Oesophageal Disease

Question 1

Acute oesophagitis is more common than chronic oesophagitis. True/False?

Answer 1

False

Question 2

What are some causes of acute oesophagitis?

Answer 2

Chemical abuse -> corrosion

Infection (herpes, candidiasis)

Question 3

What is the main cause of chronic oesophagitis?

Answer 3

Reflux disease [reflux oesophagitis]

Question 4

Define “reflux oesophagitis” (GORD)

Answer 4

Inflammation of the oesophagus due to reflux of acid from the stomach

Question 5

What are the 3 main causes of GORD?

Answer 5

Incompetent LOS
Poor oesophageal motility
Impaired mucosal barrier

Question 6

What is the dominant immune cell that accompanies acid abuse?

Answer 6

Eosinophils

Question 7

Name 3 complications of reflux oesophagitis

Answer 7

Ulceration/bleeding
Stricture formation due to scarring
Barrett’s Oesophagus

Question 8

Define “Barrett’s Oesophagus”

Answer 8

Replacement of stratified squamous epithelium -> columnar epithelium [metaplastic change]

Question 9

How is Barrett’s Oesophagus pre-malignant?

Answer 9

Mucosa becomes unstable, and persistent acid insult increases risk of developing dysplasia and carcinoma

Question 10

What is allergic oesophagitis?

Answer 10

Immune-mediated oesophagitis caused by reaction to food

Eosinophilic infiltrates present

Question 11

Benign oesophageal tumours are rarer than malignant tumours. True/False?

Answer 11

True

Question 12

What is the most common benign oesophageal tumour?

Answer 12

Squamous papilloma

Question 13

What are the two main types of malignant oesophageal tumour?

Answer 13

Squamous cell carcinoma

Adenocarcinoma

Question 14

Squamous cell carcinoma of oesophagus is commoner in males. True/False?

Answer 14

True

Question 15

Where is adenocarcinoma of the oesophagus most likely to develop? Why?

Answer 15

Lower 1/3 of oesophagus

Reflux insult is greatest here

Question 16

What are the 3 main mechanisms of metastasis of oesophageal tumours?

Answer 16

Direct invasion
Lymphatic spread
Haematogenous spread

Question 17

Give examples of symptoms of GORD

Answer 17

Heartburn
Waterbrash (hyper-salivation)
Dysphagia, odynophagia
Reflux
Chest pain

Question 18

What are the main investigations for GORD?

Answer 18

Endoscopy
Barium swallow
Manometry (pressure) studies
Nuclear imaging

Question 19

Name the ALARM Symptoms

Answer 19

Anaemia
Loss of weight
Anorexia
Recent progressive symptoms
Malaena or haematemesis
Swallowing difficulty

Question 20

Antacids provide symptomatic relief and heal oesophagitis in GORD. True/False?

Answer 20

False

Provide symptom relief but no healing or preventative qualities

Question 21

H2 receptor antagonists mainly provide symptomatic relief of GORD; give an example of one

Answer 21

Ranitidine

Question 22

Proton pump inhibitors provide symptomatic relief and heal oesophagitis. True/False? Give an example

Answer 22

True

Omeprazole

Question 23

When is surgery indicated for GORD?

Answer 23

To repair LOS

When PPIs ineffective (cheaper doing surgery than being on PPI for 7+ years)

Question 24

Which investigations are indicated for diagnosing oesophageal cancer?

Answer 24

Endoscopy
Barium meal

CT scan

Question 25

Name some contraindications to surgery for treating oesophageal cancer

Answer 25

Invasion of adjacent structures Widespread metastasis Poor health/lack of fitness Squamous cell carcinoma - usually radiotherapy/chemotherapy

Question 26

What is the likely cause of severe and prolonged vomiting, typically in teenagers?

Answer 26

Mallory Weiss tear - tear of the oesophagus resulting in bleeding

Question 27

What are the most common symptoms of oesophageal cancer?

Answer 27

``` Dysphagia Oydnophagia Hoarseness Upper GI haemorrhage Cough Anaemia Weight loss ```

Question 28

List some risk factors for oesophageal carcinoma

Answer 28

``` Diet Alcohol Smoking Achalasia Reflux +/- Barrets ```

Question 29

What is the immediate management for acute upper GI haemorrhage?

Answer 29

ABC | Endoscopy for cause

Question 30

What is the bleeding risk assessment techniques used in upper GI haemorrhage?

Answer 30

Rockall risk scoring system | Blatchford score

Question 31

What is used in the endoscopic treatment of ulcers?

Answer 31

Adrenaline injection Heater probe coagulation Clips Haemospray

Question 32

What medication is prescribed in the prevention of rebleeding?

Answer 32

Acid supression - IV omeprazole

Question 33

What is the most common cause of acute variceal bleeding?

Answer 33

Portal hypertension - veins in oesopagus, stomach and rectum enlarge to carry blood

Question 34

List the symptoms of acute variceal bleeding?

Answer 34

``` Haematemesis/ malaena Abdo pain Dysphagia Oydnophagia Pallor Shock Jaundice ```

Question 35

What is the progression of treatment in acute variceal bleeding?

Answer 35

Terlipressin - --> Endoscopic variceal ligation (banding) or SB tube (balloon) - --> Sclerotherapy (injection to encourage collapse of BV and clotting) - --> TIPS (join portal to systemic system)

Question 36

What is achalasia? What is the classical sign? How is it treated?

Answer 36

LOS fails to open properly during swallow - back up of food in oesophagus Bird beak sign on imaging Botox, Heillers cardiomyotomy, balloon oesophageal dilatation (stretch LOS)