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Gastrointestinal > Oesophageal Pathology > Flashcards

Oesophageal Pathology Flashcards

1
Q

What is Gastro-Oestophageal Reflux Disease (GORD)?

A

Reflux of gastric contents, acid and bile, through the lower oesophageal sphincter into the oesophagus, due to decreased tone

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2
Q

In what sex is GORD most common?

A

M>F

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3
Q

What are the causes of GORD?

A

Pregnancy

Obesity

Drugs that lower LOS pressure

Smoking

Alcohol

Hypomobility

Hiatus Hernia

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4
Q

Name drugs that can lower the LOS pressure

A

Nitrates

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5
Q

What are causes of hiatus hernia?

A

>Age

Pregnancy

Obesity

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6
Q

What are the types of hiatus hernia?

A

Type 1, sliding, in which the gasto-oesophageal junction slides into thorax

Type 2, rolling/para-oesophageal, in which junction remains in abdomen but different part of stomach herniates through oesophageal opening

Type 3, combination of sliding and rolling

Type 4, large opening with additional organs entering thorax

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7
Q

What is a Nissen Fundoplication?

A

Surgical management of hiatus hernia in which hernia is pulled back and fundus is tied around the lower oesophagus to narrow the LOS

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8
Q

What is the pre-operative workup for Nissens fundoplication?

A

Manometry studies prior to surgery

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9
Q

How does GORD present?

A

Heartburn/Burning retrosternal discomfort, exacerbated after meals and lying down

Nocturnal cough

Waterbrash/acid regurgitation

Bloating

Odynophagia if ulceration

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10
Q

What investigations are used in GORD diagnosis and monitoring?

A

Upper GI Endoscopy

Barium swallow, to bisualise hiatus hernia

Manometry studies

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11
Q

What is the lifestyle management of GORD?

A

Weight loss

Smoking cessation

Avoid alcohol, tea and coffee

Smaller lighter meals

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12
Q

What is the pharmacological management of GORD (endoscopically proven oesophagitis)?

A

Full dose PPI for 1-2 months

If response, low dose treatment as required

If no response, double dose PPI for 1 month

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13
Q

What is the pharmacological management of GORD (endoscopically negative oesophagitis)?

A

Full dose PPI for 1 month

If response, low dose treatment as required

If no response, H2RA or prokinetic for 1 month

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14
Q

Name examples of PPI

A

Omeprazole

Lomeprazole

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15
Q

Give side effects of PPI

A

Hyponatraemia

Hypomagnesaemia

Osteoporosis

Microscopic colitis

Clostridium Difficile infection

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16
Q

Name an example of a histamine blocker

A

Ranitidine

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17
Q

Give complications of GORD

A

Reflux esophagitis

Ulcers

Barrett’s Oesophagus

Benign stricture

Anaemia

Oesophageal carcinoma

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18
Q

What is Barrett’s oesophagus?

A

Form of metaplasia in which normal stratified squamous epithelium of the oesophagus is replaced by glandular columnar epithelium

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19
Q

What causes Barrett’s oesophagus?

A

GORD

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20
Q

Name a complication of Barret’s oesophagus

A

Oesophageal adenocarcinoma

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21
Q

How is Barret’s oesophagus managed?

A

GORD management

Endoscopic surveillance with biopsy

Endoscopic intervention

  • Offered if dysplasia is identified
  • Mucosal resection
  • Radiofrequency ablation

Oesophagectomy

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22
Q

How often do patients with Barrett’s oesophagus recieve endoscopic surveillance?

A

Every 3-5 years for patients with metaplasia

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23
Q

What are the two classifications of oesophageal cancer?

A

Squamous carcinoma

Adenocarcinoma

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24
Q

What area of the oesophagus does squamous carcinoma affect?

A

Proximal

(Upper two thirds)

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25
Q

What are of the oesophagus does adenocarcinoma effect?

A

Distal

(Lower one third)

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26
Q

What sex is oesophageal cancer most common in?

A

M>F

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27
Q

At what age is oesophageal cancer most common?

A

Onset at 65

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28
Q

Which oesophageal cancer classification is most common?

A

Adenocarcinoma > squamous

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29
Q

What is the prognosis for oesophageal cancer?

A

Poor, 5 year survival <15%

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30
Q

What are the causes of oesophageal cancer (adenocarcinoma)?

A

Barrett’s oesophagus

Obesity

31
Q

What are the causes of oesophageal cancer (squamous)?

A

Smoking

Alcohol

Dietary carcinogens

  • Fish

Achalasia

32
Q

How does oesophageal cancer present?

A

Progressive dysphagia, beeginning as solids and movig to liquids

Weight loss

Odynophagia

Chest pain/heart burn

Cough

Haematemesis and vomiting

Hoarseness/Vocal cord paralysis

Lymphadenopathy

33
Q

Give a dermatological manifestation of oesophagus cancer

A

Acanthosis nigricans

34
Q

What investigations are used in oesophageal cancer diagnosis?

A

Upper GI endoscopy and biopsy

  • Note, always prioritise endoscope if chronic reflux symptoms that have not responded to PPI

Staging

  • CT
  • US
35
Q

What is the management of oesophageal cancer?

A

Surgical resection with adjuvant chemotherapy

  • Ivor-Lewis oesophagectomy
  • Total oesophagectomy/McKeown

Palliative

  • Endoscopic stent
  • Chemotherapy
  • Radiotherapy
  • Laser ablation
36
Q

Name complications of oesophageal cancer

A

Pneumonia, due to tracheo-oesophageal fistula

37
Q

What sites can oesophageal cancer metastasise to?

A

Hepatic

Brain

Pulmonary

Bone

38
Q

Give complication of chemoradiotherapy in oesophageal cancer survivors?

A

Dysphagia due to post radiotherapy fibrosis

39
Q

What is oesophageal hypomotility?

A

Abnormal deficiency of movement

40
Q

What causes oesophageal hypomotility?

A

Connective tissue disease

Diabetes

Neuropathy

41
Q

How does oesophageal hypomotility present?

A

Heartburn

42
Q

What investigations are used in oesophageal motility disorder diagnosis?

A

Manometry

Barium swallow

Upper GI endoscopy

43
Q

What is oesophageal hypermotility?

A

Abnormal excessive movement

44
Q

What causes oesophageal hypermotility?

A

Idiopathic

45
Q

How does oesophageal hypermotility present?

A

Severe episodic retrosternal chest pain

Dysphagia

46
Q

What sign is seen on a Barium swallow suggestive of oesophageal hypermotility?

A

Corkscrew appearance

47
Q

How is oesophageal hypermotility managed?

A

Smooth muscle relaxants

  • Nitrates
  • CCB
48
Q

What is Achlasia?

A

Neuromuscular disorder characterised by functional loss of the myenteric plexus ganglion cells in the distal oesophagus, resulting in the LOS failing to relax/open, with the absence of oesophageal peristalsis

49
Q

How does achlasia present?

A

Progressive dysphagia

  • Equal to both solids and liquids from the outset

Weight loss

Chest pain/heart burn

Regurgitation of food

  • May lead to cough and aspiration pneumonia
50
Q

What barium swallow signs are seen in achlasia?

A

Proximal dilation and tapering of the distal oesophagus known as ‘bird beak’ sign

51
Q

What is the surgical management of achlasia?

A

Endoscopic pneumatic balloon dilation

  • First line

Heller’s Cardiomyotomy

  • Used if recurrent symptoms
52
Q

What is Heller’s Cardiomyotomy?

A

Procedure in which muscles of cardia are cut to allow passage to the stomach

53
Q

Name complications of achlasia

A

Aspiration pneumonia

Oesophageal squamous cell carcinoma

54
Q

Describe the difference in dysphagia between oesophageal conditions

A

Achlasia

  • Begins with solids and progresses to liquids

Oesophageal cancer

  • Solids and liquids from the onset

Motility

  • Variable between solids and liquids
55
Q

What is Zenker’s diverticulum?

A

Also known as pharyngeal pouch, protrusion of the mucosa and submucosa of the inferior pharyngeal constrictor muscle

56
Q

How does Zenker’s present?

A

Progressive dysphagia

Regurgitation of undigested food

Chronic cough

Hoarseness

Palpable lump in throat

Halitosis

57
Q

What is the area of weakness in Zenker’s known as?

A

Killian’s Dehiscence

58
Q

How is Zenker’s diverticulum managed?

A

Surgical excision of pouch, plus repair of defect in inferior constrictor

59
Q

What is Eosinophillic oesophagus?

A

Chronic allergic/immune mediated inflammatory disorder causing oesophageal dysfunction, occuring in childhood

60
Q

How does eosinophilic oesophagus present?

A

Dysphagia

Food bolus obstruction

Vomiting

Heart burn

61
Q

How is eosinophilic oesophagus managed?

A

Topical/oral corticosteroids

Dietary elimination

Endoscopic dilation

62
Q

What is a Walloru-Weiss tear?

A

Linear tear at oesophageal-gastric junction due to forceful vomiting

63
Q

How is walloru-weiss tear managed?

A

Heals itself

Endoscopic treatment

64
Q

Describe the pathophysiology of oesophageal varices

A

Portal hypertension results in dilation of veins at sites of portal-systemic anastomosis, projecting into the oesophagus

65
Q

What are the sites of portal-systemic anastomosis?

A

Lower oesophagus

Rectum

Umbilicus (caput medusae)

66
Q

How does oesophageal varices present?

A

Haematemesis/melaena, suggesting upper GI bleed

Evidence of chronic liver disease

Splenomegaly and thrombocytopenia, as portal HTN results in splenic enlargement and hyperfunction

67
Q

What is the acute management of oesophegal varice bleed?

A

Resuscitate

Correct possible clotting abnormalities

IV Terlipressin or somatostatin analogue

Upper GI Endoscopy and sclerotherapy/banding of varices

If unsuccessful, pass a Sengstaken-Blakemore tube

If continued bleeding, surgical decompression

68
Q

What is a Sengstaken-Blakemore tube?

A

Contains a inflatable balloon used to compress varices

69
Q

What is the prophylaxis management of oesophageal varices?

A

B Blockers to reduce portal pressure

Upper GI Endoscopy and sclerotherapy/banding of varices

Transjugular intra-hepatic portosystemic shunting (TIPSS)

70
Q

What is Plummer-Vinson syndrome?

A

Web thin eccentric extension of normal oesophageal tissue

71
Q

How does Plummer-Vinson syndrome present?

A

Dysphagia, secondary to oesophageal webs

Iron deficiency anaemia

Glossitis

72
Q

What drug can cause odynophagia?

A

Steroids, due to candidasis

73
Q

Give features of Boerhaave Syndrome

A

Alcohol use

Vomiting

Thoracic pain

Subcutaneous emphysema, shown as crepitus in epigastric region

Gastrointestinal (14 decks)

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