Esophageal Disorders

Question 1

What vertebral levels does the esophagus begin and end?

Answer 1

C6 - T11/12

Question 2

What muscles perform esophageal peristalsis?

Answer 2

Esophageal circular muscles

Question 3

What is significant about the pressure of the distal smooth muscle of the Lower Esophageal Sphincter?

Answer 3

It has a high resting pressure

Question 4

What are the 2 most important symptoms of esophageal disease?

Answer 4

Heartburn

Dysphagia

Question 5

Where anatomically is heartburn felt?

Answer 5

Retrosternally

Question 6

What is the cause of heartburn?

Answer 6

Reflux of acidic or bilious gastric contents into the esophagus

Question 7

What does effect does decreasing the pressure of the Lower Esophageal Sphincter have on reflux/heartburn?

Answer 7

It increases reflux/heartburn

Question 8

Give examples of substances that can reduce Lower Esophageal Sphincter pressure? (3)

Answer 8

Alcohol
Nicotine
Dietary Xanthines (coke, coffee, chocolate)

Question 9

What condition can persistent heartburn and reflux lead to?

Answer 9

Gastro-oesophageal reflux disease (GORD)

Question 10

What is Dysphagia?

Answer 10

Difficulty in swallowing

Question 11

What is Odynophagia?

Answer 11

Pain with swallowing

Question 12

What are the 5 main causes of oesophageal dysphagia?

Answer 12

Benign stricture (oesophageal web)
Malignant stricture (oesophageal cancer)
Motility disorders (achalasia)
Eosinophilic oesophagitis
Extrinsic compression (eg in lung cancer)

Question 13

What are the 3 types of investigation that could be used to diagnose oesophageal disease?

Answer 13

Endoscopy
Contrast radiology (barium swallow)
Oesophageal pH and manometry

Question 14

What are the 2 main endoscopy procedures that can be used to diagnose oesophageal disease?

Answer 14

Oesophago-Gastro-Duodenoscopy (OGD)

Upper GI Endoscopy (UGIE)

Question 15

An example of a hypermotility oesophageal disorder is “diffuse oesophageal spasm”.
How does this condition appear on a barium swallow image?

Answer 15

Has a corkscrew appearance

Question 16

What is the clearest indicative symptom of diffuse oesophageal spasm and what symptom could possibly accompany this?

Answer 16

Severe, episodic chest pain (with or without dysphagia)

Question 17

What 3 conditions is hypomotility of the oesophagus associated with?

Answer 17

Connective tissue disease
Diabetes
Neuropathy

Question 18

What effect can hypomotility have on the Lower Oesophageal Sphincter?

Answer 18

Causes LOS mechanism failure leading to heartburn, reflux and loose dilated oesophagus

Question 19

What is Achalasia?

Answer 19

A motility disorder in which there is a degeneration of myenteric plexus ganglion cells in the distal oesophagus and LOS

Question 20

What is the cardinal feature for Achalasia?

Answer 20

LOS fails to relax

Question 21

What are 5 symptoms of Achalasia?

Answer 21

Progressive dysphagia
Weight loss
Chest pain
Regurgitation
Chest infection

Question 22

What can Achalasia result in?

Answer 22

Functional obstruction of the oesophagus

Question 23

What 2 pharmacological treatments can be given to treat Achalasia?

Answer 23

Nitrates

CCBs

Question 24

What are the 3 interventional treatments that can be taken to treat Achalasia

Answer 24

Botulinum toxin
Pneumatic balloon dilation
Myotomy

Question 25

What is the Gastro-Oesophageal Reflux Disease usually due to?

Answer 25

Pathological acid and bile exposure in the lower oesophagus

Question 26

What are 3 symptoms of GORD (Gastro-Oesophageal Reflux Disease)?

Answer 26

Heartburn Cough Sleep disturbance

Question 27

Name a few risk factors for GORD (Gastro-Oesophageal Reflux Disease)? (6 available)

Answer 27

``` Pregnancy Obesity LOS pressure lowering drugs Smoking Alcoholism Hypomotility ```

Question 28

What is important to note symptomatically in the diagnosis of GORD (Gastro-Oesophageal Reflux Disease)?

Answer 28

Many patients are asymptomatic

Question 29

What is Hiatus Hernia?

Answer 29

When the fundus of the stomach moves proximally through the diaphragmatic hiatus

Question 30

What are the 2 ain types of Hiatus Hernia?

Answer 30

Sliding | Para-oesophageal

Question 31

Which oesophageal condition is often due to Hiatus Hernia?

Answer 31

GORD (Gastro-oesophageal reflux disease)

Question 32

What are the 4 most common complications GORD can lead to?

Answer 32

Ulceration Stricture Carcinoma Glandular metaplasia (Barrett's oesophagus)

Question 33

What is Barrett's esophagus?

Answer 33

Intestinal metaplasia due to prolonged acid exposure in the distal oesophagus

Question 34

How to cells change in the lower oesophagus due to Barrett's oesophagus?

Answer 34

Squamous TO Mucin-secreting columnar

Question 35

What is Barrett's oesophagus a precursor to?

Answer 35

Adenocarcinoma

Question 36

What are the 3 methods of treating Barrett's oesophagus with high grade dysplasia

Answer 36

Endoscopic Mucosal Resection (EMR) Radio-Frequency Ablation (RFA) Oesophagectomy

Question 37

What are the 3 pharmacological treatments for GORD?

Answer 37

Alginates (eg Gaviscon) H2RA (Ranitidine) Proton Pump Inhibitor (Omeprazole)

Question 38

What are the 2 main types of oesophageal cancer?

Answer 38

Squamous Cell Carcinoma | Adenocarcinoma

Question 39

What symptoms do patients with oesophageal cancer present with? (2 main + 6 additional)

Answer 39

Progressive dysphagia Anorexia and Weight loss ``` Chest pain Cough Pneumonia Vocal cord paralysis Haematemesis Odynophagiea ```

Question 40

Where do occluding squamous cell tumours often grow on the oesophagus?

Answer 40

On the surface epithelium

Question 41

What are the 2 most significant risk factors for oesophageal squamous cell carcinoma?

Answer 41

Tobacco | Alcohol

Question 42

Which are og the oesophagus does squamous cell carcinoma occur?

Answer 42

The proximal and middle third of the oesophagus

Question 43

What area of the oesophagus does adenocarcinoma occur?

Answer 43

In the distal oesophagus

Question 44

Where are the 4 most common areas of metastases for oesophageal cancer?

Answer 44

Liver Brain Pulmonary Bone

Question 45

What is the usual priority in oesophageal cancer treatment?

Answer 45

Symptom palliation

Question 46

What are the 4 main treatment options for oesophageal cancer?

Answer 46

Endoscopic (i.e. stent or laser) Chemotherapy Radiotherapy Barchytherapy