Oesophageal disorders

Question 1

what is the muscle make up of the oesophagus ?

Answer 1

upper 3-4cm is striated

rest is smooth

Question 2

what sort of epithelium makes up the oesophagus ?

Answer 2

stratified squamous epithelium

Question 3

what are symptoms of oesophageal disease ?

Answer 3

heartburn

dysphagia

Question 4

what is heartburn, what can cause it and what are its complications ?

Answer 4

retrosternal discomfort or burning, associated with waterbrash or cough
certain drugs/foods can lower LOS pressure causing reflux
persistent reflux can result in GORD

Question 5

what can cause dysphagia ?

Answer 5

benign stricture
malignant stricture
motility disorders
eosinophilic oesophagitis
extrinsic compression

Question 6

what investigations should be done for oesophageal disease ?

Answer 6

endoscopy
contrast radiology
oesophageal pH and manometry

Question 7

what is an example of a hyper motility disorder ?

Answer 7

diffuse oesophageal spasm

Question 8

what is the appearance of diffuse oesophageal spasm on a barium swallow ?

Answer 8

corkscrew appearance

Question 9

what are clinical features of diffuse oesophageal spasm ?

Answer 9

chest pain
sometimes dysphagia
often confused with angina

Question 10

what causes diffuse oesophageal spasm ?

Answer 10

idiopathic

Question 11

what would a manometry show with diffuse oesophageal spasm ?

Answer 11

uncoordinated hypertonic contractions

Question 12

how is diffuse oesophageal spasm treated ?

Answer 12

smooth muscle relaxants

Question 13

what conditions are associated with hypomotility disorders ?

Answer 13

connective tissue diseases
diabetes
neuropathy

Question 14

what is the pathology of hypomotility and what can it lead to ?

Answer 14

failure of LOS

leads to heartburn and reflux

Question 15

what is achalasia and what is its pathology ?

Answer 15

failure of the LOS to relax leading to obstruction

functional loss of the myenteric plexus ganglion in distal oesophagus and LOS

Question 16

what are symptoms of achalasia ?

Answer 16

progressive dysphagia
weight loss
chest pain
regurgitation and chest infection

Question 17

what is the treatment for achalasia ?

Answer 17

pharmacological - nitrates, calcium channel blockers
endoscopic - botox, ballon dilatation
surgical - myotomy

Question 18

what are complications of achalasia ?

Answer 18

aspiration pneumonia

risk of squamous cell oesophageal carcinoma

Question 19

what are risk factors for GORD ?

Answer 19

pregnancy
obesity
drugs lowering LOS pressure
smoking
alcoholism
hypomotility

Question 20

what are symptoms of GORD ?

Answer 20

heartburn
cough
water brash
sleep disturbance

Question 21

what is GORD often associated with ?

Answer 21

hiatus hernia

Question 22

what complication is associated with GORD ?

Answer 22

Barrett’s oesophagus

Question 23

what are the treatment options for Barrett’s oesophagus ?

Answer 23

endoscopic mucosal resection
radio frequency ablation
oesophagectomy

Question 24

what is the treatment for GORD ?

Answer 24

lifestyle changes
drugs - alginates(gaviscon), H2RA (ranitidine), PPI (omeprazole)
anti-reflux surgery - fundoplication

Question 25

how does oesophageal cancer present ?

Answer 25

``` progressive dysphagia anorexia/weight loss odynophagia chest pain cough pneumonia vocal cord paralysis haematemesis ```

Question 26

where do squamous carcinomas commonly occur in the oesophagus ?

Answer 26

the upper 2/3rds

Question 27

where do adenocarcinomas commonly occur in the oesophagus ?

Answer 27

the bottom 1/3rd

Question 28

where does oesophageal cancer commonly metastasise ?

Answer 28

liver brain bone lungs

Question 29

how do you investigate an oesophageal cancer ?

Answer 29

endoscopy and biopsy | staging - CT, USS, PET, bone scan

Question 30

how do you treat oesophageal cancer

Answer 30

surgical oesophagectomy | prognosis is poor

Question 31

what is eosinophilic oesophagitis ?

Answer 31

chronic immune/allergen mediated condition causing oesophageal dysfunction

Question 32

how does eosinophilic oesophagitis present ?

Answer 32

dysphagia | bolus obstruction

Question 33

how do you treat eosinophilic oesophagitis ?

Answer 33

topical corticosteroids dietary elimination endoscopic dilatation

Question 34

what are the ALARMS symptoms ?

Answer 34

``` Anorexia Loss of weight Anaemia Recent onset, >55 years old, persistent Melaena/heamatemesis Swallowing problems ```