He who is not courageous enough to take risks will accomplish nothing in life.

– Muhammad Ali, Champion Boxer

A. B. C. D. E.

17%

8%

67%

0%

8%

? diagnosis

A. Adenocarcinoma.

B. Acute Oesophagitis.

C. Barrett’s oesophagus

D. Oesophageal varices

E. Achalasia

A. B. C. D. E.

33%

0%

11%

56%

0%

42 year old man, chronic alcoholic, develops intractable hematemesis and ultimately exsanguination. Au autopsy, the opened up oesophagus appeared like the image. What is the most likely cause?.

A. Forced vomiting.

B. Columnar metaplasia.

C. Malignant change.

D. Portal hypertension.

E. Reflux of gastric acid.

A. B. C. D. E.

0%

69%

13%

0%

19%

65year old man with long standing GORD now has a 2 month history of hematemesis and dysphagia. His lower oesophagus gross & Microscopy appears similar to the image. What is the most likely complication?.

A. Acute oesophagitis.

B. Barrett’s oesophagus.

C. adenocarcinoma.

D. Squamous cell carcinoma.

E. Perforation.

46y male chest pain. Oesophageal biopsy.

A. B. C. D. E.

7%

50%

21%

0%

21%

A. Chronic esophagitis

B. Squamous metaplasia

C. Barrett’s

D. Adenocarcinoma.

E. Squamous carcinoma

58y Fem, hematemesis and hematochezia, alcoholic cirrhosis 2y ago, Lower oesophagus biopsy. What is the

most likely Diagnosis?

1 2 3 4 5

31%

13%

6%

0%

50%

1. Mallory Weiss Syndrome.2. Barrett’s esophagus.3. Esophageal varices4. Sliding Hiatus hernia5. Acute esophagitis.

56y male, abdominal pain, Gastric biopsy, ? arrow

A. B. C. D. E.

0% 0%6%

94%

0%

A. Barrett’s.

B. H.pylori gastritis.

C. Chronic gastritis

D. Adenocarcinoma

E. Gastric metaplasia.

46y male pain, hematemesis: Stomach.

1 2 3 4 5

11%

89%

0%0%0%

A. Malignant Gastric ulcerB. Benign peptic ulcer.C. Barrett’sD. Adenocarcinoma.E. Acute gastritis.

46y male pain, hematemesis: Stomach.

1 2 3 4 5

0% 0% 0%0%0%

A. Malignant Gastric ulcerB. Benign peptic ulcer.C. Barrett’sD. H.pylori gastritis.E. Gastric Perforation.

46y male odynophagia : Esophageal biopsy.

A. B. C. D. E.

0% 0%

13%13%

73%

A. Barrett’s

B. Acute Esophagitis.

C. Squamous Carcinoma

D. Adeno Carcinoma.

E. Chronic Esophagitis.

Correct statement about H.pylori?

1 2 3 4 5

23%

62%

8%8%

0%

A. Gram positive spirocheteB. Colonizes Gastric mucosaC. Invades duodenal mucosaD. Diagnosed by bacterial culture.E. Complication is Duodenal cancer.

Common site of Peptic Ulcer?

1 2 3 4 5

18%

0%

73%

9%

0%

A. Cardiac part of Stomach.B. Greater curvatureC. Lesser curvatureD. 2nd part of duodenumE. 1st part of duodenum

46y male odynophagia : Esophageal biopsy.

A. B. C. D. E.

0% 0% 0%0%0%

A. Barrett’s

B. Acute Esophagitis.

C. Squamous Carcinoma

D. Adeno Carcinoma.

E. Chronic Esophagitis.

35y man, chronic dysphagia, regurgitate food. Endoscopy normal. Flow studies show lack of peristalsis. ? Diagnosis?.

1 2 3 4 5

12%

53%

18%18%

0%

1. Schatzki ring.2. Achalasia3. Barrett oesophagus4. Esophageal stricture.5. Mallory-Weiss sy.

46y male chestpain,Endoscopy:oesophagus

1 2 3 4 5

0%

17%

25%

8%

50%

A. Hiatus herniaB. Acute Oesophagitis.C. Barrett’s oesophagusD. Oesophageal varicesE. Mallory weiss sy.

20y fem, 2y history of dysphagia, fatigue

and pallor, microcytic RBC ? Diagnosis?.

1 2 3 4 5

31%

15%

8%

23%23%

1. Barrett esophagus2. Diverticulum3. Esophageal web4. Schatzki ring5. Achalasia

76y man, Sudden-onset deep burning epigastric pain radiating to abdomen for 4 hours. Past history of coronary artery disease, hypertension & “indigestion.” Hyperactive bowel sounds are heard on auscultation. Xray abdomen,

? diagnosis

1 2 3 4 5

17%

0% 0%0%

83%

1.Aortic aneurysm rupture2.Acute Pancreatitis3.Pneumoperitoneum PUD4.Acute coronary syndrome5.Ruptured MI

46y male odynophagia : Esophageal biopsy.

A. B. C. D. E.

0% 0% 0%

83%

17%

A. Barrett’s

B. Acute Esophagitis.

C. Squamous Carcinoma

D. Adeno Carcinoma.

E. Chronic Esophagitis.

34y Male, Insomnia, heart burn, dysphagia.

Lower Esophagus endoscopy:

• Features ?• Etiology ?• Clinical features ?• Complications ?

45y female, attacks of wheezing, SOB, hot flashes. Abdominal cramps, diarrhoea, Tricuspid regurgitation, Increased urinary 5-HIAA, CT scan shows nodule in jejunum, stomach and few nodules in liver. ? Diagnosis.

1 2 3 4 5

8%

46%

15%

23%

8%

1. GIT Lymphoma.

2. Carcinoid tumor.

3. Mallory Weiss Syndrome.

4. Gastric carcinoma with mets.

5. Zollinger Ellison syndrome.

“Only a man who knows what it is like to be defeated can reach down to the bottom of his soul and come up with the extra ounce of power it takes to win, when the match is even.”

– Muhammad Ali, Champion Boxer

56y male, hematemesis: Gastric biopsy, ? arrow

A. Barrett’s.

B. H.pylori gastritis.

C. Chronic gastritis

D. Adenocarcinoma

E. Gastric metaplasia.

46y male pain, hematemesis: Stomach.

1 2 3 4 5

0% 0% 0%0%0%

A. Malignant Gastric ulcerB. Benign peptic ulcer.C. Barrett’sD. Adenocarcinoma.E. Acute gastritis.

46y male pain, hematemesis: Stomach.

1 2 3 4 5

0% 0% 0%0%0%

A. Malignant Gastric ulcerB. Benign peptic ulcer.C. Barrett’sD. H.pylori gastritis.E. Gastric Perforation.

46y male odynophagia : Esophageal biopsy.

A. B. C. D. E.

0% 0% 0%0%0%

A. Barrett’s

B. Acute Esophagitis.

C. Squamous Carcinoma

D. Adeno Carcinoma.

E. Chronic Esophagitis.

Correct statement about H.pylori?

1 2 3 4 5

0% 0% 0%0%0%

A. Gram positive spirocheteB. Colonizes Gastric mucosaC. Invades duodenal mucosaD. Diagnosed by bacterial culture.E. Complication is Duodenal cancer.

Common site of Peptic Ulcer?

1 2 3 4 5

0% 0% 0%0%0%

A. Cardiac part of Stomach.B. Greater curvatureC. Lesser curvatureD. 2nd part of duodenumE. 1st part of duodenum

46y male odynophagia : Esophageal biopsy.

A. B. C. D. E.

0% 0% 0%0%0%

A. Barrett’s

B. Acute Esophagitis.

C. Squamous Carcinoma

D. Adeno Carcinoma.

E. Chronic Esophagitis.

35y man, chronic dysphagia, regurgitate food. Endoscopy normal. Flow studies show lack of peristalsis. ? Diagnosis?.

1 2 3 4 5

0% 0% 0%0%0%

1. Schatzki ring.2. Achalasia3. Barrett oesophagus4. Esophageal stricture.5. Mallory-Weiss sy.

20y fem, 2y history of dysphagia, fatigue

and pallor, microcytic RBC ? Diagnosis?.

1 2 3 4 5

0% 0% 0%0%0%

1. Barrett esophagus2. Diverticulum3. Esophageal web4. Schatzki ring5. Achalasia

76y man, Sudden-onset deep burning epigastric pain radiating to abdomen for 4 hours. Past history of coronary artery disease, hypertension & “indigestion.” Hyperactive bowel sounds are heard on auscultation. Xray abdomen,

? Common cause

1 2 3 4 5

0% 0% 0%0%0%

1.Ruptured appendix2.Ruptured cholecystitis.3.Perforated peptic ulcer.4.Crohn’s disease fistula.5.Perforated diverticulitis.

46y male odynophagia : Esophageal biopsy.

A. B. C. D. E.

0% 0% 0%0%0%

A. Barrett’s

B. Acute Esophagitis.

C. Squamous Carcinoma

D. Adeno Carcinoma.

E. Chronic Esophagitis.

45y female, attacks of wheezing, SOB, hot flashes. Abdominal cramps, diarrhoea, Tricuspid regurgitation, Increased urinary 5-HIAA, CT scan shows nodule in jejunum, stomach and few nodules in liver. ? Diagnosis.

1 2 3 4 5

0% 0% 0%0%0%

1. GIT Lymphoma.

2. Carcinoid tumor.

3. Mallory Weiss Syndrome.

4. Gastric carcinoma with mets.

5. Zollinger Ellison syndrome.

34y Male, Insomnia, heart burn, dysphagia.

Lower Esophagus endoscopy:

• Features ?• Etiology ?• Clinical features ?• Complications ?

? Features? Aetiology? Complications

Esophageal varices

I hated every minute of training, but I said, "Don't quit. Suffer now and live the rest of your life as a champion."

– Muhammad Ali, Champion Boxer