Oesophagus Disorders Flashcards
Out of acute and common oesophagitis, which is common and which is rare?
Acute- rare
Chronic- common
What is oesophagitis?
Inflammatory disorder of the oesophagus
What are the 2 causes of acute oesophagitis?
Corrosion following chemical ingestion or infective in immunocompromised patients
What is the main cause of chronic oesophagitis?
Reflux disease
What is a rare cause of chronic oesophagitis?
Crohn’s disease
What is reflux oesophagitis?
Inflammation of the oesophagus due to refluxed low pH gastric content
What can reflux oesophagitis be caused by?
- Defective sphincter mechanism +/- hiatus hernia
- Abnormal oesophageal motility
- Increased intra-abdominal pressure (pregnancy)
What will reflux oesophagitis show microscopically?
Basal zone epithelial expansion (lengthening of papillae), intra-epithelial neutrophils, lymphocytes and eosinophils
What are some complications of reflux oesophagitis?
Ulceration (bleeding), stricture, Barrett’s oesophagus
What is Barrett’s oesophagus?
Stratified squamous epithelium is replaced by columnar epithelium
What is allergic oesophagitis?
Eosinophilic oesophagitis
What is allergic oesophagitis associated with?
Asthma and family history of allergic disease
What will the oesophagus look like in allergic oesophagitis?
The trachea
Who is allergic oesophagitis more likely to occur in?
Young people, predominantly male
What test would show allergic oesophagitis?
pH probe negative for reflux
What treatment is considered for allergic oesophagitis?
Steroids, cromoglicate, montelukast
What is the QOL like in GORD?
Similar to acute coronary events
What are the 3 main problems encountered in GORD?
Incompetent LOS, poor oesophageal clearance, barrier function/visceral sensitivity
What occurs in 15% of GORD sufferers and what does this mean?
Damage to the mucosa- increases risk of further problems
What are 9 symptoms of GORD?
Heartburn, acid reflux, waterbrush, dysphagia, odynophagia, weight loss, chest pain, hoarseness, coughing
What is waterbrush?
Sour taste in the mouth and excess saliva
What are 8 alarm symptoms/signs in GORD?
Dysphagia, weight loss, anaemia, vomiting, FH of gastric cancer, Barrett’s, pernicious anaemia, peptic ulcer surgery
What is pernicious anaemia?
Not enough vitamin B12
What investigations would take place for GORD?
Endoscopy, Ba swallow study, oesophageal manometry and pH, nuclear studies
What is oesophageal manometry?
Assesses function of LOS
What are the 3 management steps for GORD?
Symptom relief, healing oesophagitis, preventing complications
What lifestyle factors could be considered in GORD?
Lose weight, stop smoking, prop up head of bed, avoid provoking factors
What drugs give symptomatic relief in GORD but have no benefit in healing or preventing complications?
Antacids
What role does cimetidine have in GORD treatment?
Rapid symptom relief but not effective at healing
What are cimetidine and ranitidine examples of?
Histamine 2 antagonists
Why is ranitidine not very useful for GORD treatment?
Commonly results in tolerance and is poor in preventing relapse and complications
What drugs provide symptom relief and healing in GORD?
Proton pump inhibitors
What are the benefits of surgery for GORD?
Controls symptoms and heals oesophagitis.
When can surgery be cost effective in GORD treatment?
Young people and severe/unresponsive disease
What percentage of GORD patients develop Barrett’s?
10%
Is Barrett’s reversible?
Debatable, but mainly no
What is intestinal metaplasia?
The presence of goblet cells
What is needed to make a diagnosis of Barrett’s?
Intestinal metaplasia
What treatments are used for dysplasia management in Barrett’s?
Frequent surveillance, optimised PPI dose, endoscopic mucosal resection, radiofrequency ablation, argon
What is Barrett’s due to?
Persistent reflux of acid or bile
What are 2 cellular changes which cold cause Barrett’s?
- Expansion of columnar epithelium from gastric or submucosal glands
- Differentiation from oesophageal stem cells
What will Barrett’s show macroscopically?
Red velvety mucosa in the lower oesophagus
What will Barrett’s show microscopically?
Columnar lined mucosa with intestinal metaplasia
What does Barrett’s increase the risk of?
Dysplasia, carcinoma
What is the main benign tumour of the oesophagus?
Papilloma (squamous)
What are features of benign oesophageal tumours?
Rare, asymptomatic, HPV related
What are very rare benign tumours of the oesophagus?
Leiomyoma, lipoma, fibrovascular polyps, granular cell tumours
What types of malignant tumours occur in the oesophagus?
Squamous cell carcinoma, adenocarcinoma
Is oesophageal cancer more common in men or women?
Men
What are the treatment options for oesophageal cancer?
Radiotherapy can reduce tumour size or cure completely, surgery is best option
What is the progression of oesophageal disorders?
Normal, oesophagitis, Barrett’s, adenocarcinoma
Who is squamous cell carcinoma more common in?
Males
What are predisposing factors to squamous cell carcinoma?
Vitamin A/zinc deficiency, tannic acid/strong tea, smoking, alcohol, HPV, oesophagitis, genetics
Who are adenocarcinomas most common in?
Caucasian males
Where are adenocarcinomas most common?
Lower 1/3rd of oesophagus
What can oesophageal cancer present with?
Dysphagia or general symptoms of malignancy e.g. weight loss, anaemia, lethargy
Where does adenocarcinoma tend to come from?
Reflex disease to Barrett’s
Where does squamous cell carcinoma tend to come from?
Smoking and alcohol
What investigations should be done for oesophageal cancer?
Urgent upper GI endoscopy, colonoscopy
What investigations would you NOT do for oesophageal cancer?
Refer to ENT for dysphagia, request radiological investigation
What are the first 3 phases of oesophageal cancer treatment?
- Assess if curative or palliative
- Assess patient fitness
- Assess staging
What investigations are used for staging?
CT thorax, CT/PET, EUS, laparoscopy, search for mets
What is palliative therapy for oesophageal cancer?
Chemotherapy, radiotherapy, staging
What is curative therapy for oesophageal cancer?
Surgery +/- chemotherapy, radical chemoradiotherapy, surgery for early disease
What 3 factors worsen prognosis of oesophageal cancer?
Oesophageal obstruction, tumour >5cm, metastatic disease
Where in the mouth does cancer have a better prognosis?
Front
What can cause oral cancer?
Tobacco, alcohol, diet and nutrition, HPV, UVL, candida, syphilis
What are the alcohol limits?
2 units a day, 14 a week
What dietary factors are a risk for oral cancer?
Low vitamin A/C/iron
What are high risk sites for oral cancer?
Non-keratinising sites e.g. ventral tongue, lateral tongue, floor of mouth
What type are most cancers of the mouth?
Squamous cell
What facial features can oral cancer manifest as?
Drooping eyelids, facial palsy, fractures of the mandible, double vision, blocked/bleeding nose, facial swelling
What are warning signs of oral cancer?
Red/white/mixed lesions, ulcers, numbness, pain, changes in voice, dysphagia
What questions should you ask a patient with suspected oral cancer?
How long has it been there? Is it painful? Do you smoke or drink? What colour is the lesion?
What does pain in oral lesions usually suggest?
Benign ulcer, but can be present in late oral cancer
What is the treatment for oral squamous carcinoma?
Surgery +/- adjuvant therapy
