Oesophagus diseases

Question 1

What is oesophagitis

Answer 1

Inflammation of the oesophagus due to refluxed low pH gastric contents

Question 2

Which is more common: acute or chronic oesophagitis

Answer 2

chronic

Question 3

What are the risk factors for reflux oesophagitis (3)

Answer 3

defective lower oesophageal sphincter
Abnormal oesophageal motility
Increased intra-abdominal pressure

Question 4

What are potential complications of oesophagitis (4)

Answer 4

ulceration
Haemorrhage
Stricture
Barrett’s oesophagus

Question 5

What signs aid diagnosis of eosinophilic oesophagitis (2)

Answer 5

PH probe is negative for reflux
Increased eosinophils in blood

Question 6

What drugs are used to manage eosinophilic oesophagitis (2)

Answer 6

PPI
Steroids

Question 7

What non-pharmacological measures can be used to manage eosinophilic oesophagitis (2)

Answer 7

Avoidance of allergens
Dilation of strictures/stenosis

Question 8

What is Barrett’s oesophagus

Answer 8

when there is Metaplasia of cells within the oesophagus from squamous to columnar epithelium

Question 9

what causes Barrett’s oesophagus

Answer 9

Due to persistent reflux of acid/bile
Metaplasia occurs as a protective mechanism against the acid

Question 10

What does Barrett’s oesophagus increase the risk of (2)

Answer 10

Developing dysplasia
Developing carcinoma

Question 11

What are the risk factors for Barrett’s oesophagus (4)

Answer 11

Chronic GORD
Smoking
Obesity
Family history

Question 12

How can Metaplasia occur in Barrett’s oesophagus (3)

Answer 12

molecular reprogramming of oesophageal progenitor cells
Transdifferentiation
Migration of gastric progenitor cells

Question 13

What is used to manage Barrett’s oesophagus

Answer 13

radiofrequency ablation

Question 14

What are the possible complications of Barrett’s oesophagus (5)

Answer 14

Chest pain
Dysphagia
Strictures
Bleeding
Perforation

Question 15

What are the types of benign oesophageal sphincters (5)

Answer 15

squamous papilloma
Leiomyomas
Lipomas
Fibrovascular polyps
Granular cell tumour

Question 16

Describe squamous papilloma (3)

Answer 16

associated with HPV
Forms papillae
Asymptomatic

Question 17

What are the types of malignant oesophageal tumours (2)

Answer 17

Squamous cell carcinoma
Adenocarcinoma

Question 18

Which oesophageal tumour type is associated with Barrett’s oesophagus

Answer 18

adenocarcinoma

Question 19

Describe the pathogenesis of adenocarcinoma (4)

Answer 19

chronic reflux oesophagitis
Barrett’s oesophagus
Dysplasia
Adenocarcinoma

Question 20

Clinical presentation of oesophageal tumours

Answer 20

Dysphagia, odynophagia
Persistent indigestion/heartburn
Vomiting/regurgitation of food
Loss of appetite/weight loss
Epigastric/chest/back pain
Anaemia
Lethargy
Malaise
Hoarse voice

Question 21

What investigations are used for oesophageal tumours (3)

Answer 21

Endoscopy
CT chest abdomen and pelvis
CT PET

Question 22

What are examples of haemorrhaging conditions affecting the oesophagus (2)

Answer 22

Mallory Weiss tear
Oesophageal varices

Question 23

What causes a Mallory Weiss tear

Answer 23

Prolonged/recurrent vomiting

Question 24

Describe a Mallory Weiss tear (3)

Answer 24

a tear in the oesophagus which results in haemorrhage
The tear is longitudinal and affects superficial mucosa
The tear usually occurs at the gastro-oesophageal junction

Question 25

Describe oesophagus varies (2)

Answer 25

enlarged and weakened veins in the oesophagus which can rupture and cause massive GI haemorrhage

Question 26

What condition are oesophageal varices associated with

Answer 26

Portal hypertension

Question 27

What are symptoms of acid peristalsis (2)

Answer 27

Dysphagia Reflux

Question 28

What are the diagnostic criteria for absent peristalsis (2)

Answer 28

no contractions Normal oesophageal sphincter relaxation

Question 29

How is absent peristalsis treated (2)

Answer 29

acid suppression Dietary and lifestyle modification

Question 30

What are the types of oesophageal dysmotility (4)

Answer 30

absent peristalsis Jackhammer oesophagus Distal oesophageal spasms Achalasia

Question 31

What are the symptoms of jackhammer oesophagus (2)

Answer 31

dysphagia Retro sternal pain

Question 32

How is jackhammer oesophagus managed (2)

Answer 32

botulinum toxin injection. POEM

Question 33

What are the symptoms of distal oesophageal spasms (2)

Answer 33

dysphagia Retro sternal pain

Question 34

What are the diagnosis criteria for distal oesophageal spasms (3)

Answer 34

Norma lower oesophageal sphincter contraction Premature contractions Impaired inhibitory innervation

Question 35

How are distal oesophageal spasms managed (2)

Answer 35

nitrates Calcium channel blockers

Question 36

Describe the pathophysiology of achalasia (3)

Answer 36

lower oesophageal sphincter fails to relax Peristalsis is absent Functional obstruction of the lower oesophageal sphincter (stasis, dilation)

Question 37

What are the symptoms of achalasia (4)

Answer 37

dysphagia Regurgitation Weight loss Chest pain

Question 38

What investigations are used for achalasia (3)

Answer 38

CXR Barium swallow OGD

Question 39

What risk increases with achalasia

Answer 39

risk of squamous cell carcinoma

Question 40

What is a distinct feature of type one achalasia

Answer 40

simultaneous contractions of low amplitude

Question 41

What is a distinct feature of type two achalasia

Answer 41

Pan oesophageal pressurisation

Question 42

What is a distinct feature of type three achalasia

Answer 42

Premature spastic contractions

Question 43

What medical treatments exist for achalasia (2)

Answer 43

nitrates Calcium channel blockers

Question 44

What endoscopic treatments exist for achalasia (3)

Answer 44

Botulinum toxin Balloon dilation POEM

Question 45

What surgical treatment exists for achalasia

Answer 45

Heller’s myotomy

Question 46

If a patient presents with progressive dysphagia (can only swallow fluids) and an endoscopy shows smooth narrowing in the oesophagus above a hiatus hernia, what is the likely diagnosis

Answer 46

Benign oesophageal stricture

Question 47

If a patient presents with dysphagia, with no abnormalities found on endoscopy, and manometers showing peristaltic contractions in the oesophagus with a raised LOS pressure, what is the likely diagnosis

Answer 47

Achalasia

Question 48

If a patient presents with 6months of progressive dysphagia (fluids only), weight loss, history of reflux and Barrett’s oesophagus, what is the most likely diagnosis

Answer 48

malignant oesophageal stricture