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GI Pathology > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

What is heartburn and what is it caused by?

A

Retrosternal discomfort or burning caused by reflux of acid and/or bilious contents into the oesophagus

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2
Q

What first line and second line tests should be conducted in cases of dysphagia?

A

First an upper GI endoscopy, or a barium swallow in cases of severe dysphagia to exclude a pharyngeal pouch or post-cricoid web
Secondly, oesophageal manometry or pH studies can be conducted

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3
Q

How would hypermotility present on a barium swallow and in manometry?

A

Barium swallow- oesophagus would have a “cork-screw” appearance
Manometry- shows exaggerated, uncoordinated, hypertonic contractions

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4
Q

What are the symptoms of hypermotility?

A

Severe, episodic chest pain with or without dysphagia

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5
Q

What are the causes of hypermotility and hypomotility?

A

Hypermotility- idiopathic

Hypomotility- associated with connective tissue disease, diabetes and neuropathy

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6
Q

What are the symptoms of hypomotility?

A

Heartburn and reflux symptoms

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7
Q

Describe the pathology of achalasia

A

Degeneration of inhibitory neurons in the myenteric plexus in the distal oesophagus and LOS

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8
Q

What is the cardinal feature of achalasia, and what effect does this have on the oesophagus?

A

Cardinal feature- failure of LOS to relax

Effect- functional distal obstruction of oesophagus

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9
Q

What are the symptoms of achalasia?

A

Progressive dysphagia for solids and liquids
Weight loss
Regurgitation and chest infection
Chest pain (30%)

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10
Q

What abnormalities would be found during manometry in cases of achalasia?

A

Failure of the LOS to relax after swallowing
Absence of peristaltic contractions in the lower oesophagus
High pressure in the LOS at rest (usually above 45mmHg(normal being 10mmHg))

First two required to make diagnosis

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11
Q

What are the pharmacological treatments of achalasia?

A

Nitrates and calcium channel blockers

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12
Q

What are the radiological, endoscopic and surgical treatments of achalasia?

A

Radiological- Pneumatic balloon dilatation
Endoscopic- Botulinum Toxin pneumatic balloon dilatation
Surgical- myotomy

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13
Q

What are the symptoms of gastro-oesophageal reflux disease?

A

Heartburn
Water brash
Cough
Sleep disturbance

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14
Q

What are the risk factors for GORD?

A 
Pregnancy 
Smoking
Drugs lowering LOS pressure
Obesity
Alcoholism 
Hypomotility
Men more at risk than women
Caucasian > black > asian
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15
Q

Should endoscopy be performed in cases of GORD?

A

Poor diagnostic test as most patients with reflux symptoms have no visible evidence
Must be performed if ALARM features are present

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16
Q

What are the two types of hiatus hernia?

A

Sliding and para-oesophageal

17
Q

What are the risk factors for hiatus hernias?

A

Ageing and obesity

18
Q

Describe the pathophysiology of GORD

A

Mucosa is exposed to acid-pepsin and bile causing increased cell loss and regenerative activity, causing erosive oesophagitis

19
Q

What are the possible complications of GORD?

A

Ulceration
Stricture
Glandular metaplasia (Barrett’s oesophagus)
Carcinoma

20
Q

What is Barrett’s oesophagus?

A

Intestinal metaplasia caused by prolonged acid exposure in distal oesophagus causes change from squamous to mucous-secreting columnar epithelial cells
The condition is a precursor to dysplasia/adenocarcinoma

21
Q

What is the cancer rate of Barrett’s Oeosophagus?

A

~0.3% per year

22
Q

Describe the treatment of GORD

A

Lifestyle measures
Pharmacological:
-Alginates (gaviscon)
-H2RA (Ranitidine)
-Proton pump inhibitor (Omeprazole, lansoprazole)
Anti-reflux surgery may be necessary for refractory disease following investigation, this can be a full or partial wrap fundoplication

23
Q

Where in the world is adenocarcinoma and squamous cell carcinoma of the oeosphagus more common?

A

Western Europe and USA- adenocarcinoma more common

Rest of the world- squamous cell carcinoma more common

24
Q

What are the symptoms of oesophageal cancer?

A 
Progressive dysphagia
Anorexia and weight loss
Odynophagia
Chest pain
Cough
Pneumonia
Vocal cord paralysis
Haematemesis
25
Q

Where in the oesophagus is adenocarcinoma and squamous cell carcinoma more common?

A

Adenocarcinoma- distal oesophagus

Squamous cell carcinoma- Proximal and middle oesophagus

26
Q

What are the risk factors for squamous cell carcinoma of the oesophagus?

A

Achalasia
Caustic strictures
Plummer-Vinson syndrome
Possibly diet related (vitamin deficiency)

27
Q

What are the risk factors for adenocarcinoma of the oesophagus?

A 
Obesity
Male sex
Middle aged
Caucasian 
Barrett's Oesophagus
28
Q

Why is spread of oesophageal cancer relatively easy?

A

There is no serosal lining in the oesophagus so local invasion is common

29
Q

What are the common metastases of oesophageal cancer?

A

Hepatic, pulmonary, brain and bone

30
Q

What investigations are used for the diagnosis and staging of oesophageal cancer?

A

Diagnosis- endoscopy with biopsy

Staging- CT, endoscopic ultrasound, PET scan, bone scan

31
Q

Describe the TNM staging of oesophageal cancer

A

T1- Tumour invades lamina propria (T1a) or submucosa (T1b)
T2- Tumour invades muscularis propria
T3- Tumour invades adventitia
T4- Tumour invades adjacent structures

N1- regional lymph node metastasis
M1- Distant metastasis

32
Q

What is the only potential cure for oesophageal cancer, and what are its limits?

A

Surgical oesophagectomy with or without adjuvant or neoadjuvant chemotherapy
Limited to patients with localised disease, no co-morbidities and usually <70 years of age

33
Q

What is the mortality rate of an oesophagectomy?

A

10%

34
Q

What palliative measures can be put in place in cases of oesophageal cancer?

A

Combined chemo and radiotherapy may add some time to patients life but won’t cure
Endoscopy can be used to insert a stent to prevent dysphagia, PEG insertion if oral intake is impossible, or for laser treatment

35
Q

What is eosinophilic oesophagitis?

A

A chronic immune/allergen mediated condition characterised by symptoms of oeosphageal dysfunction and eosinophilic infiltration of the oesophageal epithelium

36
Q

Who is most at risk of eosinophilic oesophagitis?

A

Males > females

More common in children and young adults

37
Q

How does eosinophilic oesophagitis present?

A

Dysphagia and food bolus obstruction

38
Q

How is eosinophilic oesophagitis treated?

A

Topical/swallowed corticosteroids
Dietary elimination
Endoscopic dilatation

GI Pathology (21 decks)

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