Mouth & Oesophageal Diseases

Question 1

is mouth cancer common in young people?

Answer 1

incidence is inc

Question 2

what is the typical mouth cancer pt?

Answer 2

> 50 yo male

Question 3

aetiology of mouth cancer?

Answer 3

smoking (tobacco, shisha, cigars),
alcohol,
diet,
Infection: HPV, candida, syphilis

Question 4

presentation of mouth cancer?

Answer 4

asymptomatic, lesions, numbness, pain in mouth/neck, voice change, dysphagia

Question 5

where do mouth lesions occur

Answer 5

soft sites i.e. tongue & floor of mouth

Question 6

what is the malignant lesions of the mouth?

Answer 6

erythroplakia

Question 7

how to diagnose mouth cancer?

Answer 7

history of lesion, screen soft tissue sites, contemplate risk factors

Question 8

what is oesophagitis

Answer 8

inflammation of oesophagus due to reflux

Question 9

types of oesophagitis

Answer 9

acute or chronic

Question 10

what are the etiological differences between acute and chronic oseophagitis?

Answer 10

acute= corrosive aetiology (chemical) or infection
chronic= reflux

Question 11

expand on chronic (reflux) oesophagitis aetiology?

Answer 11

defective sphincter, abnormal oesophageal motility, inc intra-abdominal pressure

Question 12

how to histologically identify reflux oesophagitis

Answer 12

basal zone expansion due to presence of neutrophils, eosinophils & lymphocytes

Question 13

what are 2 common complications of reflux oesophagitis

Answer 13

ulcers and Barrett’s oesophagus

Question 14

other than acute & chronic oesophagitis, what’s the 3rd type of oesophagitis?

Answer 14

Allergic oesophagitis

Question 15

how to diagnose allergic oesophagitis?

Answer 15

pH probe, endo-corrugated oesophagus, inc eosinophilia

Question 16

tx for allergic oesophagitis

Answer 16

steroids, chromoglycate (mast cell stabiliser), montelukast (leyukotrine receptor antagonist)

Question 17

what is achalasia

Answer 17

intermittent dysphagia and impaired relaxation of lower oesophageal sphincter

Question 18

symptoms of achalasia?

Answer 18

intermittent dysphagia, regurgitation (particularly at night), chest pain due to spasms

Question 19

ix of achalasia?

Answer 19

CXR & barium swallow

Question 20

what would be seen on a CXR of an achalasia pt?

Answer 20

dilated oesophagus

Question 21

what would be seen by a barium swallow of an achalasia pt?

Answer 21

bird-beak appearance

Question 22

tx for achalasia?

Answer 22

palliative, nifedipine (Ca channel blocker), endoscopy

Question 23

what is Barrett’s oesophagus?

Answer 23

replacement of stratified squamous epithelium by columnar epi with intestinal metaplasia

Question 24

aetiology of barrett’s O?

Answer 24

persistant GORD, persistant oesophagitis

Question 25

what is the main risk barrett's O poses?

Answer 25

inc risk of oesophageal carcinoma

Question 26

ix for Barrett's O?

Answer 26

endoscopy & biopsy (exclude cancer)

Question 27

tx for Barrett's?

Answer 27

PPIs, endoscopic mucosal resection, radio frequency ablation

Question 28

what is the benign oesophageal tumour?

Answer 28

squamous papilloma (HPV related)

Question 29

what are the 2 types of malignant oesophageal tumours?

Answer 29

squamous cell carcinoma and adenocarcinoma

Question 30

where does squamous cell carcinoma occur?

Answer 30

upper 2/3 of oesophagus

Question 31

true/false... | squamous cell carcinoma is most common type of oesophageal cancer/

Answer 31

true

Question 32

aetiology of SCC of oesophagus?

Answer 32

vitA def, smoking, HPV, oesophagitis, genetics

Question 33

pathogenesis of SCC?

Answer 33

normal > GORD > Severe dysplasia > SCC

Question 34

symptoms of SCC?

Answer 34

progressive dysphagia, hoarse voice, malignant symptoms e.g. wt loss

Question 35

signs of SCC?

Answer 35

ulcer/ lump in mouth

Question 36

ix of SCC?

Answer 36

endoscopy w biopsy*, CT for staging, USS, barium swallow

Question 37

staging of SCC?

Answer 37

TNM (diameter of tumour, nodal invasion, mets)

Question 38

what are the 3 mechanisms of invasion?

Answer 38

local invasion, lymphatic spread, haemtogenous spread

Question 39

tx for SCC?

Answer 39

surgery, palliation

Question 40

epidemiology of adenocarcinoma?

Answer 40

caucasian males

Question 41

where does oesophageal adenocarcinoma occur?

Answer 41

lower 1/3 of oesophagus

Question 42

pathogenesis of adenocarcinoma?

Answer 42

reflux > chronic reflux oesophagitis > barret's O > dysplasia > adenocarcinoma

Question 43

main symptom of adenocarcinoma?

Answer 43

dysphagia

Question 44

tx of adenocarcinoma?

Answer 44

radio, surgery

Question 45

what are 2 oesophageal conditions not already mentioned?

Answer 45

mallory weis tear, oesophageal varices