Oesophageal pathology

Question 1

What factors predispose a patient to developing hiatus hernia?

Answer 1

Obesity
Lifting heavy loads
Frequent coughing fits
Tight fitting clothes
Frequent bending

Question 2

How does hiatus hernia usually present?

Answer 2

Symptoms and complications of GORD

Question 3

Which muscle type is the oesophagus controlled by?

Answer 3

Initially striated, then smooth

Question 4

Where does the oesophagus begin?

Answer 4

Cricopharyngeus muscle, C6

Question 5

What is the definition of GORD?

Answer 5

Any symptomatic condition, anatomic alteration or both that result from the reflux of noxious material in the stomach into the oesophagus

Question 6

What is a paraoesophageal hiatus hernia?

Answer 6

The herniated part of the stomach becomes parallel to the oesophagus

Question 7

What is a sliding hiatus hernia?

Answer 7

The herniated part of the stomach slides through the hiatus of the diaphragm with the gastro-oesophageal junction

Question 8

What is reflux oesophagitis?

Answer 8

Inflammation of oesophagus due to refluxed low pH gastric content

Question 9

What are some of the symptoms of reflux oesophagitis?

Answer 9

Heartburn
Acid reflux
Dysphagia
Weight loss
Chest pain
Hoarseness

Question 10

What are some of the complications of GORD?

Answer 10

Peptic stricture
Barrett’s oesophagus
Adenocarcinoma

Question 11

What are the microscopic changes that occur in reflux oesophagitis?

Answer 11

Basal zone epithelial expansion due to increased desquamation - basal zone hyperplasia
Influx of neutrophils, lymphocytes, eosinophils

Question 12

What microscopic changes occur in Barrett’s oesophagus?

Answer 12

Squamous epithelium becomes columnar epithelium - metaplasia

Question 13

What does Barrett’s oesophagus predispose to?

Answer 13

Adenocarcinoma

Question 14

What is the pathological progression from Barrett’s oesophagus to adenocarcinoma?

Answer 14

Metaplasia - dysplasia - adenocarcinoma

Question 15

What are oesophageal varices?

Answer 15

Dilated veins that protrude into the oesophagus

Question 16

What treatment is available fro oesophageal varices?

Answer 16

Banding treatment

Question 17

What is a common complication of oesophageal varices?

Answer 17

Haemorrhage

Question 18

What is the characteristic metaplasia seen in Barrett’s?

Answer 18

Intestinal metaplasia

Question 19

What is achalasia?

Answer 19

An uncommon condition characterised by loss of contractility of the oesophagus and failure to relax the lower oesophageal sphincter

Question 20

How does achalasia usually present?

Answer 20

Intermittent but progressive dysphagia
Dysphagia to both liquids and solids
Vomiting of undigested food

Question 21

What investigations might be done for achalasia?

Answer 21

Endoscopy
Ba swallow
Oesophageal manometry

Question 22

What is oesophageal manometry?

Answer 22

A test to assess muscle function in the oesophagus:
a thin, pressure-sensitive tube is passed through the nose, down the oesophagus and into the stomach
The patient is then asked to swallow - the muscle contractions are detected by the tube

Question 23

What are the main identified risk factors for oesophageal squamous carcinoma?

Answer 23

Tobacco
Alcohol
Nitrosamine in pickled/mouldy food
Vitamin deficiencies
Human papilloma virus
Hot beverages

Question 24

What are the risk factors for adenocarcinoma of the oesophagus?

Answer 24

GORD

Barrett’s

Question 25

How might cancer of the oesophagus present?

Answer 25

Dysphagia Weight loss Anaemia Fatigue (usually due to metastases)

Question 26

Where is adenocarcinoma of the oesophagus most likely to be?

Answer 26

Lower 1/3 of oesophagus

Question 27

What microscopic changes would you see in allergic oesophagitis?

Answer 27

Large numbers of eosinophils present in mucosa

Question 28

What is the main feature of GORD?

Answer 28

Heartburn | Aggravated by lying down or bending forward

Question 29

What is the best investigation for GORD?

Answer 29

Endoscopy, although mostly diagnosed on history

Question 30

What treatments are available for GORD?

Answer 30

Antacids/'over the counter' drinks Metoclopramide and domperidone H2-receptor antagonists e.g. ranitidine PPIs e.g. omeprazole

Question 31

What is the gold-standard treatment for GORD?

Answer 31

PPIs e.g. omeprazole

Question 32

What is the best investigation for Barrett's oesophagus?

Answer 32

Endoscopy and biopsy

Question 33

What is a complication of achalasia?

Answer 33

Aspiration pneumonia due to regurgitation of undigested food

Question 34

What can be seen on Xray in achalasia?

Answer 34

Dilated oesophagus | Sometimes fluid level seen behind heart

Question 35

What can be seen on barium swallow in achalasia?

Answer 35

Lack of peristalsis | Lower end of oesophagus shows 'birds beak' appearance due to failure of sphincter to relax

Question 36

How is the oesophagus affected in patients with systemic sclerosis?

Answer 36

Dimished peristalsis and oesophageal clearance due to replacement of smooth muscle with fibrotic tissue

Question 37

What is an oesophageal web?

Answer 37

A thin, membranous tissue flap covered with squamous epithelium

Question 38

In what condition does an oesophageal web cause dysphagia?

Answer 38

Plummer-Vinson syndrome

Question 39

What is a web in Plummer-Vinson syndrome associated with?

Answer 39

Chronic iron deficiency anaemia Glossitis Angular stomatitis

Question 40

What is the most common cause of benign oesophageal strictures?

Answer 40

Peptic stricture due to reflux

Question 41

What are some of the causes of oesophageal infection?

Answer 41

Candida Herpes simplex Cytomegalovirus Tuberculosis

Question 42

How is allergic/eosinophilic oesophagitis treated?

Answer 42

Topical steroids - swallowing preparations such as fluticasone