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GI > Oesophagus Disorders > Flashcards

Oesophagus Disorders Flashcards

1
Q

Out of acute and common oesophagitis, which is common and which is rare?

A

Acute- rare

Chronic- common

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2
Q

What is oesophagitis?

A

Inflammatory disorder of the oesophagus

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3
Q

What are the 2 causes of acute oesophagitis?

A

Corrosion following chemical ingestion or infective in immunocompromised patients

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4
Q

What is the main cause of chronic oesophagitis?

A

Reflux disease

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5
Q

What is a rare cause of chronic oesophagitis?

A

Crohn’s disease

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6
Q

What is reflux oesophagitis?

A

Inflammation of the oesophagus due to refluxed low pH gastric content

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7
Q

What can reflux oesophagitis be caused by?

A
  • Defective sphincter mechanism +/- hiatus hernia
  • Abnormal oesophageal motility
  • Increased intra-abdominal pressure (pregnancy)
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8
Q

What will reflux oesophagitis show microscopically?

A

Basal zone epithelial expansion (lengthening of papillae), intra-epithelial neutrophils, lymphocytes and eosinophils

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9
Q

What are some complications of reflux oesophagitis?

A

Ulceration (bleeding), stricture, Barrett’s oesophagus

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10
Q

What is Barrett’s oesophagus?

A

Stratified squamous epithelium is replaced by columnar epithelium

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11
Q

What is allergic oesophagitis?

A

Eosinophilic oesophagitis

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12
Q

What is allergic oesophagitis associated with?

A

Asthma and family history of allergic disease

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13
Q

What will the oesophagus look like in allergic oesophagitis?

A

The trachea

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14
Q

Who is allergic oesophagitis more likely to occur in?

A

Young people, predominantly male

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15
Q

What test would show allergic oesophagitis?

A

pH probe negative for reflux

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16
Q

What treatment is considered for allergic oesophagitis?

A

Steroids, cromoglicate, montelukast

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17
Q

What is the QOL like in GORD?

A

Similar to acute coronary events

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18
Q

What are the 3 main problems encountered in GORD?

A

Incompetent LOS, poor oesophageal clearance, barrier function/visceral sensitivity

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19
Q

What occurs in 15% of GORD sufferers and what does this mean?

A

Damage to the mucosa- increases risk of further problems

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20
Q

What are 9 symptoms of GORD?

A

Heartburn, acid reflux, waterbrush, dysphagia, odynophagia, weight loss, chest pain, hoarseness, coughing

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21
Q

What is waterbrush?

A

Sour taste in the mouth and excess saliva

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22
Q

What are 8 alarm symptoms/signs in GORD?

A

Dysphagia, weight loss, anaemia, vomiting, FH of gastric cancer, Barrett’s, pernicious anaemia, peptic ulcer surgery

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23
Q

What is pernicious anaemia?

A

Not enough vitamin B12

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24
Q

What investigations would take place for GORD?

A

Endoscopy, Ba swallow study, oesophageal manometry and pH, nuclear studies

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25
Q

What is oesophageal manometry?

A

Assesses function of LOS

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26
Q

What are the 3 management steps for GORD?

A

Symptom relief, healing oesophagitis, preventing complications

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27
Q

What lifestyle factors could be considered in GORD?

A

Lose weight, stop smoking, prop up head of bed, avoid provoking factors

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28
Q

What drugs give symptomatic relief in GORD but have no benefit in healing or preventing complications?

A

Antacids

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29
Q

What role does cimetidine have in GORD treatment?

A

Rapid symptom relief but not effective at healing

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30
Q

What are cimetidine and ranitidine examples of?

A

Histamine 2 antagonists

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31
Q

Why is ranitidine not very useful for GORD treatment?

A

Commonly results in tolerance and is poor in preventing relapse and complications

32
Q

What drugs provide symptom relief and healing in GORD?

A

Proton pump inhibitors

33
Q

What are the benefits of surgery for GORD?

A

Controls symptoms and heals oesophagitis.

34
Q

When can surgery be cost effective in GORD treatment?

A

Young people and severe/unresponsive disease

35
Q

What percentage of GORD patients develop Barrett’s?

A

10%

36
Q

Is Barrett’s reversible?

A

Debatable, but mainly no

37
Q

What is intestinal metaplasia?

A

The presence of goblet cells

38
Q

What is needed to make a diagnosis of Barrett’s?

A

Intestinal metaplasia

39
Q

What treatments are used for dysplasia management in Barrett’s?

A

Frequent surveillance, optimised PPI dose, endoscopic mucosal resection, radiofrequency ablation, argon

40
Q

What is Barrett’s due to?

A

Persistent reflux of acid or bile

41
Q

What are 2 cellular changes which cold cause Barrett’s?

A
  • Expansion of columnar epithelium from gastric or submucosal glands
  • Differentiation from oesophageal stem cells
42
Q

What will Barrett’s show macroscopically?

A

Red velvety mucosa in the lower oesophagus

43
Q

What will Barrett’s show microscopically?

A

Columnar lined mucosa with intestinal metaplasia

44
Q

What does Barrett’s increase the risk of?

A

Dysplasia, carcinoma

45
Q

What is the main benign tumour of the oesophagus?

A

Papilloma (squamous)

46
Q

What are features of benign oesophageal tumours?

A

Rare, asymptomatic, HPV related

47
Q

What are very rare benign tumours of the oesophagus?

A

Leiomyoma, lipoma, fibrovascular polyps, granular cell tumours

48
Q

What types of malignant tumours occur in the oesophagus?

A

Squamous cell carcinoma, adenocarcinoma

49
Q

Is oesophageal cancer more common in men or women?

A

Men

50
Q

What are the treatment options for oesophageal cancer?

A

Radiotherapy can reduce tumour size or cure completely, surgery is best option

51
Q

What is the progression of oesophageal disorders?

A

Normal, oesophagitis, Barrett’s, adenocarcinoma

52
Q

Who is squamous cell carcinoma more common in?

A

Males

53
Q

What are predisposing factors to squamous cell carcinoma?

A

Vitamin A/zinc deficiency, tannic acid/strong tea, smoking, alcohol, HPV, oesophagitis, genetics

54
Q

Who are adenocarcinomas most common in?

A

Caucasian males

55
Q

Where are adenocarcinomas most common?

A

Lower 1/3rd of oesophagus

56
Q

What can oesophageal cancer present with?

A

Dysphagia or general symptoms of malignancy e.g. weight loss, anaemia, lethargy

57
Q

Where does adenocarcinoma tend to come from?

A

Reflex disease to Barrett’s

58
Q

Where does squamous cell carcinoma tend to come from?

A

Smoking and alcohol

59
Q

What investigations should be done for oesophageal cancer?

A

Urgent upper GI endoscopy, colonoscopy

60
Q

What investigations would you NOT do for oesophageal cancer?

A

Refer to ENT for dysphagia, request radiological investigation

61
Q

What are the first 3 phases of oesophageal cancer treatment?

A
  • Assess if curative or palliative
  • Assess patient fitness
  • Assess staging
62
Q

What investigations are used for staging?

A

CT thorax, CT/PET, EUS, laparoscopy, search for mets

63
Q

What is palliative therapy for oesophageal cancer?

A

Chemotherapy, radiotherapy, staging

64
Q

What is curative therapy for oesophageal cancer?

A

Surgery +/- chemotherapy, radical chemoradiotherapy, surgery for early disease

65
Q

What 3 factors worsen prognosis of oesophageal cancer?

A

Oesophageal obstruction, tumour >5cm, metastatic disease

66
Q

Where in the mouth does cancer have a better prognosis?

A

Front

67
Q

What can cause oral cancer?

A

Tobacco, alcohol, diet and nutrition, HPV, UVL, candida, syphilis

68
Q

What are the alcohol limits?

A

2 units a day, 14 a week

69
Q

What dietary factors are a risk for oral cancer?

A

Low vitamin A/C/iron

70
Q

What are high risk sites for oral cancer?

A

Non-keratinising sites e.g. ventral tongue, lateral tongue, floor of mouth

71
Q

What type are most cancers of the mouth?

A

Squamous cell

72
Q

What facial features can oral cancer manifest as?

A

Drooping eyelids, facial palsy, fractures of the mandible, double vision, blocked/bleeding nose, facial swelling

73
Q

What are warning signs of oral cancer?

A

Red/white/mixed lesions, ulcers, numbness, pain, changes in voice, dysphagia

74
Q

What questions should you ask a patient with suspected oral cancer?

A

How long has it been there? Is it painful? Do you smoke or drink? What colour is the lesion?

75
Q

What does pain in oral lesions usually suggest?

A

Benign ulcer, but can be present in late oral cancer

76
Q

What is the treatment for oral squamous carcinoma?

A

Surgery +/- adjuvant therapy

GI (17 decks)

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