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GI PATHOLOGY > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

Oesophagus begins and ends at what vertebral levels?

A

C6 - T11/12

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2
Q

Muscle distribution of the oesophagus

A

Upper 3-4cm skeletal

Rest is smooth

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3
Q

What type of cell lines the esophagus?

A

Non-keratinising stratified squamous epithelium

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4
Q

Vagus nerve stimulation mediates what in the oesophagus?

A

Peristalsis

LOS relaxation

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5
Q

What causes heartburn?

A

Acid Reflux

Bilious gastric contents into oesophagus

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6
Q

How do certain drugs/foods cause heartburn?

A

Reducing LOS pressure increasing reflux

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7
Q

Persistent reflux and heartburn leads to what?

A

GORD

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8
Q

What is dysphagia?

A

Subjective sensation of difficulty in swallowing boli

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9
Q

What to enquire about if a patient presents with dysphagia?

A

Type of food
Pattern of symptoms
Associated symptoms
Location of sensation

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10
Q

What is odynophagia?

A

Pain with swallowing

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11
Q

Causes of oesophageal dysphagia

A

Stricture (ben/mal)
Motility disorder
Esosinophilic oesophagitis
Extrinsic compression

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12
Q

Investigations in oesophageal disease

A 
Endoscopy (UGIE)
Contrast radiology (Ba)
Oesophageal pH + manometry
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13
Q

Low oesophageal pH suggests what?

A

Acid presence

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14
Q

Manometry tests for what?

A

Dysphagia

Suspected motility issues

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15
Q

Hypermotility of the oesophagus appears as what?

A

Corkscrew Ba swallow
Severe episodic chest pain
Some dysphagia

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16
Q

Hypermotility of the oesophagus is often confused with what?

A

Angina/MI

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17
Q

Manometry of hypermotility shows what?

A

Uncoordinated, hypertonic contractions

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18
Q

Treatment for hypermotility

A

Smooth muscle relaxants

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19
Q

What is hypomotility associated with?

A

Connective tissue disease
Diabetes
Neuropathy

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20
Q

Hypomotility causes what?

A

Failure of LOS mechanism causing heartburn and reflux

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21
Q

What is achalasia?

A

Loss of myenteric plexus ganglion in distal oesophagus/LOS

22
Q

Cardinal feature of Achalasia

A

Failure of the LOS to relax leading to distal obstruction

23
Q

Symptoms of achalasia

A

Progressive Dysphagia
Chest pain
Weight loss
Regurgitation

24
Q

Treatment for achalasia

A

Nitrates, CCBs
Botulinum toxin
Pneumatic balloon dilation
Myotomy

25
Q

Complications of achalasia

A

Aspiration pneumonia

Increase risk of squamous cell carcinoma

26
Q

Symptoms of GORD

A

Heartburn
Cough
Water brash
Sleep disturbance

27
Q

Risk factors for GORD

A 
Smoking
Alcoholism
Obesity
LOS weakening
Obesity
28
Q

GORD is typically diagnosed how?

A

Symptomatically without diagnostic testing

29
Q

Why is endoscopy not ideal in GORD?

A

> 50% of patients will have no visible oesophageal abnormality

30
Q

When must an endoscopy be performed in a GORD patient?

A

Signs of malignancy:
Dysphagia
Weight loss
Vomiting

31
Q

What are the two main types of hiatus hernia?

A

Sliding

Para-oesophageal

32
Q

How does GORD cause damage to the epithelium?

A

Mucosa exposed to acid/pepsin/bile
Increased cell loss and inflammation
Erosive esophagitis

33
Q

What are the main complications of GORD?

A

Ulceration
Stricture
Barretts Oesophagus
Carcinoma

34
Q

What is barretts oesophagus?

A

Change from squamous to mucin-secreting epithelium in the distal oesophagus due to repeated acid exposure

35
Q

Barretts oesophagus is a precursor to what?

A

Adenocarcinoma

36
Q

What is the treatment for severe dysplasia in Barretts oesophagus?

A

Endoscopic Mucosal Resection
Radiofrequency ablation
Oesophagectomy (rare)

37
Q

How is GORD treated?

A 
Lifestyle changes 
Alginates
H2RA
PPIs
?Acid-reflux surgery
38
Q

How does oesophageal cancer typically present?

A 
PROGRESSIVE DYSPHAGIA
ANOREXIA/WL
Odynophagia
Chest pain
Cough
Pneumonia
Haematemesis 
Vocal cord paralysis
39
Q

Squamous cell carcinoma of the oesophagus occurs where?

A

Proximal and middle 1/3 of oesophagus

40
Q

Largest risk factors for oesophageal squamous cell carcinoma?

A

Tobacco and Alcohol

41
Q

Adenocarcinoma of the oesophagus occurs where?

A

Distal 1/3 oesophagus

42
Q

At what stage does oesophageal cancer typically present?

A

Late
Regional nodal spread
Invasive

43
Q

Why does a tumour of the oesophagus have a greater likelihood of invading surrounding structures?

A

Lack of a serosal layer

Lamina propria has a rich lymphatic supply

44
Q

Prognosis of oesophageal cancer?

A

5y survival<10%

45
Q

How is oesophageal cancer investigated?

A

Endoscopy and biopsy

Staging (TNM)

46
Q

How is oesophageal cancer staged?

A

CT Scan
Endoscopic Ultrasound
PET Scan
Bone scan

47
Q

How is oesophageal cancer treated?

A

Oesophagectomy and chemotherapy

?Palliation

48
Q

What is oesinophilic oesophagitis?

A

Chronic immune mediated oesophageal dysfunction

49
Q

What is the aetiology of eosinophilic oesophagitis?

A

Eosinophilic infiltration of the oesophageal epithelium IN ABSENCE of secondary causes

50
Q

How does eosinophilic oesophagitis usually present?

A

Dysphagia

Food bolus obstruction

51
Q

Treatment for eosinophilic oesophagitis?

A

Topical/swallowed corticosteroids
Dietary elimination
Endoscopic dilation

GI PATHOLOGY (20 decks)

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