Oesophageal Disorders

Question 1

Where does the oesophagus begin and end in terms of vertebra?

Answer 1

Begins at C6

Terminates at T11-12

Question 2

What propels food down the oesophagus in peristalsis and what nerve innervates the muscle?

Answer 2

Circular muscles surrounding the oesophagus

Vagus nerve

Question 3

How is the “Mucosal Rosette” formed?

Answer 3

The acute angle at the gastroesophageal junction (GOJ)

Question 4

What symptoms can retrosternal discomfort or burning be associated with?

Answer 4

Waterbrash

Cough

Question 5

What are symptoms of oesophageal disease?

Answer 5

Reflux
LOS pressure decreased to cause increased reflux
Persistent reflux and heartburn leads to GORD

Question 6

How do you define between oropharyngeal and oesophageal disease?

Answer 6

Oropharyngeal is high dysphagia and may have a more sinister cause e.g. Laryngeal tumour

Question 7

What are the causes of dysphagia?

Answer 7

Benign/Malignant structure
Motility disorder e.g. Achalasia
Eosinophilic oesophagitis
Extrinsic compression e.g. Lung cancer

Question 8

Dysphagia investigations?

Answer 8

Endoscopy
Barium swallow
Oesophageal pH and manometry

Question 9

What is oesophageal manometry?

Answer 9

Assessing sphincter tonicity, relaxation of sphincters and oesophageal motility

Question 10

How does hypermotility appear on x-rays?

Answer 10

Corkscrew appearance due to severe muscle spasm with an unclear cause
Often confused with Angina/MI

Question 11

What does hypomotility cause?

Answer 11

A failure of the LOS mechanism leading to heartburn and reflux symptoms

Question 12

What is hypomotility associated with?

Answer 12

Connective tissue disease
Diabetes
Neuropathy

Question 13

What is achalasia?

Answer 13

The functional loss of myenteric plexus ganglion cells in the distal oesophagus and LOS

Question 14

What does achalasia result in?

Answer 14

A functional distal obstruction of the oesophagus - Food cannot enter the stomach

Question 15

What often surrounds achalasia?

Answer 15

Lymphocytes

Question 16

What are the symptoms of achalasia?

Answer 16

Progressive dysphagia
Weight loss
Chest pain (30%)
Regurgitation & Chest infection

Question 17

How high is the pressure in the LOS and what does it fail to do after swallowing?

Answer 17

Above 45mmHg

Relax

Question 18

Achalasia investigations?

Answer 18

CXR
Manometry
OGD
Barium swallow

Question 19

Achalasia treatment?

Answer 19

Nitrate and Calcium blockers
Endoscopic
Radiological - Pneumatic balloon dilatation
Surgical - Myotomy

Question 20

What is GORD and how does it occur?

Answer 20

Gastro-Oesophageal Reflux Disease

Acid (and bile) exposure in the lower oesophagus

Question 21

GORD symptoms?

Answer 21

Heartburn
Cough
Waterbrash
Sleep disturbance

Question 22

What are the six GORD risk factors?

Answer 22

Smoking
Obesity
Alcohol
Hypomotility
Pregnancy
Drugs lowering LOS pressure

Question 23

What happens when there is GORD without abnormal anatomy?

Answer 23

INcreased relaxations of LOS
Hypotensive LOS
Delayed gastric emptying
Delayed oesophageal emptying
Decreased oesophageal acid clearance

Question 24

What happens when GORD is due to a hiatus hernia?

Answer 24

Their is an anatomical distortion of the OG junction

Question 25

What are the two types of hiatus hernia?

Answer 25

Sliding | Para-oesophageal

Question 26

What happens to the stomach fundus in a hiatus hernia?

Answer 26

Moves proximally through the diaphragmatic hiatus

Question 27

What happens in a sliding hernia?

Answer 27

The hernia moves up and down

Question 28

What happens in a para-oesophageal hernia?

Answer 28

Fundus moves up and down alongside the oesophagus

Question 29

What complications arise from GORD?

Answer 29

Ulceration Stricture Glandular metaplasia (Barrett's Oesophagus) Carcinoma

Question 30

How does erosive oesophagitis occur?

Answer 30

Mucosa is exposed to acid-pepsin and bile

Question 31

What are the treatments for GORD?

Answer 31

Lifestyle measures Pharmacological - Rennis, Gaviscon etc. Anti-reflux surgery

Question 32

What are the two types of oesophageal cancer?

Answer 32

Adenocarcinoma | Squamous cell carcinoma

Question 33

What are the symptoms of oesophageal carcinoma?

Answer 33

``` Progressive Dysphagia Anorexia & Weight loss Odynophagia Chest pain Cough Pneumonia Vocal cord paralysis Haematemsis ```

Question 34

What is odynophagia?

Answer 34

Painful swallowing in the mouth or oesophagus | *Can occur with or without dysphagia*

Question 35

What nerve must be affected for vocal cord paralysis to occur?

Answer 35

Recurrent laryngeal nerve

Question 36

Where does squamous cell carcinoma occur and how does it appear?

Answer 36

Proximal and middle third of oesophagus | Large exophytic tumours preceeded by dysplasia and carcinoma in situ

Question 37

Where does adenocarcinoma occur?

Answer 37

Distal oesophagus

Question 38

What are the predisposing factors for adenocarcinoma?

Answer 38

Obesity Male Middle ages Caucasian

Question 39

Where does direst spread occur and why?

Answer 39

Mediastinum as there is no peritoneal lining there

Question 40

What does the oesophagus lack?

Answer 40

A serosal layer

Question 41

What investigations are done for oesophageal cancer?

Answer 41

Endoscopy/Biopsy | Staging - CT/PET scan

Question 42

How does the staging work for Oesophageal cancer?

Answer 42

``` T1 – Tumour invades lamina propria/ submucosa (a-lamina propria, b-submucosa) T2 – Tumour invades muscularis propria T3 – Tumour invades adventitia T4 – Tumour invades adjacent structures N1 – Regional lymph node metastasis M1 – Distant metastasis ```