OESOPHAGEAL DISORDERS Flashcards
What three histological findings can you see in reflux oesophagitis?
- Basal zone hyperplasia
- Elongated papilla in lamina propria
- Eosinophils (characteristic of reflux oesophagitis) and neutrophils
New onset asthma in adult should make you consider which condition as a cause?
GORD
Why are babies more likely to develop GORD?
Immature lower oesophageal sphincter
Which plant is known to trigger GORD by relaxing Lower oesophageal sphincter?
Peppermint
Which lifestyle factor is most important in treatment of GORD?
Weight loss
Which surgery is reserved for people with GORD who fail to respond to medical management?
Nissen fundoplication
How can GORD eventually lead to dysphagia?
Causes ulcers to develop which are replaced by fibrous tissue leading to strictures
What is lye? What can happen if it is ingested? How does this usually happen?
Alkaline substance found in household cleaners, drain opener
- Contains sodium or potassium hydroxide
- Causes liquefactive necrosis of oesophagus (then neutralised by stomach acid)
- Usually ingested accidentally by children
- Usually recovers but damage can later cause a stricture
Which junction moves proximally in Barrett’s oesophagus?
Squamocolumnar junction
Oesophageal cancer is characterised by progressive dysphagia, what does this mean?
Starts with solids and progresses to liquids as tumour grows
What type of oesophageal cancer is associated with Barratts oesophagitis?
Adenocarcinoma
What is the most common type of oesophageal cancer worldwide? What type of things causes it?
→ what specific symptoms does this type of cancer cause?
Squamous cell
→ results from processes that damage upper oesophagus e.g. alcohol, hot tea, lye ingestion, oesophageal webs
Symptoms: Horse voice due to RLN involvement, cough due to tracheal involvement
List three infections that can cause oesophagitis
- Candida
- Herpes simplex virus 1
- Cytomegalovirus
A patient presenting with dysphagia, poor response to GORD treatment and eosinophils on biopsy is most likely to have which condition?
Eosinophilic oesophagitis
What is the name for the condition that causes inability to relax lower oesophageal sphincter?
This condition is due to loss of which cells?
Symptoms?
Diagnosis?
Achalasia
→ loss of ganglion cells in Auerbach’s plexus
→ causes dysphagia to both solids and liquids
Barium swallow
What are oesophageal varices?
main cause?
Dilated submucosal veins due to portal hypertension caused by cirrhosis
Which condition should you consider in painful haematemesis? Describe the condition and its causes
Mallory-Weiss syndrome
oesophageal mucosal tears at gastro-oesophageal junction, caused by severe and chronic vomiting:
- alcoholism
- bulimia
Patient presents with chest pain and vomiting after getting food stuck in throat the previous day, and coughing and retching to try and clear. This is his x-ray. What is your diagnosis?
BoerHaave syndrome: transmural rupture of oesophagus
Triad: chest pain, vomiting, mediastinal emphysema
Oesophageal webs and rings cause which symptom? They carry a risk of which serious condition?
Dysphagia
Squamous cell carcinoma
Zenker’s diverticulum (Pharyngeal pouch) is caused by failure of which muscle to relax during deglutition? Symptoms? Diagnosis?
Cricopharyngeal muscle
Dysphagia, halitosis
Video swallow study using fluoroscopy
