Oesophageal Disorders

Question 1

What conditions are hypo motility of the oesophagus associated with?

Answer 1

connective tissue diorders
diabetes
neuropathy

Question 2

what is hypo motility of the oesophagus?

Answer 2

failure of the LOS mechanism which results in reflux and heart burn.
the LOS doesn’t contract efficiently

Question 3

what is achalasia and what causes it?

Answer 3

Achalasia is failure of the LOS to relax

Achalasia is caused by a functional loss of myenteric plexus ganglion inhibitory cells

Question 4

what symptom is found in patients with hyper motility?

Answer 4

chest pain similar to angina

dysphagia

Question 5

what are the symptoms of achalasia?

Answer 5

progressive dysphagia with solids and liquid
chest pain
weight loss
regurgitation and chest infection

Question 6

what are the treatments for achalasia?

Answer 6

nitrates and CCB
endoscopic botulin toxin & a pneumatic balloon dilatation
radiological pneumatic balloon dilatation
surgical myotomy

Question 7

what are the complications of achalasia?

Answer 7

aspiration pneumonia and lung disease

increased risk of squamous cell oesophageal carcinoma

Question 8

what are the 3 main investigations used to investigate oesophageal disorders?

Answer 8

endoscopy 
contrast radiology (barium swallow)
oesophageal PH and Manometry

Question 9

intermittent progression of dysphagia with history of heart burn is likely to be caused by what?

Answer 9

benign peptic stricture

Question 10

relentless progression of dysphagia over weeks is likely due to what?

Answer 10

malignant structure

Question 11

slow onset dysphagia for solids and liquids at the same time is likely to be due to what?

Answer 11

motility disorder

Question 12

describe what the pathophysiology of gastro-oesophageal reflux disease is.

Answer 12

the mucosa is exposed to acid-pepsin and bile
this increases cell loss and regenerative activity (inflammation)
this results in an erosive oesophagus

Question 13

what are the risk factors for gastro-oesophageal reflux?

Answer 13

pregnancy
obesity
drugs
smoking
alcohol
hypomotility

Question 14

what are the causes of gastro-oesophageal reflux disease?

Answer 14

increase transient relaxations of the LOS
hypotensive LOS
delayed gastric emptying
delayed esophageal emptying
decreased oesophageal acid clearance
decreased tissue resistance to bile/acid
Hiatus hernia (distortion of the OG junction)

Question 15

what are the symptoms of gastro-oesophageal reflux disease?

Answer 15

asymptomatic
heart burn
cough
watersplash
sleep disturbance

Question 16

what are the treatments for GORD?

Answer 16

lifestyle changes
drugs: 
- alginates (gaviscon)
- H2 receptor antagonist (Ranitidine)
PPI (omeprazole) 
reflux surgery: fundoplication

Question 17

in what sex and ethnicity is GORD more common in?

Answer 17

male > female

caucasian > black > asian

Question 18

what are the complications of GORD?

Answer 18

ulceration
stricture
metaplasia (Barrett’s oesophagus)
carcinoma

Question 19

where in the oesophagus is squamous cell and adenocarcinoma found?

Answer 19

squamous cell - proximal and middle third

adenocarcinoma- distal

Question 20

what are the main risk factors for squamous cell and adenocarcinoma of the oesophagus?

Answer 20

squamous cell = tobacco and alcohol

adenocarcinoma = obesity, male, middle aged, caucasian

Question 21

what condition is adenocarcinoma of the oesophagus associated with and what is this?

Answer 21

barrett’s oesophagus

metaplasia of the oesophageal epithelium from squamous to columnar cells

Question 22

what conditions are squamous cell carcinoma associated with?

Answer 22

achalasia
caustic strictures
pulmmer-vinson syndrome

Question 23

what is the presentation of oesophageal cancer?

Answer 23

progressive dysphagia 
weight loss
odynophagia 
chest pain
cough
vocal cord paralysis
haematemesis
pneumonia (trachea-oesophageal fistula)

Question 24

what investigations are used in the diagnosis of oesophageal cancer?

Answer 24

endoscopy and biopsy

Question 25

what is the treatment for oesophageal cancer?

Answer 25

surgical oesophagectomy + neoadjuvant/adjuvant chemo in selected patients chemo + radiotherapy improves survival in inoperative patients

Question 26

where are metastasis most commonly found in oesophageal cancer?

Answer 26

liver lungs brain bone

Question 27

what is oesinophillic oesophagitis?

Answer 27

chronic immune/allergen mediated condition eosinophilic infiltration symptoms of oesophageal dysfunction

Question 28

what is the presentation of eosinophilic oesophagitis?

Answer 28

dysphagia and food bolus obstruction

Question 29

what is the treatment for eosinophilic oesophagitis?

Answer 29

topical (throat spray) or oral steroids dietary elimination endoscopic dilatation

Question 30

in what sex is eosinophilic oeosphagitis most common in and what age group?

Answer 30

males > females | most commonly found in young children

Question 31

what are the 3 different approaches to a oesophagectomy?

Answer 31

ivor lewis left thoracic abdominal trans hiatal

Question 32

what is the prognosis for a patient with metastasic oesophageal cancer?

Answer 32

<1 year

Question 33

what is the prognosis for a patient with resectable oesophageal cancer and has an oesophagectomy?

Answer 33

5yr survival 45%

Question 34

what is the prognosis for a patient with non metastatic oesophageal cancer and is treated with chemo+radiotherapy?

Answer 34

5 yr survival 30%

Question 35

what are the conduits for an oesophagectomy?

Answer 35

stomach | colon

Question 36

what staging classification is used for oesophageal cancer?

Answer 36

TNM

Question 37

what investigation is used for M staging oesophageal cancer?

Answer 37

PET CT

Question 38

what investigation is used for T/N staging oesophageal cancer?

Answer 38

endoscopy USS

Question 39

what are the treatment options for a patient with metastatic oesophageal cancer?

Answer 39

stenting | palliative chemotherapy and radiotherapy

Question 40

what is the morbidity and mortality statistics for an oesophagectomy and how long does it normally take a patient to recover?

Answer 40

morbidity = 20-30% mortality = 5% 10 months to get to their pre-op quality of life

Question 41

what is the treatment for hiatus hernia GORD ?

Answer 41

fundoplication surgery

Question 42

what type of hiatus hernia resulting in reflux causes chest pain?

Answer 42

paraoesophagheal

Question 43

what are the side effects of fundoplication?

Answer 43

``` dysphagia difficulty to burp and vomit gas bloating excess flatulence diarrhoea ```

Question 44

what are the 2 different hiatus hernias?

Answer 44

sliding | paraoesophagheal

Question 45

what are the complications of GORD?

Answer 45

ulceration stricture glandular metaplasia (barretts oesophagus) carcinoma

Question 46

what is barretts oesophagus?

Answer 46

chronic reflux causes the oesophageal metaplasia from simple squamous to columnar epithelium can progress to neoplasia = adenocarcinoma