GI - oesophagus

Question 1

what are some causes of acute oesophagitis (rare)

Answer 1

corrosive following chemical ingestion

infective in immunocompromised

Question 2

what are some causes of chronic oesophagitis (common)

Answer 2

reflux disease e.g. GORD
defective sphincter
hiatus hernia
pregnancy

Question 3

what is the histology of oesophagitis

Answer 3

basal zone epithelial expansion (hyperplasia) - increased proliferation
intraepithelial neutrophils, lymphocytes and eosinophils

Question 4

what are some complications of oesophagitis

Answer 4

ulceration
haemorrhage
stricture
barretts oesophagus

Question 5

“acid abuse accompanied by eosinophils”

Answer 5

oesophagitis

Question 6

what is barrett’s oesophagus

Answer 6

replacement of stratified squamous epithelium with metaplastic columnar epithelium with goblet cells (like intestine)

Question 7

what cause barrett’s oesophagus

Answer 7

prolonged exposure of normal oesophagus to GORD —> mucosal inflammation and erosion

Question 8

is barrett’s oesophagus spontaneous or patchy

Answer 8

either

Question 9

what is seen in barrett’s oesophagus macroscopically

Answer 9

red velvety mucosa in lower oesophagus

Question 10

what is seen in barrett’s oesophagus microscopically

Answer 10

columnar lined mucosa with interstitial metaplasia

Question 11

what is the treatment of barrett’s oesophagus

Answer 11

annual endoscopy + biopsy

PPIs

Question 12

why must barrett’s oesophagus be monitored

Answer 12

increased risk of dysplasia –> carcinoma

Question 13

what is allergic oesophagitis

Answer 13

immune mediated oesophagitis caused by reaction to food

Question 14

what kind of immune cell infiltrate is there in allergic oesophagitis

Answer 14

eosinophils

Question 15

what does the oesophagus look like in allergic oesophagitis

Answer 15

corrugated feline or spotty oesophagus

looks like trachea

Question 16

who is at risk of allergic oesophagitis

Answer 16

males > females
Hx Asthma / Fmhx asthma
young

Question 17

what would a pH probe for allergic oesophagitis show

Answer 17

negative for reflux

Question 18

what does achalasia show on a barium swallow

Answer 18

birds beak appearance with proximal dilation

dilated tapering oesophagus

Question 19

what is achalasia

Answer 19

disordered oesophageal motility
with inability to relax the LOS
due to degeneration of myenteric plexus

Question 20

what are some s/s of achalasia

Answer 20

dysphagia for solids and liquids
regurgitation
substernal cramps
weight loss

Question 21

what does achalasia increase risk of

Answer 21

oesophageal squamous cell carcinoma

Question 22

what are some causes of achalasia

Answer 22

Chaga’s

reduced secretion of NO

Question 23

what is the treatment for achalasia

Answer 23

endoscopic balloon dilation
Heller’s cardiomyotomy + PPI
CCBs and nitrates to relax sphincter

Question 24

what is the most common cause of death due to cirrhosis

Answer 24

oesophageal varices

Question 25

how do oesophageal varices present

Answer 25

painless haematemesis

Question 26

what are oesophageal varices

Answer 26

abnormally dilated oesophageal veins arising secondary to portal hypertension

Question 27

when should oesophageal varices be suspected

Answer 27

alcohol abuse cirrhosis - looks for signs of cirrhotic liver disease e.g. encephalopathy, splenomegaly, ascites

Question 28

what is the prophylactic treatment of oesophageal varices

Answer 28

non-selective BB e.g. propranolol | repeat endoscopic banding ligation

Question 29

what is the treatment of oesophageal varices after 1st variceal bleed

Answer 29

TIPSS

Question 30

what does TIPSS stand for

Answer 30

transjugular intrahepatic portal systemic shunt

Question 31

what is the treatment of acute variceal bleeding

Answer 31

vitamin K FFP (fresh frozen plasma) platelet transfusion

Question 32

what is a trans-oesophageal fistula

Answer 32

congenital defect where there is a connection between oesophagus and trachea

Question 33

what are some s/s of a trans-oesophageal fistula

Answer 33

vomiting polyhydramnios abdominal distension aspiration

Question 34

what is a mallory-weiss tear

Answer 34

painful haematemesis due to oesophageal mucosal tear

Question 35

what causes a mallory-weiss tear

Answer 35

persistent vomiting alcoholism bulimia

Question 36

what is corkscrew oesophagus

Answer 36

diffuse oesophageal spasm - primary oesophageal motility disorder

Question 37

what are some s/s of corkscrew oesophagus

Answer 37

dysphagia chest pain Ba swallow - abnormal contractions (cork screw oesophagus)

Question 38

what are some risk factors of a hiatus hernia

Answer 38

female obese over 50

Question 39

what is a sliding hiatus hernia

Answer 39

gastrooesophageal junction slides up into the chest | --> acid reflux

Question 40

what is a rolling hiatus hernia

Answer 40

gastrooesophageal junction remains in the abdomen but a bulge of stomach herniates into chest alongside oesophagus (paraoesophagheal)

Question 41

how is a hiatus hernia diagnosed

Answer 41

barium swallow

Question 42

how is a hiatus hernia treated

Answer 42

lose weight | treat reflux symptoms