Pathology of Oesophagus Flashcards
The normal oesophagus is made up of
Stratified squamous epithelium
Top 2/3rds of oesophagus is composed of
Skeletal muscle
Lower 1/3rd of oesophagus is composed of
Smooth muscle
Is acute oesophagitis rare or common
Rare
What is acute oesophagitis
Corrosion following chemical ingestion in immunocompromsied
Is Chronic Oesophagitis rare or common
Common
What are causes of chronic oesophagitis
Common - reflux disease
Rare - Crohn’s Disease
What is reflux eosophagitis
Inflammation of the oesophagus due to reflux of low pH gastric contents
What are the causes of reflux oesophagitis
Defensive sphincter mechanism +/- hiatus hernia
Abnormal oesophageal motility
Increased intra abdominal pressure
What are the complications of GORD
Stricture
Ulceration
Barrett’s Oesophagus
What are the symptoms of GORD
Chest pain Heart burn Wt loss Dysphagia Cough Odynophagia Hoarseness
Risk Factors for GORD
Overweight
Hiatus hernia
Older aged
Family history
investigations for GORD
Trial of PPI e.g. omeprazole
What to do if PPI unsuccessful
oesophagogastroduodenoscopy for alarming symptoms
Treatment of GORD
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
What are alarming symptoms of GORD
PUD >20 years Dysphagia Wt loss Anaemia Vomiting FH UGI cancer Barrett's
Allergic Oesophagitis increases
Esopinophil count
Who does allergic oesophagitis effect
Young patients - children and teens
Family history of allergy
Asthma
males > Females
What is the treatment for allergic oesophagitis
Steroids, chromolyclate, moteleukast
What are the microscopic changes of GORD
Increased lamina propria
Increased intraepithelial neutrophils, lymphocytes, eosinophils
Increased basal zone epithelial expansion
what type of oesophageal cancer is HPV a risk factor for
Squamous papilloma
Is squamous papilloma common or uncommon
Uncommon
What is the progression of oesophageal cancer
Direct invasion
Lymphatic permeation
Vascular Invation
What type of cancer is increasing in the western world
Adenocarcinoma
What is a general risk factor for oesophageal malignancy
Being male
What are risk factors for adenocarcinoma of the oesophagus
Caucasian
Barrett’s Oesophagus
Obesity
Hiatus hernia
What are risk factors for squamous cell carcinoma of the oesophagus
Black Family history of upper GI malignancy Alcohol Smoking Hot drinks Mate
Where does squamous cell carcinoma most commonly occur in the oesophagus
Upper or mid oesophagus
Where does adenocarcioma most commonly occur in the oesophagus
Lower oesophagus
What are the common signs and symptoms of oesophageal cancer
Dysphagia
Odynophagia
Weight loss - as it becomes more difficult to swallow
What are other symptoms
Hiccups - if pressed on phrenic nerve
Hoarseness - if press recurrent laryngeal nerve
What is the investigation and diagnostic test for oesophageal malignancy
Endoscopy and biopsy
PET - metastases
CT
