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2025 Part Twos > Oesophageal strictures > Flashcards

Oesophageal strictures Flashcards

(48 cards)

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1
Q

What is the definition of oesophageal stricture?

A

Fixed fibrous narrowing of the oesophageal lumen

Oesophageal stricture can significantly impact swallowing and overall health.

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2
Q

What is a web in the context of oesophageal strictures?

A

A thin eccentric membrane (partial circumference)

Webs may contribute to dysphagia.

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3
Q

What is a ring in the context of oesophageal strictures?

A

A thicker (2-5mm) concentric narrowing of the lumen

Rings can obstruct food passage, leading to complications.

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4
Q

What is the most common type of oesophageal ring?

A

Schatzki ring

Schatzki rings are often found distally in the oesophagus.

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5
Q

What percentage of oesophageal strictures are due to GORD?

A

Up to 75%

.

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6
Q

What are the two main categories of causes for oesophageal rings and webs?

A

Benign and malignant

.

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7
Q

What are some structural causes of oesophageal rings?

A
  • Hiatus hernia
  • Schatzki rings associated with HH

Hiatus hernia is a common contributor to Schatzki rings.

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8
Q

What is the most common inflammatory cause of oesophageal stricture?

A

GORD

Inflammation from GORD can lead to fibrous narrowing.

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9
Q

Name two infective causes of oesophageal strictures.

A
  • Candida
  • CMV

Infective agents can cause significant damage to the oesophageal lining.

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10
Q

What are some neoplastic causes of oesophageal stricture?

A

Iatrogenic causes such as endoscopic perforation, post sclerotherapy fibrosis, radiotherapy, and post oesophagectomy

Neoplastic causes may involve direct tumor growth or treatment-related changes.

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11
Q

What traumatic cause can lead to oesophageal stricture?

A

Caustic injury

Caustic substances can severely damage the oesophagus, leading to strictures.

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12
Q

What is Plummer Vinson syndrome characterized by?

A

Triad of iron deficiency anaemia, dysphagia, and cervical oesophageal web

This syndrome is associated with increased risk of oesophageal cancer.

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13
Q

What dermatological disease can cause oesophageal strictures?

A

Epidermolysis bullosa

This condition can lead to structural abnormalities in the oesophagus.

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14
Q

What is an extrinsic compression cause of oesophageal stricture?

A

Vascular rings - Aberrent Left subclavian Artery

Vascular anomalies can compress the oesophagus, leading to strictures.

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15
Q

What is the most common symptom of oesophageal strictures?

A

Dysphagia

Dysphagia refers to difficulty swallowing, which is frequently observed in patients with oesophageal strictures.

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16
Q

List three symptoms associated with oesophageal strictures.

A
  • Odynophagia
  • Weight loss
  • Regurgitation of food

Odynophagia is pain during swallowing, which can occur with strictures.

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17
Q

What investigation has close to 100% sensitivity for detecting oesophageal strictures when properly performed?

A

Barium swallow

A barium swallow involves the patient swallowing a barium solution, allowing for imaging of the oesophagus.

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18
Q

What is the role of endoscopy in the investigation of oesophageal strictures?

A

Allows visualisation and biopsy

Endoscopy can help visualize the stricture and obtain tissue samples for further analysis.

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19
Q

Why is it important to biopsy during endoscopy for oesophageal strictures?

A

To rule out malignant causes and eosinophilic oesophagitis

Biopsies help determine the underlying cause of the stricture.

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20
Q

What is the risk of perforation associated with endoscopic dilatation for benign esophageal stricture?

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A

0.5%

Perforation is a rare but serious complication of the dilatation procedure.

21
Q

What percentage of patients experience recurrent symptoms within 5 years after treatment for oesophageal strictures?

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A

89%

Recurrent symptoms indicate the chronic nature of oesophageal strictures.

22
Q

What are some conservative management strategies for oesophageal strictures?

Study These Flashcards
A
  • Cutting food smaller
  • Lifestyle measures

These strategies can help patients manage dysphagia more effectively.

23
Q

What is graded dilatation needed for?

Study These Flashcards
A

Eosinophilic oesophagitis

Graded dilatation is a specific approach for treating strictures caused by eosinophilic oesophagitis.

24
Q

What long-term medication is recommended for patients with oesophageal rings and evidence of GORD?

Study These Flashcards
A

Long term PPI

Proton Pump Inhibitors (PPIs) help reduce gastric acid and manage gastroesophageal reflux disease (GORD).

25
What is the treatment for eosinophilic oesophagitis?
* PPI (associated with >50% remission rates) * Topical glucocorticoids (fluticasone or budesonide) ## Footnote These treatments aim to reduce inflammation and promote healing in eosinophilic oesophagitis.
26
What surgical options are available for patients requiring frequent dilations despite adequate PPI?
* Antireflux procedure (+/- Collis gastroplasty) * Oesophageal resection ## Footnote Surgery may be considered when other treatments fail or complications arise.
27
What should Eosinophilic esophagitis (EoE) be considered in adults with?
A history of food impaction, persistent dysphagia, or gastroesophageal reflux disease that fails to respond to medical therapy ## Footnote EoE is a chronic immune-mediated condition affecting the esophagus.
28
What symptoms may be associated with EoE in children?
Feeding disorders, vomiting, abdominal pain, dysphagia, and food impaction ## Footnote Symptoms vary by age in children.
29
In which demographic should the diagnosis of EoE be particularly considered?
Young males or boys with a history of food or environmental allergies, asthma, or atopy ## Footnote History of esophageal perforation or severe pain after dilation of a stricture may also indicate EoE.
30
What is required to make a diagnosis of EoE?
The presence of both symptoms and histologic findings ## Footnote Other disorders causing esophageal eosinophilia must be ruled out.
31
Is a trial of proton pump inhibitor treatment required for the diagnosis of EoE?
No ## Footnote The diagnostic criteria for EoE have changed and no longer require this trial.
32
What is the first diagnostic test for suspected EoE?
An upper endoscopy with esophageal biopsies ## Footnote A minimum of two to four biopsies should be obtained from both the distal and mid or proximal esophagus.
33
What are some endoscopic features described in patients with EoE?
Stacked circular rings ('feline' esophagus) ## Footnote Other morphologic features may also be observed during endoscopy.
34
What are the endoscopic features of eosinophilic oesophagitis?
Stacked circular rings, attenuation of the subepithelial vascular pattern, linear furrowing, whitish papules, small caliber esophagus ## Footnote 'Feline' esophagus is a term used to describe the appearance of stacked circular rings.
35
What does a 'feline' esophagus refer to?
Stacked circular rings in the esophagus ## Footnote This term is used to describe a specific endoscopic feature observed in eosinophilic oesophagitis.
36
What is the peak eosinophil count indicative of eosinophilic oesophagitis?
≥15 eosinophils per high power field ## Footnote This histologic finding is a key diagnostic criterion for eosinophilic oesophagitis.
37
List the histologic features suggestive of eosinophilic oesophagitis.
* Eosinophil microabscesses * Superficial layering of eosinophils * Sheets of eosinophils * Extracellular eosinophil granules * Subepithelial and lamina propria fibrosis and inflammation * Basal cell hyperplasia * Papillary lengthening ## Footnote These histological features are essential for confirming a diagnosis of eosinophilic oesophagitis.
38
True or False: Linear furrowing in the esophagus may extend the entire length of the esophagus in eosinophilic oesophagitis.
True ## Footnote Linear furrowing is one of the characteristic endoscopic findings in eosinophilic oesophagitis.
39
What is indicated by the presence of whitish papules in the esophagus?
Eosinophil microabscesses ## Footnote These papules are a specific endoscopic finding associated with eosinophilic oesophagitis.
40
What does attenuation of the subepithelial vascular pattern indicate?
It is a characteristic endoscopic finding in eosinophilic oesophagitis ## Footnote This finding reflects the changes in vascular patterns due to inflammation.
41
Fill in the blank: The presence of _______ is a histological feature associated with eosinophilic oesophagitis.
Eosinophil microabscesses
42
What is a common feature of the esophagus in eosinophilic oesophagitis?
Small caliber esophagus ## Footnote This refers to the narrowing of the esophagus that can occur in eosinophilic oesophagitis.
43
What is the strong association mentioned in relation to eosinophilic esophagitis (EoE)?
EoE is strongly associated with allergies ## Footnote This suggests that allergies may play a significant role in the condition.
44
Who should patients with EoE undergo evaluation by?
An allergist ## Footnote This evaluation can help in identifying potential allergies contributing to EoE.
45
What may the results of the allergy evaluation imply for treatment?
Treatment implications such as elimination diets ## Footnote Identifying allergens can lead to dietary changes that may alleviate symptoms.
46
What is one of the recommended treatments for EoE?
Referral to an allergy specialist and avoidance of dietary triggers ## Footnote Avoiding known allergens can help manage EoE symptoms.
47
What types of pharmacological therapy are suggested for EoE?
PPIs or glucocorticoid topical swallowed fluticasone ## Footnote These medications can help reduce inflammation in the esophagus.
48
What endoscopic procedure is mentioned for managing strictures in EoE?
Dilatations ## Footnote This procedure helps to alleviate narrowing of the esophagus caused by inflammation.

2025 Part Twos (62 decks)

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