Oesophagus

Question 1

What is achalasia?

Answer 1

Tapering of the oesophagus due to parasympathetic plexus degeneration

Question 2

What are the main symptoms of achalasia?

Answer 2

Dysphagia
Regurgitation of undigested food
Coughing
Heartburn
Chest pain after eating

Question 3

What can be used to treat achalasia?

Answer 3

Local botox injections (only last one year)

Question 4

What is Barrett’s oesophagus?

Answer 4

Lower oesophageal metaplasia

Question 5

What cell changes occur in Barrett’s oesophagus?

Answer 5

Squamous to columnar

Question 6

How can you treat Barrett’s oesophagus?

Answer 6

Endoscopic Mucosal Resection (EMR)
Radio-Frequency Ablation (RFA)
Oesophagectomy (rarely)

Question 7

Is Barrett’s oesophagus considered premalignant?

Answer 7

Yes

Question 8

What is the most likely explanation for oral candidiasis?

Answer 8

Immunosuppression

Question 9

How can you treat oral candidiasis?

Answer 9

Fluconazole

Treat underlying immunosuppression

Question 10

What is the most common form of oesophageal carcinoma?

Answer 10

Squamous cell carcinoma (90%)

Question 11

Where do squamous cell carcinomas occur in the oesophagus?

Answer 11

Upper or middle third

Question 12

What is the second commonest cause of oesophageal carcinoma?

Answer 12

Adenocarcinoma (8%)

Question 13

Where do adenocarcinomas occur in the oesophagus?

Answer 13

Lower third

Question 14

What are the risk factors for squamous oesophageal cancer?

Answer 14

Alcohol
Tobacco
Coeliac

Question 15

What are the risk factors for oesophageal adenocarcinoma?

Answer 15

15% associated with Barrett’s oesophagus

Question 16

What are the common symptoms of oesophageal cancer?

Answer 16

Dysphagia
Respiratory symptoms
Haematemesis
Weight loss
Usually present late

Question 17

What are the treatments for oesophageal cancer?

Answer 17

Diagnosis by endoscopy and biopsy

Only potential cure is oesophagectomy with/without adjuvant or neoadjuvant chemotherapy

Question 18

What is GORD?

Answer 18

Reflux of stomach contents into oesophagus as far as the mouth

Question 19

What can GORD lead to?

Answer 19

Barrett’s oesophagus

Can cause strictures

Question 20

What are the symptoms of GORD?

Answer 20

Heartburn
Oesophagitis
Often with dysphagia

Question 21

How can you treat GORD?

Answer 21

Avoid aggravating factors
Raise head during sleep
PPI and H2 receptor antagonists
Alginates (Gaviscon)
Fundoplication

Question 22

Liver cirrhosis can often lead to?

Answer 22

Varices, common in alcoholics

Question 23

What happens in oesophageal varices?

Answer 23

Blood is shunted from the liver to the oesophagus, veins dilate and protrude into the lumen

Question 24

What can cause haemorrhage in varices?

Answer 24

Passage of food can rupture vessels, haematemesis is fatal in 40%

Question 25

How can oesophageal varices be treated?

Answer 25

Sengstaken balloon

One in stomach, one in oesophagus to put pressure on veins and prevent bleeding

Question 26

What are Mallory-Weiss tears?

Answer 26

Upper oesophageal sphincter tears due to excess vomiting

Question 27

How are Mallory-Weiss tears diagnosed?

Answer 27

History of haematemesis, definitively with endoscopy