Oesophageal conditions

Question 1

what are the two main ways which cause oesophageal conditions ?

Answer 1

mechanical obstruction
mucosal disruption

Question 2

what is oesophageal varies ?

Answer 2

when you get abnormal enlarged veins in the oesophagus

Question 3

why does oesophageal varices occur and what is the main cause of it ?

Answer 3

due to portal hypertension
mainly caused by liver cirrhosis

Question 4

what is portal hypertension ?

Answer 4

shunting of blood in anastomoses

Question 5

what are clinical features pf oesophageal varices ?

Answer 5

cirrhosis/chronic liver disease
rupture haematemesis
large volumes of dark red blood

Question 6

how would you diagnosis oesophageal varices ?

Answer 6

endoscopy

Question 7

how would you manage ruptured oesophageal varices ?

Answer 7

ABC + correct clotting (before endoscopy)

Terlipressin (vasoactive)

endoscopic variceal bad ligation

sengtaken - Blakemore (tube)

TIPS (shunt)

Question 8

what is Mallory-Weiss tear ?

Answer 8

tear of tissue of the tissue of the lower oesophagus

Question 9

what is Mallory-Weiss caused by ?

Answer 9

prolonged and vigorous retching and vomiting

Question 10

who is a risk factor for Mallory-Weiss tear ?

Answer 10

alcoholics

Question 11

what are clinical features of Mallory-Weiss tear ?

Answer 11

haematemesis (vomiting blood) after an episode of forceful or recurrent retching, vomiting, coughing or straining

Question 12

how would you diagnose mallory-Weiss tear ?

Answer 12

upper GI endoscopy

Question 13

how would you manage Mallory-Weiss tear ?

Answer 13

mostly self limiting so treatment is generally supportive

Question 14

What is GORD and what does it stand for ?

Answer 14

Gastro-esophageal reflux disease

back flow of acid and stomach contents into esophagus

Question 15

what is GORD mostly caused by ?

Answer 15

an incomponent lower oesophageal sphincter ( where sphincter fails to close)

Question 16

what are clinical features of GORD?

Answer 16

heartburn (epigastric pain) , nausea with or without vomiting, dysphagia

Question 17

how would you investigate for GORD (4) ?

Answer 17

endoscopy
barium swallow (esophagogram test)
oesophageal manometry
24 hr pH monitoring

Question 18

how would you manage GORD?

Answer 18

antacids e.g. gaviscon (over the counter)
Proton Pump Inhibitor - 1st line
H2-receptor antagonists - 2nd line

Question 19

what complications can GORD cause ?

Answer 19

strictures
oesophagitis
Barretts oesophagus

Question 20

what are main PPI ?

Answer 20

(end in -zole)
lansoprazole
omeprazole

Question 21

what are the main H2-receptor antagonists ?

Answer 21

(end in -tidine)
nizatidine
famotidine

Question 22

what is achalasia ?

Answer 22

failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter

Question 23

what causes achalasia ?

Answer 23

degenerative loss of ganglia from aurbach’s plexus

Question 24

what are clinical features of achalasia ?

Answer 24

heartburn
nausea with or vomiting
dysphagia (food and liquid)

Question 25

how would you investigate achalasia ?

Answer 25

oesophageal manometry (confirms) barium swallow would show BIRD BEAK APPEARANACE

Question 26

how would you manage achalasia ?

Answer 26

pneumatic (ballon) dilation - 1st line Heller cardiomyopathy - 2nd line ( or recurrent/persistent symptoms)

Question 27

what is oesophageal manometery ?

Answer 27

a tube that measure LOS pressure while patient sips water

Question 28

what is esophagitis ?

Answer 28

inflammation that may damage damage tissue of the oesophagus

Question 29

what causes esophagitis (4) ?

Answer 29

infection reflux allergic (eosinophilic) drug induced

Question 30

what are the symptoms of esophagitis ?

Answer 30

painful swallowing (odynophagia) difficult swallowing (dysphagia) chest pain (heartburn)

Question 31

what are the two types of esophagitis ?

Answer 31

reflux oesophagitis esophagitis (eosinophilic)

Question 32

how do you diagnose reflux oesphagitis and what would it show ?

Answer 32

upper endoscopy shows signs of erosion

Question 33

how would you manage reflux oesophagitis ?

Answer 33

PPI - 1st line

Question 34

what are main complications of reflux oesophagitis ?

Answer 34

ulceration stricture barretts oesophagus

Question 35

what is esophagitis (eosinophilic) associated with ?

Answer 35

asthma atopic dermatitis food allergies

Question 36

how would you diagnose esophagitits ( eosinophillic) and what does it show ?

Answer 36

upper endoscopy with biopsy shows presence of eosinophils and signs of trachealization

Question 37

how would you manage esophagitis (eosinophilic) ?

Answer 37

PPI + dietary advice

Question 38

what is the main complication of eosophagitis (eosinophilic) ?

Answer 38

stricture

Question 39

what is barretts oesophagus ?

Answer 39

metaplasia (transformation) of the lower oesophageal mucosa

Question 40

what causes barretts oesophagus and what is a big risk factor ?

Answer 40

chronic oesophageal injury from chronic reflux of gastric content GORD is a big risk factor

Question 41

what are clinical features of Barrett's oesophagus ?

Answer 41

often asymptomatic patients often have coexistent GORD symptoms

Question 42

how would you investigate for Barretts oesophagus and what does it show ?

Answer 42

endoscopy it would show columnar epithelium (with goblet cells)

Question 43

how would you manage Barretts oesophagus ?

Answer 43

PPI endoscopic surveillance

Question 44

what would you do if Barretts oesophagus has a dysplastic change ?

Answer 44

radio frequency ablation

Question 45

what are the two main types of oesophageal cancer ?

Answer 45

squamous cell carcinoma (upper/middle) - 90% adenocarcinoma (lower)

Question 46

what are social risk factors for oesophageal cancer ?

Answer 46

smoking, alcohol, hot drinks

Question 47

what are associated conditions of oesophageal cancer ?

Answer 47

GORD Barretts oesopphagus metabolic syndrome

Question 48

what are clinical features of oesophageal cancer ?

Answer 48

hallmark feature is dyshagia weight loss hoarseness haematemesis

Question 49

how would you investigate for oesophageal cancer ?

Answer 49

upper GI endoscopy with biopsy

Question 50

how would manage oesophageal cancer ?

Answer 50

surgical resection

Question 51

what is the main cancer type associated with Barretts ?

Answer 51

adenocarcinoma