oesophagus

Question 1

main symptoms involving the oesophagus

Answer 1

dysphasia (deficiency in speech generation)

odynophagia (pain swallowing)

heart burn

regurgitation

Question 2

oesophagitis

Answer 2

inflammation of the oesophagus due to reflux

Question 3

oesophagitis acute:

Answer 3

rare, corrosive following chemical ingestion

Question 4

oesophagitis chronic

Answer 4

common, reflux disease

Question 5

oesophagitis cause

Answer 5

reflux, defective sphincter (hiatus hernia) pregnancy (inc. intraabdominal pressure)

Question 6

allergic oesophagitis incidence

Answer 6

male > female

Question 7

allergic oesophagitis risk factor

Answer 7

history or family history of asthma

Question 8

allergic oesophagitis histology

Answer 8

eosinophils, corrugated or spotty oesophagus

Question 9

allergic oesophagitis treatment

Answer 9

steroids

chromoglycate

montelukast

Question 10

barretts oesphagus

Answer 10

Metaplastic change where stratified squamous epithelium is replaced by columnar epithelium.

• Normally the squamous mucosa of the oesophagus and the columnar mucosa of the stomach meet at the Z line

Question 11

barretts symptoms

Answer 11

largely as GORD but can be asymptomatic

Question 12

barretts macroscopic appearance

Answer 12

red velvety mucosa in lower oesophagus

Question 13

barretts complications

Answer 13

adenocarcinoma - this is a pre-malignant condition

Question 14

barretts investigations

Answer 14

endoscopy shows epithelium change

biopsy to screen for cancer

Question 15

barretts treatment

Answer 15

PPI and surveillance

Question 16

what is more rare - benign or malignant cancer

Answer 16

benign

Question 17

cancer symptoms

Answer 17

progressive dysphagia

weight loss - loss of appetite

chest pain

haematemesis

hoarse voice due to left recurrent laryngeal nerve invasion

cough due to trachea invasion

Question 18

cancer paraneoplastic symptoms

Answer 18

hypercalcaemia

Question 19

cancer investigations

Answer 19

endoscopy, biopsy barium swallow thorax/abdomen for CT staging US

Question 20

squamous cell carcinoma caused

Answer 20

smoking, alcohol, HPV

Question 21

which part of the oesophagus does SCC occur in

Answer 21

40% middle 15% lower

Question 22

which part of the oesophagus does adenocarcinoma occur in

Answer 22

lower third - reflux greatest here

Question 23

what does intermittent slow progression with a history of heart burn suggest

Answer 23

benign peptic stricture

Question 24

what does relentless progression over a few weeks suggest

Answer 24

malignant stricture

Question 25

what does odonyphagia suggest

Answer 25

• Suggests oesophagitis, cancer, oesophageal ulcer or spasm

Question 26

coffee ground vomit

Answer 26

gi bleed

Question 27

recognizable food in vomit

Answer 27

gastric stasis

Question 28

feculent vomit

Answer 28

small bowel obstruction

bacteiral overgrowth

Question 29

vomiting preceded by loud gurgling

Answer 29

gi obstruction

Question 30

vomiting relieves pain

Answer 30

peptic ulcer

Question 31

vomiting 1hr after eating

Answer 31

gastric stasis/gastroparesis