Dysphagia

Question 1

Dysphagia linked to oesophageal cancer

Answer 1

Weight loss
Anorexia
Vomiting
Past hx of Barrett’s, GORD, excessive smoking/alcohol

Question 2

Features of oesophagitis

Answer 2

History of heartburn

Odynophagia but no weight loss and systemically well

Question 3

Features of oesophageal candidiasis

Answer 3

History of HIV/risk factors such as steroid inhaler use

Question 4

Features of achalasia

Answer 4

Dysphagia of both liquids and solids from the start
Heartburn
Regurgitation of food - may lead to cough, aspiration pneumonia etc

Question 5

Features of pharyngeal pouch

Answer 5

Older men
Gurgles on palpation if large enough
Dysphagia, regurg, aspiration and chronic cough

Halitosis

Question 6

Features of systemic sclerosis

Answer 6

Calcinosis, raynaud’s phenomenon, oesophageal dysmotility, sclerodactyly, telangiectasia

Question 7

Extrinsic causes of dysphagia

Answer 7

Mediastinal masses

Cervical spondylosis

Question 8

Intrinsic causes of dysphagia

Answer 8

Tumours
Strictures
Oesophageal web
Schatzki rings

Question 9

Neurological causes of dysphagia

Answer 9

CVA
Parkinson's disease
Multiple Sclerosis
Brainstem pathology
Myasthenia Gravis

Question 10

what is Plummer Vinson syndrome

Answer 10

dysphagia (secondary to oesophageal webs)
glossitis
iron-deficiency anaemia

Treatment - iron supplementation and dilation of webs

Question 11

Most common type of oesophageal cancer

Answer 11

Adenocarcinoma in UK/US

SCC most common in developing world

Question 12

Location of oesophageal adenocarcinoma

Answer 12

Lower third - near the gastroesophageal junction

Question 13

Risk factors for adenocarcinoma

Answer 13

GORD
Barrett's oesophagus
smoking
achalasia
obesity

Question 14

Location of oesophageal SCC

Answer 14

Upper two-thirds of oesophagus

Question 15

Risk factors for oesophageal SCC

Answer 15

smoking
alcohol
achalasia
Plummer-Vinson syndrome
diets rich in nitrosamines

Question 16

Diagnosis of oesophageal cancer

Answer 16

Upper GI endoscopy
Endoscopic ultrasound for loco regional staging
CT chest, abdo and pelvis

Question 17

Treatment of oesophageal cancer

Answer 17

Surgical resection - ivar-lewis type oesophagectomy

Adjuvant chemotherapy

Question 18

IX for achalasia

Answer 18

Oesophageal manometry (excessive LOS tone which doesn’t relax on on swallowing)

barium swallow(bird beak)

CXR

Question 19

Treatment for achalasia

Answer 19

pneumatic (balloon) dilation

Surgical intervention with a Heller cardiomyotomy for recurrent symptoms

Question 20

Diagnosis of boerhaave’s syndrome

Answer 20

CT contrast swallow

Question 21

What is boerhavve’s syndrome as a result of

Answer 21

Boerhaave’s syndrome is a spontaneous rupture of the oesophagus that occurs as a result of repeated episodes of vomiting.

Question 22

Mx of boerhavve’s syndrome

Answer 22

thoracotomy and lavage, if less than 12 hours after onset then primary repair is usually feasible, surgery delayed beyond 12 hours is best managed by insertion of a T tube to create a controlled fistula between oesophagus and skin.