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General Surgery > Benign diseases of the pharynx and oesophagus > Flashcards

Benign diseases of the pharynx and oesophagus Flashcards

1
Q

How many muscle layers does the oesophagus have?

A

2/3: inner circular and outer longitudinal, each with a spiral component

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2
Q

How long is the intra-abdominal oesophagus?

A

4-5cm

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3
Q

What muscle types occur in the different segments of the oesophagus?

A

Upper 1/3: striated
Middle 1/3: mixed
Lower 1/3: smooth

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4
Q

What epithelial types occur in the oesophagus?

A

Stratified squamous epithelium with mucous glands interspersed
Junctional region between oesophagus and stomach is made up if columnar epithelium = barrier zone from stomach

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5
Q

Which cranial nerves control swallowing?

A

XI and XII

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6
Q

Which factor/s prevent occurrence of GORD?

A

Major: length of the intra-abdominal oesophagus
Minor: pinch cock action of crura of diaphragm, phreno-oesophageal ligament, angle of oesophagus and stomach (angle of His)

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7
Q

Are the oesophageal sphincters anatomical or physiological sphincters?

A

Upper: anatomical
Lower: physiological (4cm long)

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8
Q

Modalities of investigating oesophageal disorders?

A 
CXR
Barium swallow and meal
Endoscopy
CT scanning and endoscopic U/S
Manometry
24 hour pH monitoring
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9
Q

What causes GORD?

A

Incompetence/inappropriate relaxation of the lower oesophageal sphincter

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10
Q

Complications of GORD?

A 
Oesophagitis
Oesophageal ulcers
Oesophageal stenosis
Bleeding
Metaplasia --> Barrett's oesophagus --> 5-10% lifetime risk of developing adenocarcinoma
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11
Q

What are danger signs in a patient with GORD?

A

Loss of weight
Anaemia
Dysphagia

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12
Q

Treatment of simple GORD?

A

Lifestyle modifications: weight reduction, avoid situations that increase abdominal pressure e.g. stooping, elevation of the head (pillows), avoid fatty foods
Reduce smoking and excessive alcohol use
Eat smaller meals, especially at night - avoid going to bed on full stomach
Stop using NSAIDS
PPI’s most effective drug (keep on maintenance if have oesophagitis, else use as necessary)
H2 receptor blockers are useful for very mild disease

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13
Q

What is the name of the procedure to surgically treat severe GORD?

A

Nissen’s fundoplication

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14
Q

What are the two major types of hiatus hernia?

A

Sliding: stomach and oesophagus herniate upwards together

Para-oesophageal: fundus of stomach herniates up next to oesophagus (forms a pouch)

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15
Q

Which type of hiatus hernia predisposes to GORD?

A

Sliding

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16
Q

Complications of hiatus hernias?

A

Gastric volvulus and obstruction
Incarceration
Strangulation
Pulmonary complications

17
Q

What is pharyngeal dysphagia?

A

Functional disorders seen in psychiatric patients who have a fear of choking

18
Q

What makes up the Plummer-Vinson syndrome?

A 
Iron deficiency anaemia
Glossitis
Cheilosis
Koilonychia
Oesophageal web
19
Q

Causes of motor disturbances of the upper sphincter of the oesophagus?

A

Bulbar poliomyelitis
CVA
Myasthenia gravis
Radical oropharyngeal surgery

20
Q

What is achalasia?

A

A condition where there is failure of the oesophagus to perform its motor function, and absence of relaxation of the LOS

21
Q

Signs of achalasia on investigation?

A

“Bird’s beak” on barium meal study = dilated oesophagus with fluid level and smooth tapering
Manometry: absence of peristalsis of body of oesophagus and failure of relaxation of the LOS

22
Q

Why is it important to do endoscopy on a patient with features suggestive of achalasia?

A

To rule out a malignant lesion at the oesophago-gastric junction

23
Q

Treatment options for achalasia?

A

Oesophago-myotomy (Heller’s)
Pneumatic baloon dilatation
Intersphincteric botox injection

24
Q

What oesophageal motility changes are seen in scleroderma?

A

Absence of peristalsis of body of oesophagus with an incompetent LOS, and resultant GORD

25
Q

What is diffuse oesophageal spasm?

A

Oesophageal contractions are simultaneous, repetitive and of greater amplitude
Causes great pain, but doesn’t impede flow of food into stomach
May simulate angina pectoris with radiation etc
Conservative treatment

26
Q

What is a nutcracker oesophagus?

A

Hyperfunctional disorder characterised by chest pain and high amplitude, co-ordinated peristaltic waves
Treatment is usually unsatisfactory unless due to another disorder e.g. GORD
Surgery is usually not indicated

27
Q

What is a pharyngo-oesophageal/Zenker’s diverticulum?

A

Diverticulum emerging posteriorly between the inferior constrictor muscle of the pharynx and the cricopharyngeus muscle - usually left-sided
May extend into the mediastinum
Usually occurs in elderly patients

28
Q

Symptoms of Zenker’s diverticulum?

A

Dysphagia
Foul breath
Noisy deglutition
Regurgitation of food

29
Q

What is a traction diverticulum of the oesophagus?

A

Diverticulum usually found mid-oesophagus resulting from contiguous pathology e.g. TB

30
Q

What is an epiphrenic diverticulum of the oesophagus?

A

Diverticulum in the lower 10cm of the supra-diaphragmatic portion of the oesophagus
Rare, mostly the result of functional or mechanical oesophageal obstruction

31
Q

Causes of oesophageal perforation?

A

Non-instrumental:

  • Post emetic: Mallory-Weiss; submucosal haematoma; free rupture (Boerhaave’s syndrome)
  • Foreign body
  • Penetrating injuries
  • Anastomotic leak

Instrumental:

  • Endoscopy
  • Balloon dilatation
  • Intubations or stents
  • Injection sclerotherapy for varices
32
Q

Major complication of oesophageal rupture?

A

Mediastinitis

33
Q

What is the difference between dysphagia and odynophagia?

A 
Dysphagia = difficulty swallowing
Odynophagia = painful swallowing
34
Q

Benign causes of dysphagia?

A 
GORD
Caustic ingestion
Webs
Schatzki ring (thickened band of mucosa)
Motility disorders
Drug induced
Post-Nissen fundoplication
Eosinophilic oesophagitis
35
Q

Malignant causes of dysphagia?

A

Squamous carcinoma
Adenocarcinoma
Metastases

36
Q

Causes of odynophagia?

A 
Hypermotility disorders
Candidiasis
Herpes simplex
Drugs:
 - Abx (e.g. tetracyclines)
 - NSAIDs
 - Ascorbic acid
 - Emepromium bromide

General Surgery (15 decks)

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