GI - oesophagus Flashcards
what are some causes of acute oesophagitis (rare)
corrosive following chemical ingestion
infective in immunocompromised
what are some causes of chronic oesophagitis (common)
reflux disease e.g. GORD
defective sphincter
hiatus hernia
pregnancy
what is the histology of oesophagitis
basal zone epithelial expansion (hyperplasia) - increased proliferation
intraepithelial neutrophils, lymphocytes and eosinophils
what are some complications of oesophagitis
ulceration
haemorrhage
stricture
barretts oesophagus
“acid abuse accompanied by eosinophils”
oesophagitis
what is barrett’s oesophagus
replacement of stratified squamous epithelium with metaplastic columnar epithelium with goblet cells (like intestine)
what cause barrett’s oesophagus
prolonged exposure of normal oesophagus to GORD —> mucosal inflammation and erosion
is barrett’s oesophagus spontaneous or patchy
either
what is seen in barrett’s oesophagus macroscopically
red velvety mucosa in lower oesophagus
what is seen in barrett’s oesophagus microscopically
columnar lined mucosa with interstitial metaplasia
what is the treatment of barrett’s oesophagus
annual endoscopy + biopsy
PPIs
why must barrett’s oesophagus be monitored
increased risk of dysplasia –> carcinoma
what is allergic oesophagitis
immune mediated oesophagitis caused by reaction to food
what kind of immune cell infiltrate is there in allergic oesophagitis
eosinophils
what does the oesophagus look like in allergic oesophagitis
corrugated feline or spotty oesophagus
looks like trachea
who is at risk of allergic oesophagitis
males > females
Hx Asthma / Fmhx asthma
young
what would a pH probe for allergic oesophagitis show
negative for reflux
what does achalasia show on a barium swallow
birds beak appearance with proximal dilation
dilated tapering oesophagus
what is achalasia
disordered oesophageal motility
with inability to relax the LOS
due to degeneration of myenteric plexus
what are some s/s of achalasia
dysphagia for solids and liquids
regurgitation
substernal cramps
weight loss
what does achalasia increase risk of
oesophageal squamous cell carcinoma
what are some causes of achalasia
Chaga’s
reduced secretion of NO
what is the treatment for achalasia
endoscopic balloon dilation
Heller’s cardiomyotomy + PPI
CCBs and nitrates to relax sphincter
what is the most common cause of death due to cirrhosis
oesophageal varices
how do oesophageal varices present
painless haematemesis
what are oesophageal varices
abnormally dilated oesophageal veins arising secondary to portal hypertension
when should oesophageal varices be suspected
alcohol abuse
cirrhosis
- looks for signs of cirrhotic liver disease e.g. encephalopathy, splenomegaly, ascites
what is the prophylactic treatment of oesophageal varices
non-selective BB e.g. propranolol
repeat endoscopic banding ligation
what is the treatment of oesophageal varices after 1st variceal bleed
TIPSS
what does TIPSS stand for
transjugular intrahepatic portal systemic shunt
what is the treatment of acute variceal bleeding
vitamin K
FFP (fresh frozen plasma)
platelet transfusion
what is a trans-oesophageal fistula
congenital defect where there is a connection between oesophagus and trachea
what are some s/s of a trans-oesophageal fistula
vomiting
polyhydramnios
abdominal distension
aspiration
what is a mallory-weiss tear
painful haematemesis due to oesophageal mucosal tear
what causes a mallory-weiss tear
persistent vomiting
alcoholism
bulimia
what is corkscrew oesophagus
diffuse oesophageal spasm - primary oesophageal motility disorder
what are some s/s of corkscrew oesophagus
dysphagia
chest pain
Ba swallow - abnormal contractions (cork screw oesophagus)
what are some risk factors of a hiatus hernia
female
obese
over 50
what is a sliding hiatus hernia
gastrooesophageal junction slides up into the chest
–> acid reflux
what is a rolling hiatus hernia
gastrooesophageal junction remains in the abdomen but a bulge of stomach herniates into chest alongside oesophagus (paraoesophagheal)
how is a hiatus hernia diagnosed
barium swallow
how is a hiatus hernia treated
lose weight
treat reflux symptoms
