Pathology of Oesophagus

Question 1

The normal oesophagus is made up of

Answer 1

Stratified squamous epithelium

Question 2

Top 2/3rds of oesophagus is composed of

Answer 2

Skeletal muscle

Question 3

Lower 1/3rd of oesophagus is composed of

Answer 3

Smooth muscle

Question 4

Is acute oesophagitis rare or common

Answer 4

Rare

Question 5

What is acute oesophagitis

Answer 5

Corrosion following chemical ingestion in immunocompromsied

Question 6

Is Chronic Oesophagitis rare or common

Answer 6

Common

Question 7

What are causes of chronic oesophagitis

Answer 7

Common - reflux disease

Rare - Crohn’s Disease

Question 8

What is reflux eosophagitis

Answer 8

Inflammation of the oesophagus due to reflux of low pH gastric contents

Question 9

What are the causes of reflux oesophagitis

Answer 9

Defensive sphincter mechanism +/- hiatus hernia
Abnormal oesophageal motility
Increased intra abdominal pressure

Question 10

What are the complications of GORD

Answer 10

Stricture
Ulceration
Barrett’s Oesophagus

Question 11

What are the symptoms of GORD

Answer 11

Chest pain
Heart burn
Wt loss
Dysphagia
Cough
Odynophagia
Hoarseness

Question 12

Risk Factors for GORD

Answer 12

Overweight
Hiatus hernia
Older aged
Family history

Question 13

investigations for GORD

Answer 13

Trial of PPI e.g. omeprazole

Question 14

What to do if PPI unsuccessful

Answer 14

oesophagogastroduodenoscopy for alarming symptoms

Question 15

Treatment of GORD

Answer 15

Lifestyle management - lose wt if overweight, stop smoking, sleep lying up, avoid provoking (e.g. certain foods)
PPI - Omeprazrole
Symptoms relief - antacids - ranitidine
Nissen Fundoplication - young pts or those that don’t adhere to treatment

Question 16

What are alarming symptoms of GORD

Answer 16

PUD >20 years
Dysphagia
Wt loss
Anaemia
Vomiting
FH UGI cancer
Barrett's

Question 17

Allergic Oesophagitis increases

Answer 17

Esopinophil count

Question 18

Who does allergic oesophagitis effect

Answer 18

Young patients - children and teens
Family history of allergy
Asthma
males > Females

Question 19

What is the treatment for allergic oesophagitis

Answer 19

Steroids, chromolyclate, moteleukast

Question 20

What are the microscopic changes of GORD

Answer 20

Increased lamina propria
Increased intraepithelial neutrophils, lymphocytes, eosinophils
Increased basal zone epithelial expansion

Question 21

what type of oesophageal cancer is HPV a risk factor for

Answer 21

Squamous papilloma

Question 22

Is squamous papilloma common or uncommon

Answer 22

Uncommon

Question 23

What is the progression of oesophageal cancer

Answer 23

Direct invasion
Lymphatic permeation
Vascular Invation

Question 24

What type of cancer is increasing in the western world

Answer 24

Adenocarcinoma

Question 25

What is a general risk factor for oesophageal malignancy

Answer 25

Being male

Question 26

What are risk factors for adenocarcinoma of the oesophagus

Answer 26

Caucasian Barrett's Oesophagus Obesity Hiatus hernia

Question 27

What are risk factors for squamous cell carcinoma of the oesophagus

Answer 27

``` Black Family history of upper GI malignancy Alcohol Smoking Hot drinks Mate ```

Question 28

Where does squamous cell carcinoma most commonly occur in the oesophagus

Answer 28

Upper or mid oesophagus

Question 29

Where does adenocarcioma most commonly occur in the oesophagus

Answer 29

Lower oesophagus

Question 30

What are the common signs and symptoms of oesophageal cancer

Answer 30

Dysphagia Odynophagia Weight loss - as it becomes more difficult to swallow

Question 31

What are other symptoms

Answer 31

Hiccups - if pressed on phrenic nerve | Hoarseness - if press recurrent laryngeal nerve

Question 32

What is the investigation and diagnostic test for oesophageal malignancy

Answer 32

Endoscopy and biopsy PET - metastases CT