Oesophageal disorders

Question 1

Where does the oesophagus begin?

Answer 1

C6

Lower level of the cricoid cartilage

Question 2

Where des the oesophagus terminate?

Answer 2

T11/12

Where it enters stomach

Question 3

What is the structural difference between the upper 1/3 and lower 2/3 of oesophagus?

Answer 3

Upper- striated muscle

Lower- smooth muscle

Question 4

What is the epithelium of the oesophagus?

Answer 4

Stratified squamous non keratinised epithelium

Question 5

What does the vagus nerve mediate?

Answer 5

Peristalsis and relaxation of lower oesophageal sphincter

Question 6

What is the lower oesophageal sphincter?

Answer 6

Striated muscle of the right crus of the diaphragm

Question 7

What level of reflux is there naturally in the oesophagus?

Answer 7

Degree occurs physiologically

Certain drugs and food can lower LOS pressure and increase reflux without pathology

Question 8

What can persistent reflux cause?

Answer 8

Gastro oesophageal reflux disease

Question 9

What can gastrooesophageal reflux disease cause?

Answer 9

Dysphagia and odynophagia

Question 10

What must be enquired about in dysphagia?

Answer 10

Type of food, pattern, associated features, location

Question 11

What are the possible causes of dysphagia?

Answer 11

Benign stricture
Malignancy stricture
Motility disorders
Eosiniphilic infiltrate
Extrinsic compression

Question 12

What investigations can be carried out for oesophageal disorders?

Answer 12

Endoscopy
Contract radiology- barium swallow
Oesophageal pH and manometry

Question 13

What are the motility disorders of the oesophagus?

Answer 13

Hypermotility
Hypomotility
Achlasia

Question 14

What is diagnostic of hypermotility of the oesophagus?

Answer 14

Corkscrew appearance on barium swallow

Exaggerated, uncoordinated hypertonic contractions with manometry

Question 15

What are the symptoms of hypermotility of the oesophagus?

Answer 15

Severe pain, with or without dysphagia

Question 16

How is hyper motility of the oesophagus treated?

Answer 16

Smooth muscle relaxants

Question 17

What is hypo motility of the oesophagus often caused by?

Answer 17

Connective tissue disease
Diabetes
Neuropathy

Question 18

What does hypo motility cause?

Answer 18

Failure of LOS mechanism, leading to heartburn and reflux symptoms

Question 19

What is achalasia?

Answer 19

Functional loss of myenteric plexus ganglion cells in distal oesophagus and LOS

Question 20

What is the cardinal feature of achalasia?

Answer 20

Failure of LOS to relax causing functional distal obstruction of the oesophagus

Question 21

What are the symptoms of achalasia?

Answer 21

Progressive dysphagia
Weight loss
Chest pain
Regurgitation
Chest infection

Question 22

What is the treatment of achalasia?

Answer 22

Nitrates and calcium channel blockers
Endoscopic pneumatic balloon dilatation
Surgical myotomy

Question 23

What are the complications of achalasia?

Answer 23

Aspiration pneumonia and lung disease

Increased risk of squamous cell oesophageal carcinoma

Question 24

What are the symptoms of gastro-oesophageal reflux disease?

Answer 24

Heartburn
Cough
Water brash
Sleep disturbance

Question 25

What are the risk factors for gastrooesophageal reflux?

Answer 25

``` Pregnancy Obesity Drugs lowering LOS pressure Smoking Alcohol Hypomotility ```

Question 26

How is gastrooesophageal reflux disease diagnosed?

Answer 26

On basis of characteristic symptoms without testing

Question 27

When is an endoscopy performed with gastrooesophageal reflux?

Answer 27

ALARM features Dysphagia Weight loss Vomiting

Question 28

What can the causes of gastrooesophageal reflux disease be with normal anatomy?

Answer 28

``` Increased transient relaxations of LOS Hypotensive LOS Delayed gastric emptying Delayed oesophageal emptying Decreased oesophageal acid clearance Decreased tissue resistance to acid/bile ```

Question 29

What can the anatomical causes of gastrooesophageal reflux disease be?

Answer 29

Hiatus hernia

Question 30

What are the 2 main types of hiatus hernia?

Answer 30

Sliding | PAraoesophageal

Question 31

What is the pathology of hiatus hernia?

Answer 31

Fundus of stomach moves proximally through hiatus in diaphragm

Question 32

What is the pathology of gastrooesophageal reflux disease?

Answer 32

Mucosa exposed to pepsin and bile Increased cell loss ad regenerative activity Erosive oesophagitis

Question 33

What are the complications of gastrooesophageal reflux?

Answer 33

Ulceration Stricture Glandular metaplasia Carcinoma

Question 34

What is Barrett's oesophagus?

Answer 34

Intestinal metaplasia related to prolonged exposure to acid in distal oesophagus

Question 35

What histological change is present in Barrett's oesophagus?

Answer 35

Squamous to mucin secreting columnar epithelial cells

Question 36

What is Barrett's oesophagus a precursor to?

Answer 36

Dysplasia or adenocarcinoma

Question 37

What is the treatment of Barrett's oesophagus?

Answer 37

Endoscopic mucosal resection Rediofrequency ablation Oesophagectomy

Question 38

What is the treatment of gastrooesophageal reflux disease?

Answer 38

Lifestyle measures Pharmacologocal For refractory disease- anti reflux surgery

Question 39

What are the types of oesophageal cancer?

Answer 39

Squamous cell carcinoma | Adenocarcinoma

Question 40

What is the usual presentation of oesophageal cancer?

Answer 40

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

Question 41

What is the pathology of squamous cell carcinoma in the oesophagus?

Answer 41

Large exophytic occluding tumours

Question 42

Where do squamous ell carcinomas occur in the oesophagus?

Answer 42

Proximal and middle third

Question 43

What is squamous cell carcinoma preceeded by?

Answer 43

Dysplasia and carcinoma in situ

Question 44

What is squamous cell oesophageal carcinoma associated with?

Answer 44

Achalasia Caustric strictures Plummer-Vinson syndrome

Question 45

Where are oesophageal adenocarcinomas situated?

Answer 45

Distal oesophagus

Question 46

What is oesophageal adenocarcinoma associated with?

Answer 46

Barrett's oesophagus

Question 47

What are the risk factors for oesophageal adenocarcinoma?

Answer 47

Obesity Male Middle age Caucasian

Question 48

Where does oesophageal cancer commonly spread to?

Answer 48

Liver Brain Lung Bone

Question 49

What is the issue with presentation od oesophageal cancer?

Answer 49

Often presents late when there is already invasion of regional lymph nodes and/or liver

Question 50

What is the prognosis for oesophageal cancer?

Answer 50

5 year survival <10%

Question 51

What investigations are done for oesophageal cancer?

Answer 51

``` Diagnosis- endoscopy and biopsy Staging- CT Endocopic ultrasound PET Bone scan ```

Question 52

What is the treatment of oesophageal cancer?

Answer 52

Oesophagectomy with or with our neo- and adjuvant therapy | Palliative- chemo, radio, brachytherapy, endoscopic stent, laser/APC orr PEG

Question 53

What is the issue with curative oesophagectomy in oesophageal cancer?

Answer 53

Limited to patients with localised disease | Long recovery, high mortality