Oesophagus

Question 1

What is GORD

Answer 1

Gastro-oesophageal reflux disorder

Question 2

When does a patient with GORD typically have worsening symtpoms

Answer 2

After meals

Question 3

What prevents reflux in health

Answer 3

Lower oesophageal sphincter pressure
Angle of Hiss: oblique angle between cardia and oesophagus - anatomical barrier
Oesophageal clearance: any material that gets back into the oesophagus will be rapidly cleared by peristaltic contractions

Question 4

What is a hiatus hernia

Answer 4

herniation of the stomach in to the thorax

Question 5

Are all hiatus hernias symptomatic

Answer 5

No

Question 6

What are the 2 forms of hiatus hernia

Answer 6

Sliding and rolling

Question 7

What is the most common form of hiatus hernia

Answer 7

Sliding

Question 8

How does a hiatus hernia cause reflux

Answer 8

Reducing the LOS pressure
Increasing the TLSORs
Straightening out the angle of Hiss

Question 9

What is a gastric volvulus

Answer 9

When the stomach twitsts on itself causing severe pain and dysphagia

Question 10

Define gastroparesis

Answer 10

Any condition that delays gastric emptying

Question 11

What can increase the gastric volume

Answer 11

Pregnancy, binge drinking, poorly controlled diabetes

Question 12

What can cause an increase n the intra-abdominal pressure

Answer 12

Pregnancy
Obesity
Chronic cough

Question 13

What increases the gastric acid production in the stomach

Answer 13

Smoking
eating fat and calorie rich foods
binge drinking
regular use of NSAIDs

Question 14

What are some of the clinical features of GORD

Answer 14

Heartburn
Fluid/ Food regurgitaiton
Waterbrash
Nocturnal cough 
Chest pain
Dysphagia or odynophagia

Question 15

What is the first line investigation

Answer 15

Endoscopy

Question 16

What is helpful if surgery is being considered

Answer 16

24 h pH measurement

Question 17

What is helpful if surgery is being considered

Answer 17

24 h pH measurement

Question 18

What is oesophagitis

Answer 18

Endoscopic change ranging from minor erythmea to frank ulceration and stricturing

Question 19

What does an oesophageal stricture result in

Answer 19

Narrowing of the distal oeosphagus following repeated peptic ulceration and scarring

Question 20

How does an oesophageal stricture present

Answer 20

Dysphagia

Question 21

What is the treatment for an oesophageal stricture

Answer 21

Endoscopic dilatation and long term PPIs

Question 22

What is Barrett’s oesophagus

Answer 22

A metaplasia of distal oesophageal mucosa from squamous to columnar epithelium caused by an adaptive response to chronic acid exposure

Question 23

Barrett’s oeosphagus is usually symptomatic. True or False.

Answer 23

False. It is usually asymptomatic

Question 24

What are 4 risk factors for Barrett’s oesophagus developing into carcinoma

Answer 24

White males
OVer 50 year olds
Obese
Smokers

Question 25

How is a diagnosis of Barrett's oesophagus made

Answer 25

BAsed on mucosal appearances and histology

Question 26

What are the treatment options for Barrett's oeosphagus

Answer 26

Endoscopic ablation through photodynamic therapy - has lots of side effects

Question 27

What might be considered when high-grade dysplasia is observed

Answer 27

Oesophagectomy

Question 28

What are the 2 main forms of conservative management for GORD

Answer 28

Lifestyle modification - weight loss, smoking cessation, elevation of bed head, avoiding fatty meals before bed Antacids - provide symptoms relief

Question 29

What are the 2 main medical ways of managing GORD

Answer 29

H2 receptor antagonists- need to be taken less frequently than anatacids but are just as effective PPI - achieve symptom relief - they also heal oesophagitic mucosa

Question 30

Who is laparoscopic or open fundoplication suitable for

Answer 30

Patients with large hiatus hernias

Question 31

What is corrosive ingestion

Answer 31

Deliberate self-harm through ingestion of bleach or battery acid

Question 32

What is the management for corrosive infestion

Answer 32

Analgesia Antiemetics NBM

Question 33

What is the major risk with corrosive ingestion

Answer 33

Oesophageal perforation

Question 34

What drugs cause drug induced oeopshageitis

Answer 34

NSAIDs potassium supplements bisphosphonates

Question 35

What should be considered for patients with known strictures

Answer 35

Liwuid or paarenteral preparations

Question 36

What is achalasia

Answer 36

Failure of propagation of peristalsis in the body of the oeosophagus Progressive dilatation of the body of the oesophagus Failure of relaxation of the LOS High pressure LOS

Question 37

What is the cause of achalasia

Answer 37

THe degeneration of the ganglia in the distal oesophagus and LOS

Question 38

What are the clinical features of achalasia

Answer 38

``` Dysphagia (for solids) Heartburn Chest pain Regurgitation (late disease) Pulmonary aspiration (late disease) ```

Question 39

What is commonly seen in a CXR of achalasia

Answer 39

Bird beak appearance

Question 40

What is the endoscopic management for Achalasia

Answer 40

Forced pneumatic dilatation | LOS botulinium toxin injection

Question 41

What types of operation indicated for young patients or those requiring multiple dilatations

Answer 41

Heller's myotomy

Question 42

What does diffuse oesophageal spasm typically present with

Answer 42

Angina like chest pain in middle age

Question 43

What is required for the diagnosis of difffuse oeosphageal spasm

Answer 43

Oesophageal manometry and 24hour pH

Question 44

Gastrointestinal stromal tumours (GISTs) are malignant tumours. True or false

Answer 44

False - they are benign lesions

Question 45

What is the treatment for GISTs

Answer 45

None - the do not cause symptoms

Question 46

What are the 2 different types of oesophageal carcinoma

Answer 46

Adenocarcinoma and Squamous carcinoma

Question 47

Where does adenocarcinoma typically appear in the oesophagus

Answer 47

Lower third (barrett's oesophagus)

Question 48

is the incidence of adenocarcinoma increasing or decreasing

Answer 48

Increasing

Question 49

Where does squamous carcinoma typically appear in the oesophagus

Answer 49

Anywhere along the oesophagus

Question 50

What are the risk factors for squamous carcinoma

Answer 50

``` Smoking alcohol betel nut tobacco chewing achalasia post circoid web coeliac and post corrosive ingestion ```

Question 51

What are the clinical features of oesophageal carcinoma

Answer 51

``` Painless, rapidly pregressive dysphagia weight loss chest pain hoarse voice coughing after swallowing ```

Question 52

What should be looked for during examination

Answer 52

Cervical nodes

Question 53

What are the investigations for oesophageal carcinoma

Answer 53

Upper GI endoscopy Barium swallow CT of the thorax and abdomen Endoscopic ultrasound

Question 54

What is the management for oesophageal carcinoma

Answer 54

30% have operable disease - oesophagectomy or preoperative chemo 70% have inoperable: palliation of dysphagia palliation of pain squamous cancers: radiotherapy Provision of nutritional supplementation

Question 55

What is the prognosis for oesophageal carcinoma

Answer 55

Overall 5 year survival is

Question 56

What is a pharyngeal pouch also known as

Answer 56

Zenker's diverticulum

Question 57

If Zenker's diverticulum is suspected, what is the first line investigation

Answer 57

Barium swallow

Question 58

Males are affected by eosiniphilic oesophagitis twice as often as females. True or false

Answer 58

True

Question 59

What are the 2 age peaks for eosinophilic oesophagitis

Answer 59

children and early 30s

Question 60

What is a Schatzkis's ring

Answer 60

A cricumferential narrowing in the mid or lower third of the oesophagus

Question 61

What is Plummer-Vinson syndrome

Answer 61

When iron-deficiency anaemia is associated with an oesophageal web

Question 62

What is a Mallory-Weiss Tear

Answer 62

A cause of haematemesis . Is is caused by recurrent retching or forceful vomiting (typically after alcohol binges) resulting in mucosal tear of the oesophogastric junction

Question 63

What is the characteritic history of a Mallory-Weiss tear

Answer 63

That the initial vomit did not contain blood

Question 64

What is the treatment for a Mallory-Weiss tear

Answer 64

Most settle spontaneously | Acid suppression and endoscopic therapy are rarely necessary