Gastroenterology — MCQs

Q: Motility in the upper third of the esophagus is decreased in all of the following conditions except which one?

Scleroderma. ***Scleroderma*** - **Scleroderma** primarily affects the **smooth muscle** of the distal two-thirds of the esophagus, leading to decreased motility and reflux [1]. - The **upper third of the esophagus** consists of **striated muscle** and is typically spared in scleroderma [1]. *Pseudo-bulbar palsy* - **Pseudo-bulbar palsy** involves motor neuron damage affecting the **corticobulbar tracts**, leading to impaired function of the **striated muscles** of the pharynx and upper esophagus. - This results in **dysphagia** and reduced motility in the voluntary phase of swallowing, which includes the upper third of the esophagus. *Chagas disease* - **Chagas disease** causes destruction of **ganglion cells** in the myenteric plexus, leading to denervation of the smooth muscle. - While it primarily affects the **distal esophagus** (leading to megaesophagus), it can also impact the coordinated activity of the **gastrointestinal tract**, including the more complex coordination required for the upper esophagus, especially if there's extensive involvement. *Myasthenia gravis* - **Myasthenia gravis** is an **autoimmune disorder** characterized by antibodies against **acetylcholine receptors** at the neuromuscular junction, affecting **striated muscles** [1], [2]. - Since the **upper third of the esophagus** is composed of striated muscle, its function is often impaired in myasthenia gravis, leading to **dysphagia** [1].

Q: A 50-year-old man presents with chronic abdominal pain and weight loss. A barium study shows a "string sign" in the terminal ileum. What is the most likely diagnosis?

Crohn's disease. ***Crohn's disease*** - The **"string sign"** observed in the barium study indicates narrowed, inflamed terminal ileum typical of Crohn's disease [1]. - Presents with **chronic abdominal pain** and weight loss, aligning with the patient's symptoms [1]. *Diverticulitis* - Characterized by **inflammation of diverticula**, usually presenting with **left lower quadrant pain** and fever, not a "string sign". - Barium studies typically reveal **diverticula**, not the strictures seen in Crohn's. *Irritable bowel syndrome* - IBS presents with **crampy abdominal pain** and changes in bowel habits, but not with severe **weight loss** or strictures. - There are no specific findings like the **"string sign"** in imaging studies for IBS. *Ulcerative colitis* - Primarily affects the **colon** with continuous lesions and presents with bloody diarrhea, not with a "string sign". - Does not typically cause **narrowing** of the intestines like seen in Crohn's disease [2].

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Esophageal Disorders

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Peptic Ulcer Disease

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Inflammatory Bowel Disease

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Irritable Bowel Syndrome

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Malabsorption Syndromes

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Pancreatitis (Acute and Chronic)

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Gastrointestinal Bleeding

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Liver Diseases and Cirrhosis

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Viral Hepatitis

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Biliary Tract Disorders

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Gastrointestinal Motility Disorders

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Gastrointestinal Malignancies

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