Pathology of the Oesophagus Flashcards
Acute oesophagitis
- after chemical ingestion
- in immunocompromised patients e.g HIV, AIDS, CMV, herpes
Causes of Chronic oesophagitis (GORD)
- resting tone of LOS is absent
- LOS tone does not increase when lying flat (patient often wakes at night)
- abnormal oesophageal motility
- delayed gastric emptying
- hiatus hernia
Investigations for GORD
- gastroscopy
- barium meal
Treatment for GORD
- PPIs
- H2 receptor antagonist
- metoclopramide (increased rate of gastric emptying)
- fundoplication (increased tone of LOS)
complications of GORD
- ulceration
- stricture formation
- Barrett’s
What is Barrett’s?
premalignant metaplastic change of squamous -> columnar, due to persistent reflux of acid
Treatment of Barrett’s
PPIs, surveilience, oesophagectomy
Why does Barrett’s put the patient at risk of malignancies?
as the metaplastic change may be followed by a dysplastic change
What is allergic oesophagitis?
allergic condition of the oesophagus, involving increased amounts of eosinphils and inflam
Aetiology of allergic oesophagitis
- males
- young
- personal of family history of allergies (in particular asthma)
Treatment of allergic oesophagitis
steroids, montelukast, chromoglycate
What are the three congenital conditions of the oesophagus?
- stenosis (narrowing)
- agenisis (absence of oesophagus)
- atresia and tracheo-oesophageal fistula
what is achalasia?
loss of peristalsis of the lower oesophagus and spasms of LOS
What does achalasia look like on imaging
dilatation and beak deformity
treatment of achalasia
- endoscopic balloon dilatation
- surgery to weaken the sphincter (must have a fundoplication performed also)
What are the two types of hiatus hernia?
Sliding - the GO junction sliding through the hiatus and lying above the diaphragm
Rolling - part of the fundus of the stomach rolling through the hernia and sitting next to the oesophagus
What is a diverticula of the oesophagus
outpouchings, due to impaired motor function
pharyngeal pouch is most common
Benign tumours of the oesophagus
- squamous papilloma
- leiomyomas
- lipomas
- granular cell tumours
- fibrovascular polyps
Malignant tumours of the oesophagus and where they are most commonly found
squamous cell carcinoma, in the middle
adenocarcinoma, the lower third (due to Barrett’s)
common routes of metastases
lymphatic, direct, haematogenous
