Week 2.5 - Oesophageal Disorders

Question 1

Where does the oesophagus begin and end?

Answer 1

C6 at cricoid and T11-12 at duodenum

Question 2

What type of muscle is found in the oesopahgus?

Answer 2

top 3-4cm is striated skeletal muscle and rest is smooth muscle

Question 3

What nerve mediates movement of food in the oesophagus?

Answer 3

vagal nerve

Question 4

What are the 3 components of the lower oesophageal sphyncter?

Answer 4

• high resting pressure
• striated muscle in diaphragm
• mucosal rosette at angle of his

Question 5

What are 5 commonly occuring oesophageal disorders?

Answer 5

• achalasia
• oesophageal cancer
• eosinophillic oesophagitis
• barrett’s oesophagus
• gastro-oesophageal reflux disease

Question 6

What are symptoms of oesophageal disorders?

Answer 6

heart burn (retrosternal discomfort), dysphagia, cough, waterbrash, odynophagia

Question 7

What is the commonest cause of dysphagia symptoms?

Answer 7

stricture. occurs with
- fibrosis,
- barretts,
- cancer,
- external compression,
- eusinophillic oesophagitis

Question 8

What are 2 types of motility disorders?

Answer 8

hypermotility or hypomotility

Question 9

What is an example of a hypermotility disease?

Answer 9

diffuse oesophageal spasm. causes corkscrew appearance and exaggerated uncoordinated contractions on manometry

Question 10

What tests can we do to investigate oesophageal issues? (4)

Answer 10

• OGD (oesophogastroduodenoscopy)
• upper GI endoscopy (UGIE)
  both with barium swallow
• pH metry
• manometry

Question 11

What does manometry measure?

Answer 11

waves within oesophagus. food eaten and liquid drank and measure waves producesd.

Question 12

What is an example of a hypomotility disease?

Answer 12

connective tissue disease causing LOS failure - heartburn and reflux. stasis of food

Question 13

What is achalasia?

Answer 13

in late 20’s-30’s functional loss of myenteric plexus ganglion so fail to contract LOS.

Question 14

What is the appearance of achalasia and symptoms?

Answer 14

rats tail appearance, progressive dysphagia, chest pain, hypomotility

Question 15

How do you treat achalasia?

Answer 15

• nitrates and calcium channel blockers to relax LOS.
• botox relaxes.
• balloon dilatation
• myotomy of LOS

Question 16

What is GORD?

Answer 16

gastro-oesophageal reflux disease. acid and bile exposure in lower oesophagus, leading to ulceration, stricture, barrett’s or carcinoma

Question 17

What are risk factors for GORD?

Answer 17

obesity, pregnancy, collagen disorder, drugs lowering LOS pressure, men and white.

Question 18

What are symptoms of GORD?

Answer 18

diagnosed based on symptoms:
- heartburn,
- cough,
- water brash,
- sleep disturbance.

Question 19

How do you treat GORD pharmaceutically?

Answer 19

• omeprazole (PPI)
• Ranitidine (H2RA)
• Gaviscon (alginate foam)
• Stop NSAID’s
• surgery fundoplication

Question 20

What is barrett’s oesophagus?

Answer 20

intestinal metaplasia in oesophagus from acid exposure. leads to ulceration and fibrosis - precursor for dysplasia.

Question 21

What is a symptom of barrett’s oesophagus and a possibility?

Answer 21

dysphagia from fibrosis.

6% lead to oesophageal cancer through dysphagia and neoplasia

Question 22

What is the treatment for barrett’s oesophagus?

Answer 22

• endoscopic mucosal resection
• radio frequency ablation
• oesophagectomy (10% mortality)

Question 23

What type of oesophageal cancer is common and where?

Answer 23

adenocarcinoma in west europe and USA, squamous in rest of the world

Question 24

Which part of the oesophagus do we see different types of cancer?

Answer 24

adenocarcinoma in distal oesophagus
squamous carcinoma in first and second 1/3rds

Question 25

What is the 5YSR of oesophageal cancer?

Answer 25

<10%

Question 26

What are symptoms of oesophageal cancer?

Answer 26

• dysphagia
• anorexia and weight loss
• odynophagia
• chest pain
• cough

Question 27

How do you treat oesophageal cancer?

Answer 27

only cure is oesophagectomy.
usually try to cure dysphagia - endoscopic laser/stent or chemo/RT to shrink tumour

Question 28

What is eosinophillic oesophagitis?

Answer 28

eosinophil infiltration in epithelial lining. leads to dysphagia, strictures and mucosal stripping

Question 29

How do you treat eosinophillic oesophagitis?

Answer 29

• swallowed/topical corticosteroids
• dietary elimination in kids
• endoscopic dilatation if needed

Question 30

What is plummer vision syndrome?

Answer 30

triad of dysphagia, iron deficiency anaemia and oesophageal webbing