Oesophageal Disease Flashcards
Acute oesophagitis is more common than chronic oesophagitis. True/False?
False
What are some causes of acute oesophagitis?
Chemical abuse -> corrosion
Infection (herpes, candidiasis)
What is the main cause of chronic oesophagitis?
Reflux disease [reflux oesophagitis]
Define “reflux oesophagitis” (GORD)
Inflammation of the oesophagus due to reflux of acid from the stomach
What are the 3 main causes of GORD?
Incompetent LOS
Poor oesophageal motility/clearance
Impaired mucosal barrier
What is the dominant immune cell that accompanies acid abuse?
Eosinophils
Name 3 complications of reflux oesophagitis
Ulceration/bleeding
Stricture formation due to scarring
Barrett’s Oesophagus
Define “Barrett’s Oesophagus”
Replacement of stratified squamous epithelium -> columnar epithelium [metaplastic change]
How is Barrett’s Oesophagus pre-malignant?
Mucosa becomes unstable, and persistent acid insult increases risk of developing dysplasia and carcinoma
What is allergic oesophagitis?
Immune-mediated oesophagitis caused by reaction to food
Eosinophilic infiltrates present
Benign oesophageal tumours are rarer than malignant tumours. True/False?
True
What is the most common benign oesophageal tumour?
Squamous papilloma
What are the two main types of malignant oesophageal tumour?
Squamous cell carcinoma
Adenocarcinoma
Squamous cell carcinoma of oesophagus is commoner in males. True/False?
True
Where is adenocarcinoma of the oesophagus most likely to develop? Why?
Lower 1/3 of oesophagus
Reflux insult is greatest here
What are the 3 main mechanisms of metastasis of oesophageal tumours?
Direct invasion
Lymphatic spread
Haematogenous spread
Give examples of symptoms of GORD
Heartburn Waterbrash (hyper-salivation) Dysphagia, odynophagia Reflux Chest pain
What are the main investigations for GORD?
Endoscopy
Barium swallow
Manometry (pressure) studies
Nuclear imaging
Name the ALARM Symptoms
Anaemia Loss of weight Anorexia Recent progressive symptoms Malaena or haematemesis Swallowing difficulty
Antacids provide symptomatic relief and heal oesophagitis in GORD. True/False?
False
Provide symptom relief but no healing or preventative qualities
H2 receptor antagonists mainly provide symptomatic relief of GORD; give an example of one
Ranitidine
Proton pump inhibitors provide symptomatic relief and heal oesophagitis. True/False?
True
When is surgery indicated for GORD?
To repair LOS
When PPIs ineffective (cheaper doing surgery than being on PPI for 7+ years)
Which investigations are indicated for diagnosing oesophageal cancer?
Endoscopy
Barium meal
CT scan
Name some contraindications to surgery for treating oesophageal cancer
Invasion of adjacent structures
Widespread metastasis
Poor health/lack of fitness
