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Oesophageal Pathology Flashcards

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1
Q

What is Gastro-Oestophageal Reflux Disease (GORD)?

A

Reflux of gastric contents, acid and bile, through the lower oesophageal sphincter into the oesophagus, due to decreased tone

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2
Q

In what sex is GORD most common?

A

M>F

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3
Q

What are the causes of GORD?

A

Pregnancy

Obesity

Drugs that lower LOS pressure

Smoking

Alcohol

Hypomobility

Hiatus Hernia

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4
Q

Name drugs that can lower the LOS pressure

A

Nitrates

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5
Q

What are causes of hiatus hernia?

A

>Age

Pregnancy

Obesity

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6
Q

What are the types of hiatus hernia?

A

Type 1, sliding, in which the gasto-oesophageal junction slides into thorax

Type 2, rolling/para-oesophageal, in which junction remains in abdomen but different part of stomach herniates through oesophageal opening

Type 3, combination of sliding and rolling

Type 4, large opening with additional organs entering thorax

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7
Q

What is a Nissen Fundoplication?

A

Surgical management of hiatus hernia in which hernia is pulled back and fundus is tied around the lower oesophagus to narrow the LOS

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8
Q

What is the pre-operative workup for Nissens fundoplication?

A

Manometry studies prior to surgery

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9
Q

How does GORD present?

A

Heartburn/Burning retrosternal discomfort, exacerbated after meals and lying down

Nocturnal cough

Waterbrash/acid regurgitation

Bloating

Odynophagia if ulceration

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10
Q

What investigations are used in GORD diagnosis and monitoring?

A

Upper GI Endoscopy

Barium swallow, to bisualise hiatus hernia

Manometry studies

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11
Q

What is the lifestyle management of GORD?

A

Weight loss

Smoking cessation

Avoid alcohol, tea and coffee

Smaller lighter meals

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12
Q

What is the pharmacological management of GORD (endoscopically proven oesophagitis)?

A

Full dose PPI for 1-2 months

If response, low dose treatment as required

If no response, double dose PPI for 1 month

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13
Q

What is the pharmacological management of GORD (endoscopically negative oesophagitis)?

A

Full dose PPI for 1 month

If response, low dose treatment as required

If no response, H2RA or prokinetic for 1 month

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14
Q

Name examples of PPI

A

Omeprazole

Lomeprazole

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15
Q

Give side effects of PPI

A

Hyponatraemia

Hypomagnesaemia

Osteoporosis

Microscopic colitis

Clostridium Difficile infection

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16
Q

Name an example of a histamine blocker

A

Ranitidine

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17
Q

Give complications of GORD

A

Reflux esophagitis

Ulcers

Barrett’s Oesophagus

Benign stricture

Anaemia

Oesophageal carcinoma

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18
Q

What is Barrett’s oesophagus?

A

Form of metaplasia in which normal stratified squamous epithelium of the oesophagus is replaced by glandular columnar epithelium

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19
Q

What causes Barrett’s oesophagus?

A

GORD

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20
Q

Name a complication of Barret’s oesophagus

A

Oesophageal adenocarcinoma

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21
Q

How is Barret’s oesophagus managed?

A

GORD management

Endoscopic surveillance with biopsy

Endoscopic intervention

  • Offered if dysplasia is identified
  • Mucosal resection
  • Radiofrequency ablation

Oesophagectomy

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22
Q

How often do patients with Barrett’s oesophagus recieve endoscopic surveillance?

A

Every 3-5 years for patients with metaplasia

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23
Q

What are the two classifications of oesophageal cancer?

A

Squamous carcinoma

Adenocarcinoma

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24
Q

What area of the oesophagus does squamous carcinoma affect?

A

Proximal

(Upper two thirds)

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25
What are of the oesophagus does adenocarcinoma effect?
Distal | (Lower one third)
26
What sex is oesophageal cancer most common in?
M\>F
27
At what age is oesophageal cancer most common?
Onset at 65
28
Which oesophageal cancer classification is most common?
Adenocarcinoma \> squamous
29
What is the prognosis for oesophageal cancer?
Poor, 5 year survival \<15%
30
What are the causes of oesophageal cancer (adenocarcinoma)?
Barrett's oesophagus Obesity
31
What are the causes of oesophageal cancer (squamous)?
Smoking Alcohol Dietary carcinogens * Fish Achalasia
32
How does oesophageal cancer present?
Progressive dysphagia, beeginning as solids and movig to liquids Weight loss Odynophagia Chest pain/heart burn Cough Haematemesis and vomiting Hoarseness/Vocal cord paralysis Lymphadenopathy
33
Give a dermatological manifestation of oesophagus cancer
Acanthosis nigricans
34
What investigations are used in oesophageal cancer diagnosis?
Upper GI endoscopy and biopsy * Note, always prioritise endoscope if chronic reflux symptoms that have not responded to PPI Staging * CT * US
35
What is the management of oesophageal cancer?
Surgical resection with adjuvant chemotherapy * Ivor-Lewis oesophagectomy * Total oesophagectomy/McKeown Palliative * Endoscopic stent * Chemotherapy * Radiotherapy * Laser ablation
36
Name complications of oesophageal cancer
Pneumonia, due to tracheo-oesophageal fistula
37
What sites can oesophageal cancer metastasise to?
Hepatic Brain Pulmonary Bone
38
Give complication of chemoradiotherapy in oesophageal cancer survivors?
Dysphagia due to post radiotherapy fibrosis
39
What is oesophageal hypomotility?
Abnormal deficiency of movement
40
What causes oesophageal hypomotility?
Connective tissue disease Diabetes Neuropathy
41
How does oesophageal hypomotility present?
Heartburn
42
What investigations are used in oesophageal motility disorder diagnosis?
Manometry Barium swallow Upper GI endoscopy
43
What is oesophageal hypermotility?
Abnormal excessive movement
44
What causes oesophageal hypermotility?
Idiopathic
45
How does oesophageal hypermotility present?
Severe episodic retrosternal chest pain Dysphagia
46
What sign is seen on a Barium swallow suggestive of oesophageal hypermotility?
Corkscrew appearance
47
How is oesophageal hypermotility managed?
Smooth muscle relaxants * Nitrates * CCB
48
What is Achlasia?
Neuromuscular disorder characterised by functional loss of the myenteric plexus ganglion cells in the distal oesophagus, resulting in the LOS failing to relax/open, with the absence of oesophageal peristalsis
49
How does achlasia present?
Progressive dysphagia * Equal to both solids and liquids from the outset Weight loss Chest pain/heart burn Regurgitation of food * May lead to cough and aspiration pneumonia
50
What barium swallow signs are seen in achlasia?
Proximal dilation and tapering of the distal oesophagus known as 'bird beak' sign
51
What is the surgical management of achlasia?
Endoscopic pneumatic balloon dilation * First line Heller's Cardiomyotomy * Used if recurrent symptoms
52
What is Heller's Cardiomyotomy?
Procedure in which muscles of cardia are cut to allow passage to the stomach
53
Name complications of achlasia
Aspiration pneumonia Oesophageal squamous cell carcinoma
54
Describe the difference in dysphagia between oesophageal conditions
Achlasia * Begins with solids and progresses to liquids Oesophageal cancer * Solids and liquids from the onset Motility * Variable between solids and liquids
55
What is Zenker's diverticulum?
Also known as pharyngeal pouch, protrusion of the mucosa and submucosa of the inferior pharyngeal constrictor muscle
56
How does Zenker's present?
Progressive dysphagia Regurgitation of undigested food Chronic cough Hoarseness Palpable lump in throat Halitosis
57
What is the area of weakness in Zenker's known as?
Killian's Dehiscence
58
How is Zenker's diverticulum managed?
Surgical excision of pouch, plus repair of defect in inferior constrictor
59
What is Eosinophillic oesophagus?
Chronic allergic/immune mediated inflammatory disorder causing oesophageal dysfunction, occuring in childhood
60
How does eosinophilic oesophagus present?
Dysphagia Food bolus obstruction Vomiting Heart burn
61
How is eosinophilic oesophagus managed?
Topical/oral corticosteroids Dietary elimination Endoscopic dilation
62
What is a Walloru-Weiss tear?
Linear tear at oesophageal-gastric junction due to forceful vomiting
63
How is walloru-weiss tear managed?
Heals itself Endoscopic treatment
64
Describe the pathophysiology of oesophageal varices
Portal hypertension results in dilation of veins at sites of portal-systemic anastomosis, projecting into the oesophagus
65
What are the sites of portal-systemic anastomosis?
Lower oesophagus Rectum Umbilicus (caput medusae)
66
How does oesophageal varices present?
Haematemesis/melaena, suggesting upper GI bleed Evidence of chronic liver disease Splenomegaly and thrombocytopenia, as portal HTN results in splenic enlargement and hyperfunction
67
What is the acute management of oesophegal varice bleed?
Resuscitate Correct possible clotting abnormalities IV Terlipressin or somatostatin analogue Upper GI Endoscopy and sclerotherapy/banding of varices If unsuccessful, pass a Sengstaken-Blakemore tube If continued bleeding, surgical decompression
68
What is a Sengstaken-Blakemore tube?
Contains a inflatable balloon used to compress varices
69
What is the prophylaxis management of oesophageal varices?
B Blockers to reduce portal pressure Upper GI Endoscopy and sclerotherapy/banding of varices Transjugular intra-hepatic portosystemic shunting (TIPSS)
70
What is Plummer-Vinson syndrome?
Web thin eccentric extension of normal oesophageal tissue
71
How does Plummer-Vinson syndrome present?
Dysphagia, secondary to oesophageal webs Iron deficiency anaemia Glossitis
72
What drug can cause odynophagia?
Steroids, due to candidasis
73
Give features of Boerhaave Syndrome
Alcohol use Vomiting Thoracic pain Subcutaneous emphysema, shown as crepitus in epigastric region

Gastrointestinal (14 decks)

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