Oesophageal Disorders

Question 1

Oesophagus begins and ends at what vertebral levels?

Answer 1

C6 - T11/12

Question 2

Muscle distribution of the oesophagus

Answer 2

Upper 3-4cm skeletal

Rest is smooth

Question 3

What type of cell lines the esophagus?

Answer 3

Non-keratinising stratified squamous epithelium

Question 4

Vagus nerve stimulation mediates what in the oesophagus?

Answer 4

Peristalsis

LOS relaxation

Question 5

What causes heartburn?

Answer 5

Acid Reflux

Bilious gastric contents into oesophagus

Question 6

How do certain drugs/foods cause heartburn?

Answer 6

Reducing LOS pressure increasing reflux

Question 7

Persistent reflux and heartburn leads to what?

Answer 7

GORD

Question 8

What is dysphagia?

Answer 8

Subjective sensation of difficulty in swallowing boli

Question 9

What to enquire about if a patient presents with dysphagia?

Answer 9

Type of food
Pattern of symptoms
Associated symptoms
Location of sensation

Question 10

What is odynophagia?

Answer 10

Pain with swallowing

Question 11

Causes of oesophageal dysphagia

Answer 11

Stricture (ben/mal)
Motility disorder
Esosinophilic oesophagitis
Extrinsic compression

Question 12

Investigations in oesophageal disease

Answer 12

Endoscopy (UGIE)
Contrast radiology (Ba)
Oesophageal pH + manometry

Question 13

Low oesophageal pH suggests what?

Answer 13

Acid presence

Question 14

Manometry tests for what?

Answer 14

Dysphagia

Suspected motility issues

Question 15

Hypermotility of the oesophagus appears as what?

Answer 15

Corkscrew Ba swallow
Severe episodic chest pain
Some dysphagia

Question 16

Hypermotility of the oesophagus is often confused with what?

Answer 16

Angina/MI

Question 17

Manometry of hypermotility shows what?

Answer 17

Uncoordinated, hypertonic contractions

Question 18

Treatment for hypermotility

Answer 18

Smooth muscle relaxants

Question 19

What is hypomotility associated with?

Answer 19

Connective tissue disease
Diabetes
Neuropathy

Question 20

Hypomotility causes what?

Answer 20

Failure of LOS mechanism causing heartburn and reflux

Question 21

What is achalasia?

Answer 21

Loss of myenteric plexus ganglion in distal oesophagus/LOS

Question 22

Cardinal feature of Achalasia

Answer 22

Failure of the LOS to relax leading to distal obstruction

Question 23

Symptoms of achalasia

Answer 23

Progressive Dysphagia
Chest pain
Weight loss
Regurgitation

Question 24

Treatment for achalasia

Answer 24

Nitrates, CCBs
Botulinum toxin
Pneumatic balloon dilation
Myotomy

Question 25

Complications of achalasia

Answer 25

Aspiration pneumonia | Increase risk of squamous cell carcinoma

Question 26

Symptoms of GORD

Answer 26

Heartburn Cough Water brash Sleep disturbance

Question 27

Risk factors for GORD

Answer 27

``` Smoking Alcoholism Obesity LOS weakening Obesity ```

Question 28

GORD is typically diagnosed how?

Answer 28

Symptomatically without diagnostic testing

Question 29

Why is endoscopy not ideal in GORD?

Answer 29

>50% of patients will have no visible oesophageal abnormality

Question 30

When must an endoscopy be performed in a GORD patient?

Answer 30

Signs of malignancy: Dysphagia Weight loss Vomiting

Question 31

What are the two main types of hiatus hernia?

Answer 31

Sliding | Para-oesophageal

Question 32

How does GORD cause damage to the epithelium?

Answer 32

Mucosa exposed to acid/pepsin/bile Increased cell loss and inflammation Erosive esophagitis

Question 33

What are the main complications of GORD?

Answer 33

Ulceration Stricture Barretts Oesophagus Carcinoma

Question 34

What is barretts oesophagus?

Answer 34

Change from squamous to mucin-secreting epithelium in the distal oesophagus due to repeated acid exposure

Question 35

Barretts oesophagus is a precursor to what?

Answer 35

Adenocarcinoma

Question 36

What is the treatment for severe dysplasia in Barretts oesophagus?

Answer 36

Endoscopic Mucosal Resection Radiofrequency ablation Oesophagectomy (rare)

Question 37

How is GORD treated?

Answer 37

``` Lifestyle changes Alginates H2RA PPIs ?Acid-reflux surgery ```

Question 38

How does oesophageal cancer typically present?

Answer 38

``` PROGRESSIVE DYSPHAGIA ANOREXIA/WL Odynophagia Chest pain Cough Pneumonia Haematemesis Vocal cord paralysis ```

Question 39

Squamous cell carcinoma of the oesophagus occurs where?

Answer 39

Proximal and middle 1/3 of oesophagus

Question 40

Largest risk factors for oesophageal squamous cell carcinoma?

Answer 40

Tobacco and Alcohol

Question 41

Adenocarcinoma of the oesophagus occurs where?

Answer 41

Distal 1/3 oesophagus

Question 42

At what stage does oesophageal cancer typically present?

Answer 42

Late Regional nodal spread Invasive

Question 43

Why does a tumour of the oesophagus have a greater likelihood of invading surrounding structures?

Answer 43

Lack of a serosal layer | Lamina propria has a rich lymphatic supply

Question 44

Prognosis of oesophageal cancer?

Answer 44

5y survival<10%

Question 45

How is oesophageal cancer investigated?

Answer 45

Endoscopy and biopsy | Staging (TNM)

Question 46

How is oesophageal cancer staged?

Answer 46

CT Scan Endoscopic Ultrasound PET Scan Bone scan

Question 47

How is oesophageal cancer treated?

Answer 47

Oesophagectomy and chemotherapy | ?Palliation

Question 48

What is oesinophilic oesophagitis?

Answer 48

Chronic immune mediated oesophageal dysfunction

Question 49

What is the aetiology of eosinophilic oesophagitis?

Answer 49

Eosinophilic infiltration of the oesophageal epithelium IN ABSENCE of secondary causes

Question 50

How does eosinophilic oesophagitis usually present?

Answer 50

Dysphagia | Food bolus obstruction

Question 51

Treatment for eosinophilic oesophagitis?

Answer 51

Topical/swallowed corticosteroids Dietary elimination Endoscopic dilation