Oesophagus

Question 1

How long is the oesophagus and where does it expand between?

Answer 1

~25cm

Lower border of cricoid cartilage to cardiac orifice of the stomach at 7th costal cartilage level

Question 2

In endoscopy, what landmark indicates the start of the oesophagus?

Answer 2

The cricopharyngeal sphincter

Question 3

Name the 3 main landmarks visible during an endoscopy of the oesophagus.

Answer 3

Main - oesophagogastric mucosal junction
Indentation from the left main bronchus (T5)
Pulsation of the left atrium (T6-7)

Question 4

Describe the visible change that occurs at the oesophagogastric mucosal junction.

Answer 4

Pale pink squamous oesophageal mucosa transitions into dark red stratified columnar gastric mucosa

Question 5

What is the approximate distance to the oesophagogastric mucosal junction in a typical adult?

Answer 5

38-40cm from incisor teeth endoscopically

Question 6

What is Barrett’s oesophagus?

Answer 6

Metaplastic change of the lower oesophageal squamous epithelium into gastric columnar epithelium

Question 7

What are the associated risks with Barrett’s oesophagus?

Answer 7

Increased incidence of adenocarcinoma of the oesophagus due to dysplasia
Barrett’s ulcers - pain on swallowing, haematemesis, anaemic symptoms
Stricture - narrowing of the oesophagus leading to dysphagia and weight loss

Question 8

What are common causes of Barrett’s oesophagus?

Answer 8

Chronic oesophageal "acid" reflux
Excessive alcohol consumption
Smoking
Obesity
Diet - lack of fruit and vegetables

Question 9

What usually cuffs the oesophagus at or below the the oesophagogastric mucosal junction?

Answer 9

Diaphragm

Question 10

Name the arterial supply to the upper 2/3 and lower 1/3 of the oesophagus.

Answer 10

Upper 2/3 - inferior thyroid artery and aortic branches

Lower 1/3 - left gastric branch of celiac trunk and left inferior phrenic artery

Question 11

Name the venous drainage of the upper 2/3 and lower 1/3 of the oesophagus.

Answer 11

Upper 2/3 - inferior thyroid vein and azygos branches directly into systemic circulation
Lower 1/3 - left gastric vein into portal system

Question 12

What are oesophageal varices and where in the oesophagus are they more likely to occur?

Answer 12

Dilation of veins draining from the oesophagus

Distal oesophagus

Question 13

Oesophageal varices are important to recognise, why?

Answer 13

Haemorrhage is characteristically severe and often life threatening

Question 14

The size of oesophageal varices and their tendency to rupture are directly related to… Which is usually directly related to…

Answer 14

Portal pressure (hypertension)
Underlying liver disease

Question 15

Common signs and symptoms of oesophageal varices include:

Answer 15

Haematemesis
Melaena (black faeces)
Abdominal pain
Dysphagia
Peripherally shut down
Pallor
Shock
Symptoms of chronic liver disease