

Proton pump inhibitors

Question 33

Operative management of Barrett’s oesophagus includes:

Answer 33

Radiofrequency ablation

Question 34

Radiofrequency ablation of Barrett’s oesphagus is indicated in:

Answer 34

High-grade dysplasia

Question 35

Eosinophilic oesophagitis definition

Answer 35

Chronic inflammatory disorder of the oesophagus characterised by eosinophilia and resultant oesophageal dysfunction

Question 36

Eosinophilic oesophagitis affects _ in 100 adults

Answer 36

1

Question 37

Eosinophilic oesophagitis affects _ in 10,000 children

Answer 37

1

Question 38

Eosinophilic oesophagitis most commonly affects which patient group?

Answer 38

Men aged <40yo

Question 39

Eosinophilic oesophagitis pathophysiology

Answer 39

Exposure to allergens → chronic inflammation and eosinophilic infiltration of the oesophagus → subepithelial fibrosis, oesophageal remodelling and dysfunction

Question 40

Symptoms of eosinophilic oesophagitis include:

Answer 40

Dysphagia, dyspepsia refractory to acid suppression therapy, vomiting, food ‘sticking’ while swallowing, cough, melaena

Question 41

Histopathological findings in eosinophilic oesophagitis include:

Answer 41

Eosinophilia and subepithelial fibrosis

Question 42

Features of eosinophilic oesophagitis on endoscopy include:

Answer 42

Trachealisation of the oesophagus (circumferential mucosal lesions), longitudinal furrows, mucosal fragility

Question 43

Non-operative management of eosinophilic oesophagitis includes:

Answer 43

Avoidance of trigger allergens

Question 44

Pharmacological management of eosinophilic oesophagitis includes:

Answer 44

Proton pump inhibitors and topical glucocorticoids (e.g. fluticasone)

Question 45

Operative management of eosinophilic oesophagitis includes:

Answer 45

Oesophageal dilation

Question 46

In the setting of eosinophilic oesophagitis, oesophageal dilation is indicated:

Answer 46

In oesophageal strictures or disease refractory to conservative therapy

Question 47

Oesophageal varices definition

Answer 47

Dilation of the submucosal veins of the distal oesophagus as a complication of portal hypertension

Question 48

__% of cirrhotic patients have concurrent oesophageal varices

Answer 48

30%

Question 49

__% of patients with oesophageal varices will experience bleeding

Answer 49

50%

Question 50

__% of variceal bleeds are fatal

Answer 50

30%

Question 51

Risk factors for the development of oesophageal varices include:

Answer 51

Alcohol consumption, increased variceal size, advanced Child-Pugh classification

Question 52

Oesophageal varices pathophysiology

Answer 52

Liver cirrhosis → cannot accommodate blood flow → resultant retrograde portal hypertension → collateral enlargement → congestion of submucosal veins in the oesophagus → potential rupture +/- haemorrhage

Question 53

Symptoms of ruptured oesophageal varices

Answer 53

Sudden onset haematemesis, melaena, haematochezia (if rapid-transit bleed), abdominal discomfort

Question 54

Physical examination signs of oesophageal varices

Answer 54

Caput medusae, gynaecomastia, palmar erythema, testicular atrophy, splenomegaly, shifting dullness

Question 55

CBE in the setting of liver cirrhosis may show:

Answer 55

Normocytic normochromic anaemia and thrombocytopaenia

Question 56

LFTs in the setting of liver cirrhosis may show:

Answer 56

Increased AST/ALT and hypoalbuminaemia

Question 57

Endoscopy in the setting of oesophageal varices is useful to:

Answer 57

Identify active bleeding sites and provide treatment

Question 58

Non-operative management of bleeding oesophageal varices includes:

Answer 58

Resuscitation and stabilisation

Question 59

Pharmacological management of bleeding oesophageal varices includes:

Answer 59

Octreotide and erythromycin

Question 60

Octreotide is indicated for what time period in the setting of bleeding oesophageal varices?

Answer 60

3-5 days.

Question 61

Operative management of bleeding oesophageal varices includes:

Answer 61

Endoscopic band ligation, injection sclerotherapy and balloon tamponade

Question 62

Mallory Weiss syndrome definition

Answer 62

Longitudinal lacerations of the mucous membrane in the oesophagus

Question 63

Risk factors associated with Mallory Weiss syndrome include:

Answer 63

Prolonged severe vomiting, alcoholism, blunt abdominal trauma and GORD

Question 64

Mallory Weiss syndrome pathophysiology

Answer 64

Acute excessive rise in oesophageal intraluminal pressure, resulting in tearing of the oesophageal mucous membrane and submucosal arteries/veins leading to bleeding

Question 65

Endoscopic findings consistent with Mallory Weiss tear include:

Answer 65

Longitudinal tear limited to the mucosa and submucosa around the GOJ

Question 66

Operative management of Mallory Weiss syndrome includes:

Answer 66

Endoscopic adrenaline and endoscopic electrocoagulation

Question 67

Hiatus hernia definition

Answer 67

Abnormal protrusion of any abdominal structure, usually the stomach, into the thoracic cavity through a laxity in the diaphragmatic oesophageal junction

Question 68

Risk factors for the development of hiatus hernia include:

Answer 68

Obesity, increasing age, smoking and increased abdominal pressure

Question 69

Type I hiatus hernia may be associated with which symptom?

Answer 69

Retrosternal burning pain

Question 70

The following symptoms may be associated with type II or III hiatus hernia

Answer 70

Epigastric or substernal pain and early satiety

Question 71

Non-operative management of hiatus hernia includes:

Answer 71

Avoidance of triggers, smaller meals, weight loss and PPIs

Question 72

Operative management of hiatus hernias includes:

Answer 72

fundoplication

Question 73

Achalasia definition

Answer 73

Oesophageal motility disorder characterised by inadequate relaxation of the lower oesophageal sphincter and non-peristaltic contractions in the distal 2/3 of the oesophagus due to the degeneration of inhibitory neurons

Question 74

Achalasia commonly affects which age group?

Answer 74

25-60yo

Question 75

Clinical features of achalasia include:

Answer 75

Dysphagia progressing from solids to liquids, regurgitation, retrosternal pain and weight loss

Question 76

Pathophysiology of achalasia

Answer 76

Atrophy of inhibitory neurons → deficiency in inhibitory neurotransmitters → imbalance in excitatory vs inhibitory neurotransmitters → lack of relaxation and increased LOS resting pressure with dilation proximal to LOS

Question 77

Manometric findings in achalasia include:

Answer 77

Absence peristalsis in the lower 2/3 of the oesophagus, absent LOS relaxation and increased LOS resting pressure

Question 78

Signs of achalasia on barium swallow include:

Answer 78

Rats tail sign and widened proximal oesophagus

Question 79

Operative management of achalasia includes:

Answer 79

pneumatic dilatation

Question 80

Pharmacological management of achalasia includes:

Answer 80

Botox injection (indicated in poor surgical candidates)