Oesophageal Diseases

Question 1

Which type of cancer is typically present in the lower 1/3 of the oesophagus?

Answer 1

Adenocarcinoma

Question 2

What does adenocarconima in the oesophagus typically arise from?

Answer 2

Barrett’s Oesophagus

Question 3

What are the 2 types of cancer that can arise in the oesophagus?

Answer 3

Squamous carcinoma

Adenocarcinoma

Question 4

Why is prognosis for oesophageal cancer so poor?

Answer 4

Because it is relatively asymptomatic until late presentation

Question 5

What are the main alarm symptoms of presenting oesophageal cancer?

Answer 5

DYSPHAGIA 
Weight loss
Anorexia 
Chest pain 
Hoarse voice

Question 6

What investigations need to be carried out in oesophageal cancer?

Answer 6

Upper GI endoscopy
Barium swallowing
CT - staging
Endosocopic Ultrasound

Question 7

What is Barrett’s oesophagus?

Answer 7

Consequence of GORD
Acid causes a change from squamous epithelium to glandular epithelium in the oesophagus
Dysplasia which can lea to metaplasia
Predisposition for cancer

Question 8

What is a palliative treatment for oesophageal cancer?

Answer 8

Endoscopic stenting

Question 9

What are the requirements for the surgical resection of oesophageal cancer?

Answer 9

Need to be fit for surgery (consider age)
No metastases
Pre-op chemotherapy

Question 10

Is heartburn common?

Answer 10

Yes

Question 11

What is GORD disease?

Answer 11

Recurrent reflux of gastric acid into the oesophagus

Question 12

What are the symptoms of GORD?

Answer 12

Heartburn - recurrent
Dysphagia
Nocturnal cough
Chest pain

Question 13

What are the investigations for GORD?

Answer 13

Endoscopy

24 hour ABPM pH monitoring

Question 14

What is the Pathology of GORD?

Answer 14

Oesphagus is not designed to cope with an acidic environment
Oesophagitis
Endoscopic change
Scarring and ulceration

Question 15

What is a potential consequence of GORD that can be a predisposition to cancer?

Answer 15

Barrett’s oesophagus

Question 16

What is the patient required to do during 24 hours ABPM pH monitoring?

Answer 16

Record a symptom diary

Question 17

What is the treatment for GORD?

Answer 17

Anti-acids
PPI
H2 antagnosits
Endoscopic surveillance for dysplasia

Question 18

Why does GORD require endoscopic surveillance?

Answer 18

To monitor for barrett’s oesophagus

And dysplasia

Question 19

What is a hiatus hernia?

Answer 19

When part of the stomach protrudes into the oesophagus

Question 20

What are the symptoms of a hiatus hernia similar to that of?

Answer 20

GORD

Question 21

What is the treatment for hiatus hernia?

Answer 21

Essentially the same as treatment for GORD

Question 22

How long is the oesophagus?

Answer 22

Approximately 25cm long

Question 23

Where does the oesophagus begin anatomically?

Answer 23

Cricoid cartilage C6

Question 24

Where does the oesophagus terminated anatomically?

Answer 24

T11-T12

Question 25

What epithelium lines the oesophagus?

Answer 25

Stratified squamous keratinised epithelium

Question 26

What is water brash?

Answer 26

Acid taste in the mouth

Question 27

What is dysphagia?

Answer 27

Symptom - difficulty with swallowing

Question 28

What are differential diagnoses for dysphagia?

Answer 28

``` Benign stricture Malignant stricture Motility disorders Oesophagitis Extrinsic compression (i.e from a tumour in the lung ect..) ```

Question 29

What investigations are common for suspected oesophageal disorders?

Answer 29

``` OGD - oesophago-gastro-duodenoscopy Upper GI endoscopy Endoscopy Contrast radiology e.g barium swallowing Oesophageal pH and manometry ```

Question 30

What is hypermotility often confused with?

Answer 30

Angina

Question 31

What is the treatment for hypermotility?

Answer 31

Smooth muscle relaxants

Question 32

What are the symptoms of oesophageal hypermotility?

Answer 32

Chest pain | Dysphagia

Question 33

Is GORD more common in men or women

Answer 33

Men

Question 34

What are the risk factors for GORD?

Answer 34

Anything that increases pressure on the abdomen e.g obesity or pregnancy

Question 35

Is Endoscopy useful for diagnosis of GORD?

Answer 35

No - usually no clinical findings

Question 36

Describe type I hiatus hernia?

Answer 36

When the proximal stomach moves up and down in the oesophagus

Question 37

Describe type II hiatus hernia?

Answer 37

When the stomach moves up alongside the oesophagus | The fundus of the stomach moves proximally though the diaphragmatic hiatus alongside the oesphagus

Question 38

What are potential complications of reflux disease?

Answer 38

Ulceration Stricture Glandular metaplasia (Barrett's oesophagus) Carcinoma

Question 39

What is Barrett's oesophagus?

Answer 39

Intestinal metaplasia related to prolonged acid exposure in distal oesophagus Changes from squamous to glandular epithelium Metaplasia can change into dysplasia Which is a precursor for carcinoma

Question 40

Are benign tumours of the oesophagus common or rare?

Answer 40

Rare

Question 41

What are the 2 types of carcinoma of the oesophagus?

Answer 41

Squamous cell | Adenocarcinoma

Question 42

What are the main symptoms of oesophageal cancer?

Answer 42

``` Progressive dysphagia Anorexia and weight loss Odynophagia Chest pain Cough Pneumonia Vocal cord paralysis ```

Question 43

Where does squamous cell carcinoma commonly occur?

Answer 43

Proximal and middle 1/3 of oesophagus

Question 44

What are risk factors for squamous cell carcinoma?

Answer 44

Smoking and alcohol | Potentially diet

Question 45

Where does adenocarcinoma commonly occur anatomically?

Answer 45

Distal oesophagus

Question 46

Which carcinoma is associated with barrett's oesophagus?

Answer 46

Adenocarcinoma

Question 47

Does oesophageal cancer usually present early or late?

Answer 47

Late

Question 48

Where are common metastases for oesophageal cancer?

Answer 48

Liver Brain Lungs bone

Question 49

By what investigation is oesophageal cancer diagnosed?

Answer 49

Endoscopy and biopsy

Question 50

By what investigations is oesophageal cancer stages?

Answer 50

CT Endoscopic US PET Bone scan

Question 51

What classification system is used to stage oesophageal cancer?

Answer 51

TNM

Question 52

What is the cure for oesophageal cancer?

Answer 52

Surgery

Question 53

What can be done to relieve the symptoms of dysphagia?

Answer 53

Inserting a stent

Question 54

Who is oesophageal surgery for cancer limited to?

Answer 54

Those with primary disease without co-morbidity

Question 55

How long is the oesophagus?

Answer 55

25cm

Question 56

Which nerve mediates peristalsis?

Answer 56

CN X

Question 57

What is waterbrash?

Answer 57

Acid taste in the mouth