Oesophageal pathology Flashcards
What factors predispose a patient to developing hiatus hernia?
Obesity Lifting heavy loads Frequent coughing fits Tight fitting clothes Frequent bending
How does hiatus hernia usually present?
Symptoms and complications of GORD
Which muscle type is the oesophagus controlled by?
Initially striated, then smooth
Where does the oesophagus begin?
Cricopharyngeus muscle, C6
What is the definition of GORD?
Any symptomatic condition, anatomic alteration or both that result from the reflux of noxious material in the stomach into the oesophagus
What is a paraoesophageal hiatus hernia?
The herniated part of the stomach becomes parallel to the oesophagus
What is a sliding hiatus hernia?
The herniated part of the stomach slides through the hiatus of the diaphragm with the gastro-oesophageal junction
What is reflux oesophagitis?
Inflammation of oesophagus due to refluxed low pH gastric content
What are some of the symptoms of reflux oesophagitis?
Heartburn Acid reflux Dysphagia Weight loss Chest pain Hoarseness
What are some of the complications of GORD?
Peptic stricture
Barrett’s oesophagus
Adenocarcinoma
What are the microscopic changes that occur in reflux oesophagitis?
Basal zone epithelial expansion due to increased desquamation - basal zone hyperplasia
Influx of neutrophils, lymphocytes, eosinophils
What microscopic changes occur in Barrett’s oesophagus?
Squamous epithelium becomes columnar epithelium - metaplasia
What does Barrett’s oesophagus predispose to?
Adenocarcinoma
What is the pathological progression from Barrett’s oesophagus to adenocarcinoma?
Metaplasia - dysplasia - adenocarcinoma
What are oesophageal varices?
Dilated veins that protrude into the oesophagus
What treatment is available fro oesophageal varices?
Banding treatment
What is a common complication of oesophageal varices?
Haemorrhage
What is the characteristic metaplasia seen in Barrett’s?
Intestinal metaplasia
What is achalasia?
An uncommon condition characterised by loss of contractility of the oesophagus and failure to relax the lower oesophageal sphincter
How does achalasia usually present?
Intermittent but progressive dysphagia
Dysphagia to both liquids and solids
Vomiting of undigested food
What investigations might be done for achalasia?
Endoscopy
Ba swallow
Oesophageal manometry
What is oesophageal manometry?
A test to assess muscle function in the oesophagus:
a thin, pressure-sensitive tube is passed through the nose, down the oesophagus and into the stomach
The patient is then asked to swallow - the muscle contractions are detected by the tube
What are the main identified risk factors for oesophageal squamous carcinoma?
Tobacco Alcohol Nitrosamine in pickled/mouldy food Vitamin deficiencies Human papilloma virus Hot beverages
What are the risk factors for adenocarcinoma of the oesophagus?
GORD
Barrett’s
How might cancer of the oesophagus present?
Dysphagia
Weight loss
Anaemia
Fatigue (usually due to metastases)
Where is adenocarcinoma of the oesophagus most likely to be?
Lower 1/3 of oesophagus
What microscopic changes would you see in allergic oesophagitis?
Large numbers of eosinophils present in mucosa
What is the main feature of GORD?
Heartburn
Aggravated by lying down or bending forward
What is the best investigation for GORD?
Endoscopy, although mostly diagnosed on history
What treatments are available for GORD?
Antacids/’over the counter’ drinks
Metoclopramide and domperidone
H2-receptor antagonists e.g. ranitidine
PPIs e.g. omeprazole
What is the gold-standard treatment for GORD?
PPIs e.g. omeprazole
What is the best investigation for Barrett’s oesophagus?
Endoscopy and biopsy
What is a complication of achalasia?
Aspiration pneumonia due to regurgitation of undigested food
What can be seen on Xray in achalasia?
Dilated oesophagus
Sometimes fluid level seen behind heart
What can be seen on barium swallow in achalasia?
Lack of peristalsis
Lower end of oesophagus shows ‘birds beak’ appearance due to failure of sphincter to relax
How is the oesophagus affected in patients with systemic sclerosis?
Dimished peristalsis and oesophageal clearance due to replacement of smooth muscle with fibrotic tissue
What is an oesophageal web?
A thin, membranous tissue flap covered with squamous epithelium
In what condition does an oesophageal web cause dysphagia?
Plummer-Vinson syndrome
What is a web in Plummer-Vinson syndrome associated with?
Chronic iron deficiency anaemia
Glossitis
Angular stomatitis
What is the most common cause of benign oesophageal strictures?
Peptic stricture due to reflux
What are some of the causes of oesophageal infection?
Candida
Herpes simplex
Cytomegalovirus
Tuberculosis
How is allergic/eosinophilic oesophagitis treated?
Topical steroids - swallowing preparations such as fluticasone
