Case 1 - barrett's oesophagus Flashcards

1
Q

what is Barrett’s oesophagus a complication of

A

long term oesophageal reflux

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2
Q

what does it look like

A

a bit like white pasty finger like projections coming up from the bottom of the oesophagus

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3
Q

what is Barrett’s defined by

A

> 3cm of columnar epithelium present at the bottom of the oesophagus

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4
Q

what are the two mechanisms that could explain this

A
  1. some argue that it is the migration of the epithelium of the bottom 2cm of the oesophagus further up the lumen - i.e the migration of essentially the gastric epithelium
  2. others would say that as both squamous and columnar epithelium are derived from the same stem cells, it is just perhaps a change in the intra-luminal conditions that determine what those stem cells develop into; more acidic conditions will cause a columnar epithelium to form. the second idea is more popular
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5
Q

what percentage of patients who have an endoscopy for reflux symptoms is it found in

A

10%

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6
Q

what is it seen as endoscopically

A

seen as a pinker/redder epithelium as opposed to the whiter epithelium that lines the rest of the oesophagus. at first it may just extend up as thin bands of epithelium, but later it may encircle the entire lower oesophagus.

on microscopic examnation, the cells resemble those of the stomach, however they secrete intestinal like mucins, and as a result, Barrett’s oesophaagus is actually a form of intestinal metaplasia

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7
Q

when does metaplasia normally occur

A

as a result of an environmental factor. it is when an existing epithelium is replaced by a different one; one that now has an advantage due to the change in environmental conditions

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8
Q

what is it a major risk factor for

A

oesophageal adenocarcinoma

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9
Q

what is Barrett’s described as

A

a ‘premalignant condition’ and patients who have it are at 100 times greater risk of cancer than the gen pop. this however, is still a relatively small risk overall and as such the patients overall risk of getting any cancer is still about 2-3%

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10
Q

who is Barrett’s more commonly associated with

A

men >50

increased risk due to smoking but not drinking

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11
Q

what does treatment and anti-reflux medicine do

A

absolutely fuck all - does not lead to recession

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