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GI: Oesophagus > Inflammatory Disorders of the Oesophagus > Flashcards

Inflammatory Disorders of the Oesophagus Flashcards

1
Q

can be ___ or ____ with acute being ____

A

acute, chronic , rare

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2
Q

what are the three types of acute oesophagitis?

A

heartburn

corrosive following chemical ingestion

infections

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3
Q

infections of the oesophagus are rare except in those who are ______

A

immunocompromised

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4
Q

give three examples of the infective organisms of the oesophgus

A

candidiasis oesophagitis, herpes oesophagitis, CMV (cytomegalovirus) oesophagitis

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5
Q

chronic oesophagitis is more common - what are the chronic inflammatory conditions 2

A
  • reflux disease

- rare causes include crohn’s disease

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6
Q

With chronic inflammation of any kind there is always an increased risk of _____

A

neoplasia

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7
Q

reflux oesophagitis is inflammation of the oesophagus due to ______ ____ ____ ______ content.

A

This is inflammation of the oesophagus due to refluxed low pH gastric content.

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8
Q

what may happen to the oesophagus if reflux is prolonged? 3

A

it may cause oesophagitis, benign oesophageal strictures (because of the scar formation) or barrett’s oesophagus (pre-malignancy)

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9
Q

what are some of the causes of reflux oesophagitis? 4

A
  • May be due to defective sphincter mechanism ± hiatus hernia
  • Abnormal oesophageal motility
  • Increased intra-abdominal pressure
  • can have over-secretion of acid
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10
Q

what things cause increased intra-abdominal pressure which can cause reflux oesophagitis? 3

A
  • pregnancy
  • more commonly in those who are overweight
  • weight lifters
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11
Q

what can cause oversecretion of acid which may be responsible for relux disease? 2

A

smoking and alcohol

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12
Q

pathophysiology of reflux oesophagitis : Reflux causes cell damage to the _____ _____ ______. The cell loss causes compensatory _____ ____ ______ along with influx of intraepithelial _____,_____ and _______

A

Reflux causes cell damage to the superficial squamous epithelium. The cell loss causes compensatory basal cell hyperplasia along with influx of intraepithelial neutrophils, lymphocytes and eosinophils

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13
Q

what are the symptoms of reflux oesophagitis? 4

A
  • discomfort or pain retrosternally
  • mimic cardiac symptoms because of oesophageal muscle spasm
  • odontophagia
  • reflux bronchitis causing a cough- if acid goes further up
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14
Q

what are some characteristics of pain caused by reflux disease? 4

A

After meals, lying, stooping or straining and relieved by antacids

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15
Q

what is odontophagia?

A

painful swallowing from oesophagitis or ulceration

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16
Q

what are the complications of reflux oesophagitis? 4

A
  • ulceration
  • stricture
  • iron-deficiency
  • barrett’s oesophagus
17
Q

what is the commonest complication of reflux oesophagitis?

A

ulceration

18
Q

what are the 4 grades of ulceration in reflux oesophagitsi?

A

1: tiny erosions - less than 5 mm
2: greater than 5mm in length
3: less than 75% of the circumference of the oesophagus is involved
4: over 75%

19
Q

why do strictures develop in reflux oesophagitis?

A

from scar formation and contraction

20
Q

what is barrett’s oesophagus?

A

a metaplasia involving the repleacement of stratified squamous epithelium by columnar epithelium

21
Q

what tests are carried out in reflux oesophagitis?

A

Endoscopy

Barium swallow may show hiatus hernia

22
Q

when is an endoscopy performed in reflux oesophagitis?

A

Endoscopy if:

Symptoms >4 wks, persistent symptoms

weight loss

23
Q

what are the two treatment options in reflux oesophagitis?

A

Can physically repair the defect e.g. the valve can be tightened - solves the problem but there are risks with surgery

Can use acid blocking medication

24
Q

what are the options for acid block in reflux oesophagitis?

A
  • H2 receptor antagonists
  • PPI
  • Antacids
25
Q

why are H2 receptor antagonists good in the short term but not the long term?

A

This is because gastrin and ACh also control acid production as well as histamine and so the body compensates for the histamine blockage by up regulating the ACh and gastrin mechanisms
If you then stop the H2 antagonists then acid production may be paradoxically high

26
Q

PPIs - they are not just good for controlling ____ but are also useful _____ acid related _____.
They need to be taken at ____ _____

A

They are not just good for controlling symptoms but are also useful in preventing acid related damage
They need to be taken at specific times

27
Q

what are people on PPIs at slightly higher risk of?

A

gastroenteritis

28
Q

antacids only treat ____ so dont prevent ______

A

symptoms, complications

29
Q

barrett’soesophagus is a _____ response and may be due to differentiation from oesophageal ___ cells

A

protective, stem

30
Q

histologically what three basic patterns may be seen on the columnar epithelium in barrett’s oesophagus ?

A
  • Junctional (resembling gastric cardia)
  • Gastric fundic (including acid and pepsin-secreting cells)
  • Intestinal (with small intestinal type goblet cells)
31
Q

how is a diagnosis of barrett’s made?

A

Mainly endoscopically but histopathology is used to make sure it has not become dysplastic

32
Q

what are the complications of barretts’

A

high risk that it will develop into dysplasia and carcinoma of the oesophagus

mucosa requires surveillance

33
Q

allergic oesophagitis is also knwon as ______ oesophagitis

A

eosinophilic

34
Q

when should you suspect allergic oesophagitis

A

If patients don’t get better from antireflux therapy or surgery then you have to think of another reason for the acid

35
Q

what is allergic oesophagitis associated with?

A 
Atopy 
personal/family history of allergy 
Asthma 
Young people 
males> females
36
Q

in allergic oesophagitis the pH probe would be ___ for reflux, would have increased ____ in the blood and a ___ or _____ looking oesophagus

A

negative, eosinophils, corrugated or spotty

37
Q

what are the treatment options for allergic oesophagitis ?

A

steroids - dont really want to give these to kids

cromoglycate

montelukast

GI: Oesophagus (3 decks)

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