Upper GIT Disorders

Question 1

Pathogenesis of GORD

Answer 1

Transient relaxation of lower oesophageal sphincter = muscle disease

Question 2

GORD risk factors

Answer 2

Obesity, hiatus hernia, alcohol, drugs, smoking

Question 3

Is H pylori GORD risk?

Answer 3

No conclusive evidence on this

Question 4

Dx of GORD

Answer 4

Symptoms alone + PPI trial

Question 5

When to gastroscope?

Answer 5

New onset >50 yo
Red flags - dysphagia, weight loss, haemetemesis
Refractory to good PPI

Question 6

Barrett’s oesophagus is___ and classification?

Answer 6

Intestinal metaplasia of distal oesophageal mucosa

Short vs long (>3cm)

Question 7

Barrett’s is main risk factor for? + its risk factors are?

Answer 7

Risk factor for oesophageal adenocarcinoma

Smoking, obesity

Question 8

When to treat Barrett’s?

Answer 8

High grade dysphagia - ablate/surgery + 3 monthly surveil

Low grade - 6 monthly then 1 year (treating is individual)

No dysphagia - 3 yearly surveil

Question 9

PPI causes (2)

Answer 9

Acute interstitial nephritis, hypomagnesaemia

Lacks evidence for - fractures/severe pneumonia

Question 10

Common agents for pill induced oesophagitis

Answer 10

Abx, bisphosphonates (alendronate), NSAIDs

Question 11

Eosinophilic oesophagitis?

Answer 11

Young male food bolus (recurrent) atopy

Question 12

Endoscopic findings of EoE?

Answer 12

Concentric rings (corrugated iron)

Question 13

Therapy for EoE?

Answer 13

Budesonide oral dispersible tablet (Biopsy + 8 week improvement histology for PBS)

Endoscopic dilatation only when stricture (perforation risk with procedure)

Question 14

What is achalasia?

Answer 14

Failed relaxation of lower oesophageal sphincter

Question 15

Achalasia, Scleroderma, spasm on manometry?

Answer 15

Achalasia - Pressure do not drop when swallowing

Scleroderma - Low resting sphincter tone

Spasm - High amplitude pressure

Question 16

Management of achalasia

Answer 16

1st line - POEM (per-oral endoscopic myotomy)

Pneumatic dilatation (younger pt)
Botox injection (older pt)

Surgery (Hellers myotomy)

Question 17

Risk factors for peptic ulcer disease?

Answer 17

H pylori, NSAIDs

Question 18

Gastric phys?

Answer 18

HC acid from parietal cells by gastric (G cell) and histamine (H2 receptor)

Too much acid? -> somatostatin (D cell) causing negative feedback for G cell

Question 19

H pylori phys?

Answer 19

High urease activity makes survivable in stomach

Flagella motility to move

Adhesion

Virulence
- CagA - breakdown cell integrity
- VacA - more breakdown/cell apoptosis

Question 20

H pylori tests?

Answer 20

Urea breath and stool antigen both as good

Serology - not as good

Question 21

H pylori eradication first line?

Answer 21

Amox + Clarithro + PPI 7-14 days (be aware clarithro resistant tx failure)

Question 22

NSAID ulcer phys?

Answer 22

COX1/2 inhibition = Prostaglandin inhibition

Prostaglandin
- Improve mucosal blood flow, mucin, bicarb, epithelium production (all protective)

Question 23

NSAID and if it must be used?

Answer 23

Use COX-2 inhibitor + PPI

Question 24

PUD treatment and red flag?

Answer 24

PPI heals ulcers

Repeat gastroscopy to exclude gastric cancer (esp refractory cases)

Question 25

High risk/re-bleed endoscopic lesions?

Answer 25

Active arterial bleed Non-bleeding visible vessel Non-bleeding adherent clot Oozing ulcer

Question 26

Exclusions for restrictive transfusion practice?

Answer 26

IHD, PVD, CVA/TIA

Question 27

Coeliac disease common associations?

Answer 27

Thyroid T1DM Dermatitis herpetiformis/vasculitis Osteoporosis Infertility

Question 28

Test for coeliac disease? Gold standard is?

Answer 28

TTG + anti-endomysial ab (IgA test) + total IgA level Then must require small bowel biopsy

Question 29

Common biopsy finding of coeliac disease

Answer 29

Villous atrophy/blunting Increased lymphocytes

Question 30

Main complications of coeliac disease?

Answer 30

Lymphoma (MALT), Small bowel adenocarcinoma

Question 31

Coeliac disease management?

Answer 31

Gluten free diet Treat metabolic complication - Iron, folate, osteoporosis

Question 32

Occult vs Obscure bleeding?

Answer 32

Occult - no overt bleeding seen Obscure - blood but no source on scope

Question 33

What to test when occult bleed?

Answer 33

Capsule endoscopy -> Balloon enteroscopy after capsule