Oesophageal Disorders

Question 1

vertebral extent of the oesophagus

Answer 1

C6 to T11/12

Question 2

true/false the LOS is a true sphincter

Answer 2

false - while there is some muscle thickening it is largely functional from the muscle of the diaphragm around it

Question 3

how do certain drugs cause heartburn

Answer 3

by reducing LOS pressuring and increasing reflux

Question 4

what does GORD stand for

Answer 4

gastro-oesophageal reflux disease

Question 5

what problem with eating do people with oesophageal disease encounter

Answer 5

dysphagia

Question 6

causes of oesophageal dysphagia

Answer 6

stricture
motility disorder
eosinophilic oesophagitis
external compression (such as from lung cancer)

Question 7

investigations that can be used to view the oesophagus

Answer 7

endoscopy

contrast radiology with barium swallow

Question 8

what would be the preferred test to investigate dysphagia or reflux symptoms

Answer 8

endoscopy

Question 9

what is a manometry

Answer 9

investigation to measure pressure through the oesophagus and sphincters

Question 10

when would you use manometry

Answer 10

when investigating dysphagia or a motility disorder

Question 11

what are the motility disorders

Answer 11

hypermotility, hypomotility and achalasia

Question 12

what does hypermotility look like on barium swallow

Answer 12

corkscrew appearance

Question 13

presentation of hypermotility

Answer 13

severe episodic chest pain with/out dysphagia

Question 14

how do you treat hypermotility

Answer 14

smooth muscle relaxants

Question 15

how does hypomotility present

Answer 15

heartburn and reflux symptoms

Question 16

what is achalasia

Answer 16

loss of inhibitory neurons in myenteric plexus of oesophagus. Function is lost in distal and LOS

essentially the LOS won’t relax and the oesophagus is obstructed

Question 17

presentation of achalasia

Answer 17

dysphagia
weight loss
chest pain
regurgitation

Question 18

medical treatment for achalasia

Answer 18

nitrates and CCBs

Question 19

endoscopic treatment for achalasia

Answer 19

endoscopic balloon dilatation

Question 20

what is motility disorder is aspiration a common complication of

Answer 20

achalasia

Question 21

how is reflux diagnosed

Answer 21

on the basis of symptoms

Question 22

when would you do an endoscopy in someone with reflux

Answer 22

if there are accompanying alarm symptoms

Question 23

what are the alarms symptoms

Answer 23

Anorexia
Loss of weight
Anaemia
Recent Onset
Malaena/Mass
Swallowing Problems

Question 24

what causes barrett’s oesophagus

Answer 24

prolonged exposure to acid

Question 25

what is the epithelium change in barrett's

Answer 25

stratified squamous --> mucus secreting simple columnar

Question 26

Treatment of barrett's oesophagus to prevent cancer

Answer 26

endoscopy mucosal resection | radio-frequency ablation

Question 27

treatment for GORD

Answer 27

alginates (gaviscon) PPI (reduce stomach acid) H2 receptor antagonists

Question 28

how do H2 receptor antagonists work

Answer 28

they block histamine from binding and stimulating acid production

Question 29

what is a surgery than can be done in GORD

Answer 29

fundoplication - wrapping the fundus around the LOS region

Question 30

two types of oesophageal cancer

Answer 30

squamous and adeno

Question 31

which type of oesophageal cancer is most common in the western world

Answer 31

adenocarcinoma

Question 32

presentation of oesophageal cancer

Answer 32

``` dysphagia anorexia weight loss odynophagia chest pain cough haematemesis pneumonia from a fistula hoarseness ```

Question 33

given the different causes of the two oesophageal cancers where do they occur in the oesophagus

Answer 33

adenocarcinoma in the distal part because it is caused by metaplasia from acid reflux

Question 34

which oesophageal cancer has smoking and drinking as risk factors

Answer 34

squamous

Question 35

what feature of the oesophagus makes tumour invasion easier

Answer 35

it's lack of a serosal later

Question 36

invasions of oesophageal cancer

Answer 36

heart, trachea, aorta

Question 37

lymph node spread in oesophageal cancer is common/uncommon

Answer 37

common - richly lymphatic in lamina propria of oesophagus

Question 38

staging scans of oesophageal cancer

Answer 38

CT, PET, endoscopic US, bone scan

Question 39

treatment for oesophageal cancer

Answer 39

oesophagectomy with/out neo/adjuvant chemo

Question 40

how can you surgically eleviate symptoms in the cancer

Answer 40

by putting in a stent to help with the dysphagia

Question 41

what is eosinophilic oesophagitis

Answer 41

an autoimmune condition of eosinophil infiltration of oesophagus epithelium

Question 42

treatment of eosinophilic oesophagitis

Answer 42

topical or swallowed corticosteroids dietary changes endoscopic dilatation

Question 43

presentation of eosinophilic oesophagitis

Answer 43

dysphagia

Question 44

treatment in non resectable oesophageal cancer

Answer 44

stenting and palliative radio/chemo

Question 45

treatment in resectable oesophageal cancer

Answer 45

oesophagectomy and chemo, or just chemo/radio if unfit for surgery

Question 46

morbidity rate of an oesophagectomy

Answer 46

20%

Question 47

mortality rate of an oesophagectomy

Answer 47

5%