Mouth & Oesophagus

Question 1

What are some oral manifestation of Crohn’s disease?

Answer 1

• Oral ulceration
• Mucosal tags
• Cobblestone mucosa
• Swollen lips
• Angular cheilitis

Question 2

What is the most common cancer found in the mouth?

Answer 2

Squamous cell carcinoma

Question 3

What are the two most common cancers in the oesophagus and what causes them?

Answer 3

Adenocarcinoma - caused by reflux disease, Barrett’s oesophagus
Squamous cell carcinoma - caused by smoking and alcohol

Question 4

What are some common signs and symptoms of oesophageal cancer?

Answer 4

Dysphagia
Odynophagia
Haematemesis, regurgitation, dysphonia
Weight loss

Question 5

Give some contraindications of surgery for oesophageal cancer.

Answer 5

Direct invasion of adjacent structures -trachea or bronchus; aorta; pericardium; lung
Fixed cervical lymph nodes
Widespread metastases
Poor medical condition

Question 6

What palliative treatment is available for oesophageal cancer?

Answer 6

Chemotherapy - not very useful
Radiotherapy - used to eradiate narrow part of oesophagus to help swallowing without stent
Stenting

Question 7

What are the three main physiological problems with reflux?

Answer 7

1. The lower oesophageal sphincter valve mechanism doesn’t work as well as it should
2. This is caused by an increased in abdominal pressure, which can be caused by obesity or weight lifting
3. It tends to get worse with age because of degradation of the muscle

Question 8

What treatment is there for reflux/GORD?

Answer 8

PPIs are mos used - e.g. omeprazole
Antacids provide symptomati relief but don’t prevent complications.
Surgery to tighten the valve - carries risk of analgesia
If patients have ongoing problems despite a PPI, reconsider the diagnosis

Question 9

What is the gold standard test for achalasia?

Answer 9

Manometry - tests the pressures in the valve vs oesophagus

Question 10

What is nutcracker oesophagus?

Answer 10

Spasm in the upper oesophagus - very difficult to treat

Question 11

Allergic oesophagitis
What is the inflammatory infiltrate?
Who does it tend to occur in?
Tests?
Treatment?

Answer 11

EOSINOPHILS
FHx of allergy, asthma, young, male, pH pron-ve for reflux
Increased eosinophils in blood
Endoscopy shows corrugated or “spotty” oesophagus
treatment may include steroids; cromoglycate; montelukast

Question 12

What is the most common benign oesophageal tumour?

Answer 12

Squamous papilloma