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Gastrointestinal > Oesophageal pathology > Flashcards

Oesophageal pathology Flashcards

1
Q

What factors predispose a patient to developing hiatus hernia?

A 
Obesity
Lifting heavy loads
Frequent coughing fits
Tight fitting clothes
Frequent bending
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2
Q

How does hiatus hernia usually present?

A

Symptoms and complications of GORD

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3
Q

Which muscle type is the oesophagus controlled by?

A

Initially striated, then smooth

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4
Q

Where does the oesophagus begin?

A

Cricopharyngeus muscle, C6

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5
Q

What is the definition of GORD?

A

Any symptomatic condition, anatomic alteration or both that result from the reflux of noxious material in the stomach into the oesophagus

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6
Q

What is a paraoesophageal hiatus hernia?

A

The herniated part of the stomach becomes parallel to the oesophagus

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7
Q

What is a sliding hiatus hernia?

A

The herniated part of the stomach slides through the hiatus of the diaphragm with the gastro-oesophageal junction

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8
Q

What is reflux oesophagitis?

A

Inflammation of oesophagus due to refluxed low pH gastric content

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9
Q

What are some of the symptoms of reflux oesophagitis?

A 
Heartburn
Acid reflux
Dysphagia
Weight loss
Chest pain
Hoarseness
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10
Q

What are some of the complications of GORD?

A

Peptic stricture
Barrett’s oesophagus
Adenocarcinoma

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11
Q

What are the microscopic changes that occur in reflux oesophagitis?

A

Basal zone epithelial expansion due to increased desquamation - basal zone hyperplasia
Influx of neutrophils, lymphocytes, eosinophils

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12
Q

What microscopic changes occur in Barrett’s oesophagus?

A

Squamous epithelium becomes columnar epithelium - metaplasia

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13
Q

What does Barrett’s oesophagus predispose to?

A

Adenocarcinoma

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14
Q

What is the pathological progression from Barrett’s oesophagus to adenocarcinoma?

A

Metaplasia - dysplasia - adenocarcinoma

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15
Q

What are oesophageal varices?

A

Dilated veins that protrude into the oesophagus

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16
Q

What treatment is available fro oesophageal varices?

A

Banding treatment

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17
Q

What is a common complication of oesophageal varices?

A

Haemorrhage

18
Q

What is the characteristic metaplasia seen in Barrett’s?

A

Intestinal metaplasia

19
Q

What is achalasia?

A

An uncommon condition characterised by loss of contractility of the oesophagus and failure to relax the lower oesophageal sphincter

20
Q

How does achalasia usually present?

A

Intermittent but progressive dysphagia
Dysphagia to both liquids and solids
Vomiting of undigested food

21
Q

What investigations might be done for achalasia?

A

Endoscopy
Ba swallow
Oesophageal manometry

22
Q

What is oesophageal manometry?

A

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

23
Q

What are the main identified risk factors for oesophageal squamous carcinoma?

A 
Tobacco
Alcohol
Nitrosamine in pickled/mouldy food
Vitamin deficiencies
Human papilloma virus
Hot beverages
24
Q

What are the risk factors for adenocarcinoma of the oesophagus?

A

GORD

Barrett’s

25
Q

How might cancer of the oesophagus present?

A

Dysphagia
Weight loss
Anaemia
Fatigue (usually due to metastases)

26
Q

Where is adenocarcinoma of the oesophagus most likely to be?

A

Lower 1/3 of oesophagus

27
Q

What microscopic changes would you see in allergic oesophagitis?

A

Large numbers of eosinophils present in mucosa

28
Q

What is the main feature of GORD?

A

Heartburn

Aggravated by lying down or bending forward

29
Q

What is the best investigation for GORD?

A

Endoscopy, although mostly diagnosed on history

30
Q

What treatments are available for GORD?

A

Antacids/’over the counter’ drinks
Metoclopramide and domperidone
H2-receptor antagonists e.g. ranitidine
PPIs e.g. omeprazole

31
Q

What is the gold-standard treatment for GORD?

A

PPIs e.g. omeprazole

32
Q

What is the best investigation for Barrett’s oesophagus?

A

Endoscopy and biopsy

33
Q

What is a complication of achalasia?

A

Aspiration pneumonia due to regurgitation of undigested food

34
Q

What can be seen on Xray in achalasia?

A

Dilated oesophagus

Sometimes fluid level seen behind heart

35
Q

What can be seen on barium swallow in achalasia?

A

Lack of peristalsis

Lower end of oesophagus shows ‘birds beak’ appearance due to failure of sphincter to relax

36
Q

How is the oesophagus affected in patients with systemic sclerosis?

A

Dimished peristalsis and oesophageal clearance due to replacement of smooth muscle with fibrotic tissue

37
Q

What is an oesophageal web?

A

A thin, membranous tissue flap covered with squamous epithelium

38
Q

In what condition does an oesophageal web cause dysphagia?

A

Plummer-Vinson syndrome

39
Q

What is a web in Plummer-Vinson syndrome associated with?

A

Chronic iron deficiency anaemia
Glossitis
Angular stomatitis

40
Q

What is the most common cause of benign oesophageal strictures?

A

Peptic stricture due to reflux

41
Q

What are some of the causes of oesophageal infection?

A

Candida
Herpes simplex
Cytomegalovirus
Tuberculosis

42
Q

How is allergic/eosinophilic oesophagitis treated?

A

Topical steroids - swallowing preparations such as fluticasone

Gastrointestinal (17 decks)

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