OESOPHAGEAL DISORDERS

Question 1

What three histological findings can you see in reflux oesophagitis?

Answer 1

• Basal zone hyperplasia
• Elongated papilla in lamina propria
• Eosinophils (characteristic of reflux oesophagitis) and neutrophils

Question 2

New onset asthma in adult should make you consider which condition as a cause?

Answer 2

GORD

Question 3

Why are babies more likely to develop GORD?

Answer 3

Immature lower oesophageal sphincter

Question 4

Which plant is known to trigger GORD by relaxing Lower oesophageal sphincter?

Answer 4

Peppermint

Question 5

Which lifestyle factor is most important in treatment of GORD?

Answer 5

Weight loss

Question 6

Which surgery is reserved for people with GORD who fail to respond to medical management?

Answer 6

Nissen fundoplication

Question 7

How can GORD eventually lead to dysphagia?

Answer 7

Causes ulcers to develop which are replaced by fibrous tissue leading to strictures

Question 8

What is lye? What can happen if it is ingested? How does this usually happen?

Answer 8

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

Question 9

Which junction moves proximally in Barrett’s oesophagus?

Answer 9

Squamocolumnar junction

Question 10

Oesophageal cancer is characterised by progressive dysphagia, what does this mean?

Answer 10

Starts with solids and progresses to liquids as tumour grows

Question 11

What type of oesophageal cancer is associated with Barratts oesophagitis?

Answer 11

Adenocarcinoma

Question 12

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?

Answer 12

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

Question 13

List three infections that can cause oesophagitis

Answer 13

• Candida
• Herpes simplex virus 1
• Cytomegalovirus

Question 14

A patient presenting with dysphagia, poor response to GORD treatment and eosinophils on biopsy is most likely to have which condition?

Answer 14

Eosinophilic oesophagitis

Question 15

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?

Answer 15

Achalasia

→ loss of ganglion cells in Auerbach’s plexus

→ causes dysphagia to both solids and liquids

Barium swallow

Question 16

What are oesophageal varices?

main cause?

Answer 16

Dilated submucosal veins due to portal hypertension caused by cirrhosis

Question 17

Which condition should you consider in painful haematemesis? Describe the condition and its causes

Answer 17

Mallory-Weiss syndrome

oesophageal mucosal tears at gastro-oesophageal junction, caused by severe and chronic vomiting:

• alcoholism
• bulimia

Question 18

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?

Answer 18

BoerHaave syndrome: transmural rupture of oesophagus

Triad: chest pain, vomiting, mediastinal emphysema

Question 19

Oesophageal webs and rings cause which symptom? They carry a risk of which serious condition?

Answer 19

Dysphagia

Squamous cell carcinoma

Question 20

Zenker’s diverticulum (Pharyngeal pouch) is caused by failure of which muscle to relax during deglutition? Symptoms? Diagnosis?

Answer 20

Cricopharyngeal muscle

Dysphagia, halitosis

Video swallow study using fluoroscopy