Oesophageal Medicine

Question 1

Hiatus Hernia

Answer 1

part of the stomach rises through diaphragm into chest

Question 2

2 types of hiatus hernia

Answer 2

Sliding (GOJ slides through hiatus)

Rolling (part of the stomach - usually part of the fundus-rolls up around the oesophagus through hiatus)

Question 3

What is GORD

Answer 3

Gastric contents returning to the oesophagus. Failure of anti-reflux mechanisms such as relaxation of the Lower Oesophageal Sphincter unrelated to swallowing,

Question 4

Complications of GORD

Answer 4

Peptic Stricture
Barretts Oesophagus -> Ca
Fe deficiancy

Question 5

Causes of GORD

Answer 5

LOS hypotension
Hiatus Hernia
Decreased peristalsis and slow gastric emptying

Question 6

Risk Factors for GORD

Answer 6

H pylori Infection
Systemic Sclerosis
Obesity
Smoking
Alcohol ++
Pregnancy
Surgical Hx
Overeating
Acid secretion ++
Drugs - tricyclics, anticholinergics, nitrates

Question 7

Presentation of GORD

Answer 7

Dyspepsia
Waterbrush- increased saliva 
odynophagia
nocturnal asthma
chronic cough
laryngitis

Question 8

Investigations and diagnosis of GORD

Answer 8

Clinical diagnosis
2WW ENDOSCOPY: 4/52 vomiting, GI bleed, Anaemia, palable mass, >55yrs, dysphagia, no improvment with PPI
Barium swallow: identify HHernia
Intraluminal pH monitoring: diagnosis remains uncertain after endoscopy

Question 9

Prague Criteria grading Barretts

Answer 9

By number and position of mucosal breaks. (mucosal break= erosion/ulceration -well demarcated slough with erythema 
1. Small <5mm Mucosal Breaks
2. Breaks in 1 mucosal fold only
3 Breaks in multple folds 
4. breaks in >75% of circumference

Question 10

Treament of GORD

Answer 10

Conservative:
raise bed head, weight loss, small regular meals, avoid triggers, smoking cessation, over the counter antacids.

Medical
Aligate antacids, PPI, prokinetic (domperidone) H2 receptor antagonists (ranitidine)

Surgical
medical managment failed in cases with complications / extra oesophageal features.

Question 11

Achalasia

Answer 11

Aperistalsis and impaired relaxation of LOS

Question 12

Systemic Sclerosis + Oesophagus

Answer 12

Nearly all patients with SS will have oesophageal involvement

Question 13

Diffuse Oesophageal spasm

Answer 13

dysmotility. Contractions occur but random and peristalsis is inefficient

Question 14

Oesphageal diverticulum

Answer 14

outpouchings anywhere along oesophagus. Most commonly pharengeal pouch.

Question 15

Barretts Oesophagus

Answer 15

Metaplasia of oesophageal SQUAMOUS epithelium into abnormal COLUMNAR mucosa
precancerous condition that follows metaplasia- dysplasia- neoplasia pattern and is graded using Prague criteria (A-D)

Question 16

Oesophageal Ca types

Answer 16

Squamous Cell - 55%

Adenocarcinoma - 45%

Question 17

Oesophageal Ca RF

Answer 17

Smoking, Alcohol, Radiotherapy, occupational exposure, steaming drinks.
AC: Obesity, heartburn, age,
SS: Achalasia, Ceoliac disease,

Question 18

Presentation of Oesophageal Ca

Answer 18

Progressive unrelenting dysphagia (initially solids, then liquids then saliva)
Pain on eating
Weight loss
(Lypmhadenopathy
Recurrent pneumonia)

Question 19

Investigations Oesophageal Ca

Answer 19

GS: Endoscopy + Biopsy

Barium Swallow
CT PET
US
Laproscopic exploration

Question 20

Managment Oesophageal Ca

Answer 20

Surgery curative intent
Neoadjuvant chemo-radiation

Photodynamic therapy
Palliative car: NUTRITION and PAIN