oesophageal diseases

Question 1

what can cause acute oesophagitis (inflammation)

Answer 1

corrosive chemicals, infection in immunocompromised patients eg candidiasis/ herpes

Question 2

what are common causes of chronic oesophagitis (GORD)

Answer 2

inflammation from stomach acid: hiatus hernia, abnormal motility (Sphincters don’t work), pregnancy (rare)

Question 3

what is allergic oesophagitis, how do you treat it

Answer 3

allergic response to food, eosinophillic, common with asthma. steroids and CysLt1

Question 4

what can cause GORD (reflux disease)

Answer 4

incompetent LOS, barrier function, poor oesophageal clearance

Question 5

what are the symptoms of GORD

Answer 5

heartburn (worse when lying down), regurgitation, odynophagia, coughing

Question 6

what investigations would you do for GORD

Answer 6

endoscopy (OGD), Ba swallow, manometry, pH and nuclear studies

Question 7

what are alarm symptoms of GORD

Answer 7

dysphagia, weight-loss, anaemia, vomiting, peptic ulcers, cancer, Barrett’s

Question 8

what lifestyle advice would you give for someone with GORD

Answer 8

stop smoking, cut back alcohol, lose weight, prop up bed

Question 9

what medications can be used for symptoms relief of GORD

Answer 9

antacids

Question 10

name a H2 antagonist used for relief and one for preventing relapse

Answer 10

cimetide, ranitidine

Question 11

name a PPI and what it is for

Answer 11

omeprazole, for healing and relief

Question 12

what is Barrett’s oesophagus

Answer 12

replacement of stratified squamous epithelium to columnar epithelium (metaplasia). from persistent reflux

Question 13

how can barrett’s progress to cancer

Answer 13

unstable cells can progress to adenocarcinoma

Question 14

how does adenocarcinoma metastases

Answer 14

direct invasion –> lymphatic –> vascular

Question 15

what are complications of GORD

Answer 15

ulceration/ bleeding, scarring and barretts

Question 16

what cancers are more common in oesophagus benign or malignant

Answer 16

malignant

Question 17

what is the most common benign cancers

Answer 17

squamous papilloma

Question 18

name the 2 most common cancers and where they are found

Answer 18

adenocarcinoma, bottom part of oesophagus, squamous top 2/3rds

Question 19

what are risk factors for adenocarcinoma

Answer 19

males, smoking + alcohol, obesity, low fruit + veg

Question 20

what is the investigations for cancer

Answer 20

endoscopy, Ba swallow, CT for staging

Question 21

what is the management for cancer

Answer 21

surgery or palliative

Question 22

what is achalasia

Answer 22

oesophageal aperistalsis, impaired relaxation of sphincter

Question 23

If Barrett’s and GORD can’t be treated with drugs what can you do next

Answer 23

surgery

Question 24

what can be done to treat Barrett’s

Answer 24

optimise PPI, endoscopic mucosal resection, radio-frequency ablation

Question 25

what is gastroparesis

Answer 25

delayed gastric emptying with no physical obstruction

Question 26

what are the symptoms of gastroparesis

Answer 26

feeling full, nausea, vomiting weight loss, upper epigastric pain

Question 27

what studies would you oo

Answer 27

gastric emptying studies

Question 28

what management would you do for gastropareisis

Answer 28

liquid diet, eat little and often, gastric pacemaker, pro-motility agents

Question 29

what is achalasia

Answer 29

reduced oesophagus motility, leading to dysphagia and regurge

Question 30

how do you investigate achalasia

Answer 30

Ba swallow (birds beak), manometry and OGD