Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

304: GI > Benign and malignant Oesophageal and stomach disease > Flashcards

Benign and malignant Oesophageal and stomach disease Flashcards

1
Q

Benign obstructive oesophageal disease mechanisms

A

Extrinsic/ extraluminal

Transmural

Neurogenic

Luminal

Functional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Examples of extrinsic/extraluminal benign obstructive oesophageal disease

A

Retrosternal goitre

Bronchogenic tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Examples of Transmural benign obstructive oesophageal disease

A

GIST (GI stromal tumour)
Rare–>can resect or enucleate.
- Interstitial, cajal GI cells.
- Low malignant potential, compared to others in GIT.

Leiomyoma

  • Smooth muscle tumour, more common than GIST
  • Treatment= Enucleating, resection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Examples of neurogenic benign obstructive oesophageal disease

A

Achalasia

CREST syndrome
- Connective tissue disorder

Chaga’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Achalasia

  • Pathophysiology
  • Classification
A

Failure of LES to relax/open
- Due to degeneration of myenteric (Auerbach’s) plexus

Primary

  • Idiopathic (most common, in younf adulthood)
  • Secondary : Chaga’s disease)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Chaga’s disease

A

Parasitic disease- Trypanosoma cruzi.

- Can cause enlarged oesophagus, secondary achalasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Causes of luminar benign obstructive oesophageal disease

A
  • Schatzki’s ring

- Benign stricture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes of functional benign obstructive oesophageal disease

A

Nutcracker oesophagus

Diffuse oesophageal spasms

Hypertensive LES.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hiatus hernia

  • Description
  • Risk factors
  • Types
A

Herniation of some/ all of the stomach through the diaphragm, into the mediastinum.

Risk factors

  • M> F
  • Obesity, previous surgery

Types

  • Type 1, Reflux
  • Type 2, Rolling.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Type 1, reflux hiatus hernia

A

Hernia in which there is a shifting Z line
- Most common

Herniation is due to circumferential laxity of the phrenoesophageal membrane.
- May result in GORD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Type 2, rolling hiatus hernia

A

Hernia in which the Z-line is non-shifiting.

Herniation is due to focal weakness of phrenoesophageal membrane.
- Risk of strangulation which can cut off blood supply/ obstruction

Symptoms

  • Hiccough
  • Pressure in chest
  • Odynophagia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Gastric volvulus

  • Pathophysiology
  • Types
  • Treatment
A

Rotation of the stomach of >180 degrees, causing a closed loop obstruction.

Types:
Mesentericoaxial
- Rotates on an axial axis.

Organoaxial
- rotates around vertical axis of organ.

Treatment

  • RESUS if necessary
  • NBM
  • NGT decompression
  • Strangulation= surgery (fundoplication, gastropexy, venting PEG)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Three investigations for obstructive oesophagopathy

A

OGD

  • Shows mass
  • Herniation

Manometry

  • Rules out achalasia
  • Will show LES failing to relax

Barium swallow
- Depicts achalasia (rat’s tail)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Boerhaave’s syndrome

A

Transmural tear of oesophagus to due sudden increase in pressure from vomiting.

Cricopharyngeus muscle of pharynx fails to contract so bolus cannot escape, causing high pressure and rupture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

GORD

  • Definition
  • Complications
  • Risk factor
A

SYMPTOMATIC reflux of gastric content into the oesophagus, sometimes pharynx.

Complications

  • Oesophagitis
  • Stricture
  • Barrett’s oesophagus–>cancer
Risk factors
-	Smoking
-	Alcohol
-	Hiatus hernia
-	Pregnancy
Obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pathophysiology of GORD

A

Lower oesophagus sphincter incompetency

  1. Prolonged relaxation
  2. Hypotensive
  3. Disruption of eosophago-gastric junction (hernia)
17
Q

Red flag signs in dyspepsia

A
  • Dysphagia
  • Vomiting
  • Weight loss
  • Iron deficiency
  • Blood loss
  • Mass
18
Q

Grades of reflux oesophagitis (1-5)

A
  1. Single or multiple erosions in single longitudinal fold
  2. Erosions on multiple folds
  3. Confluent, circular erosions. Friability
  4. Strictures, deep ulcers
  5. Barrett’s oesophagus
19
Q

Differentials for GORD [7]

A

Infection: CMV, herpes, Candida

Peptic ulcers
Gastric cancer
Achalasia
Oesophagitis

20
Q

Investigations for GORD

A

Bloods:
- FBC, U+E, CRP, LFT

OGD

24 Hr oesophageal pH measurement

  • 8%, pH<4
  • Used when: atypical symptoms, treatment not working, pre-surgery, no oesophagitis in OGD

LES manometry
- Rules out achalasia

21
Q

Indications for surgical management of GORD

A
  1. Failed medical management
    - Side effects
    - No symptomatic relief
  2. Consideration of quality of life and long-term medication despite medical management
  3. Complications of GORD
    - Barrett’s
    - Strictures
    - large volume reflux with aspiration risk
  4. Extra-oesophageal manifestations
22
Q

Extra-oesophageal manifestations of GORD

A
  • Asthma
  • Cough
  • Aspiration
  • Hoarse voice
  • Chest pain
23
Q

Surgical procedures for GORD

A

Nissen’s fundoplication
- Wrap the fundus of stomach, 360, around lower oesophagus

Toupet Partial fundo
- Fundus is only partially wrapped around oesophagus. Less aggravation of dysphagia.

Belsey Mark IV

Hill repair
- Partial wrap of fundus around oesophagus

Gastropexy
- Suture the stomach to abdominal wall or diaphragm

24
Q

Achalasia

  • Presentation
  • complications
A

Slowly progressive dysphagia
- Initially worse for fluids, than solids

Later disease
- Regurgitation of undigested food

Weight loss

Aspiration pneumonia

Complications
- Oesophageal SCC

25
Q

Diffuse oesophageal spasm

  • Description
  • Diagnosis
A

Acute pain along the esophagus induced by ingestion (odynophagia)

  • May be accompanied with dysphagia
  • Due to uncoordinated contraction

Diagnosis

  • Barium swallow shows ‘corkscrew’ appearance
  • Manometry= diffuse hypertonicity
  • Endoscopy= rules out malignancy
26
Q

Achalasia

- Management

A

Palliative

  • CCB
  • Nitrates
  • Lifestyle changes

Interventions

  • Endoscopic guided controlled balloon dilatation: need multiple procedures, but successful in most patients.
  • Botulinum toxin injections

Surgery
- Heller myotomy= cut out muscle layer of lower oesophagus, but not inner layer.
Complications: reflux, obstruction at GOJ, oesophageal perforation

  • Dor patch= Partial wrapping of stomach around oesophagus. Makes low pressure valve.
27
Q

Diffuse oesophageal spasm

- Management

A

Medications

  • Oral CCB
  • Relaxants= benzos
  • Long acting nitrates

Pneumatic dilatations
- usually repeated

Surgical
- Open myotomy (rare)

28
Q

Pharyngeal pouch

  • Description
  • Causes
  • Presentation
A

Also called Zenker’s diverticulum

Acquired diverticulum arising from tissue between inferior constrictor and cricopharyngeus muscle of the oesophagus.
- Typically affects elderly

Cause

  • Inappropriate relaxation of cricopharyngeus= increased pressure on tissue above during swallowing
  • Lower CN dysfunction

Presentation

  • Supper cervical dysphagiia
  • Intermmittent lump appearing when swallowing
  • Regurgiation of undigested food
  • Nocturnal aspiration
29
Q

Pharyngeal pouch

- Diagnosis

A

Observation of swallowing
- Transient neck swelling appears

Video barium swallow
- Filling of pouch

Gastroscopy avoided

30
Q

Pharyngeal pouch

- Treatment

A

Stapled pharyngoplasty

  • Endoscopic
  • Staple pouch to upper oesophagus
31
Q

Hiatus hernia treatment

  • Lifestyle
  • Medical
  • Surgical (indications
A

Lifestyle

  • Stop smoking
  • Weight loss
  • Reduce alcohol consumption

Medical

  • PPIs
  • Antacids
  • Promote gastric emptying: metoclopramide

Surgical

32
Q

Hiatus hernia treatment

  • Surgical (indications
  • Procedures
A

Indications

  • Persistent symptoms despite maximal medical management
  • Complications of rolling hernia

Procedures

  • Gastropexy (with crural plication)
  • Fundoplication (Nissen’s) for GORD
  • Gastrectomy (rare)
33
Q

Hiatus hernia

- diagnosis

A

CXR
- Gas bubble/ fluid in chest

Upper Gi series
- Barium examination of GIT= diagnostic

OGD (reflux symptoms)
- Oesophagitis

24 pH manometry
- Excludes achalasia, dysmotility

34
Q

Upper GI cancer referral symptoms/ signs

A

Nausea and vomiting

Dyspepsia

Upper abdominal pain

Reflux

Haematemesis

Anaemia/ Thrombocytopenia

304: GI (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions