Oesophagus

Question 1

what is achalasia

Answer 1

failure of peristalsis and relaxation of lower oesophageal sphincter due to degenerative loss of ganglia in Auerbach’s plexus

Question 2

clinical picture of achalasia

Answer 2

dysphagia to solids and liquids from outset

heartburn, regurg of food, middle aged

Question 3

investigation of achalasia

Answer 3

manometry shows increased lower oesophageal sphincter tone
barium swallow - birds beak
CXR wide mediastinum

Question 4

oesophageal cancer as a result of Barrets is what histiologically

Answer 4

adenocarcinoma

Question 5

outline the treatment of an acute variceal haemorrhage

Answer 5

ABCDE - vit K and FFP and terlipressan
then upper GI endoscopy –>band ligation –> TIPSS procedure
can give prophylacitc antibiotics if liver cirrhossis

Question 6

what is the propylacitc treatment of variceal haemorrhage

Answer 6

propranolol
Endoscopic variceal ligation at 2 weekly intervals until all bands removed
PPI given during EVL treatment as EVL can cause ulceration