oesophageal disorders

Question 1

where does the oesophagus begin and terminate?

Answer 1

cricoid cartilage (C6)

T11-T12

Question 2

upper 3-4cm of the oesophagus is ….. muscle

remainder is …… muscle

Answer 2

striated

smooth

Question 3

oesophagus is lined with?

Answer 3

stratified squamous epithelium

Question 4

oesophageal peristalsis is produced by oesophageal …

Answer 4

circular muscles and propels swelled materials distally into the stomach

Question 5

contraction in the oesophageal body (peristalsis) and relaxation of the LOS is mediated via the….

Answer 5

vagus nerve

Question 6

LOS - striated muscle of the

Answer 6

right crus of the diaphragm

Question 7

heartburn is a consequence of….

Answer 7

reflux of acidic and/or billows gastric contents into the oesophagus

Question 8

certain drugs (alcohol/nicotine) can reduce the LOS pressure resulting in increased ….

Answer 8

reflux/heartburn

Question 9

persistant reflux and heartburn leads to

Answer 9

gastro-oesophageal reflux disease (GORD)

Question 10

with dysphagia you should enquire about

Answer 10

type of food (solid, liquid)

pattern (progressive, intermittent)

associated features (weight loss, regurgitation)

Question 11

causes of oesophageal dysphagia

Answer 11

benign stricture

malignant stricture (oesophageal cancer)

motility disorders

eosinophilic oesphagitis

extrinsic compression

Question 12

oesophageal disease investigations

Answer 12

endoscopy (upper GI)

contrast radiology (barium swallow)

oesophageal pH and manometry

Question 13

hyper motility

Answer 13

severe, episodic chest pain

often confused with angina

cause is unclear

Question 14

hypo motility

Answer 14

associated with connective tissue disease

causes failure of LOS mechanism leading to heartburn and reflux symptoms

Question 15

achalasia

Answer 15

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

Question 16

main symptoms of achalasia

Answer 16

failure of LOS to relax

Question 17

result of achalasia

Answer 17

functional distal obstruction of oesophagus

Question 18

symptoms of achalasia

Answer 18

progressive dysphagia for solids and liquids

weight loss

cheat pain (30%)

regurgitation and chest infection

Question 19

treatment of achalasia

Answer 19

nitrates

calcium channel blockers

botulinum toxin

balloon dilatation

myotomy

Question 20

complications of achalasia

Answer 20

aspiration pneumonia and lung disease

increased risk of squamous cell oesophageal carcinoma

Question 21

Gastro-oesophageal reflux disease

Answer 21

due to pathological acid (and bile) exposure in lower oesophagus

Question 22

symptoms of GORD

Answer 22

heartburn

cough

water brash

sleep disturbance

Question 23

risk factors of GORD

Answer 23

pregnancy

obesity

drugs lowering LOS pressure

smoking

alcoholism

hypomotility

Question 24

GORD aetiology

GORD without abnormal anatomy

Answer 24

increase in transient relaxations of the LOS

delayed gastric emptying

hypotensive LOS

delayed oesophageal emptying

reduced oesophageal acid clearance

Question 25

GORD aetiology | GORD due to hiatus hernia

Answer 25

anatomical distortion of the oesophageal junction

Question 26

hiatus hernia 2 main types

Answer 26

sliding and para-oesophageal

Question 27

hiatus hernia

Answer 27

fundus of the stomach moves proximally through the diaphragmatic hiatus

Question 28

what 2 factors predispose you to a hiatus hernia

Answer 28

obesity ageing

Question 29

GORD pathophysiology

Answer 29

mucosa exposed to acid-pepsin and bile increased cell loss and regenerative activity (ie inflammation) erosive oesphagitis

Question 30

GORD complications

Answer 30

ulceration stricture glandular metaplasia (barretts oesophagus) carcinoma

Question 31

Barrett's oesophagus

Answer 31

intestinal metaplasia related to prolonged acid exposure on distal oesophagus change from squamous to mucin secreting columnar cells

Question 32

barretts oesophagus is a precursor to

Answer 32

dysplasia / adenocarcinoma

Question 33

Treatment of barretts oesophagus

Answer 33

endoscopic mucosal resection radio-frequency ablation oesophagectomy (rarely)

Question 34

GORD treatment

Answer 34

lifestyle measures alginates --> Gaviscon H2RA --> Ranitidine Proton Pump Inhibitor --> Omeprazole anti-reflux surgery

Question 35

oesophageal cancers are usually

Answer 35

squamous cell carcinomas adenocarcinoma

Question 36

oesophageal cancer presentation

Answer 36

progressive dysphagia anorexia and weight loss chest pain cough pneumonia vocal cord paralysis haematemesis

Question 37

squamous cell carcinoma

Answer 37

often large exophytic occluding tumours occur in proximal and middle third of oesophagus

Question 38

where do adenocarcinomas usually occur?

Answer 38

distal oesophagus

Question 39

adenocarcinoma is associated with what condition?

Answer 39

Barretts oesophagus

Question 40

common metastasis from oesophageal cancer

Answer 40

hepatic brain pulmonary bones

Question 41

oesophageal investigation

Answer 41

endoscopy biopsy CT scan endoscopic ultrasound PET scan bone scan

Question 42

oesophageal cancer treatment

Answer 42

palliation endoscopic chemotherapy radiotherapy brachytherapy