clinical overview gastro-oesophageal disease Flashcards
what are the three physiological constrictions of the oesophagus ?
cricopharynxgeus
aortic arch
hiatus
what is the lining of the oesophagus ?
stratified squamous epithelium
what is the general clinical presentation of oesophageal disorders ?
dysphagia with or without pain n
regurgitation/ drooling
malnutrition
what are the investigations for oesophageal disorders?
contrast radiology endoscopy and special tests such as: pH meter (GERD) Motility study (Achalasia)
what is the nature of the stricture of post corrosive oesophageal stricture ?
tight
long segment
multiple ( esoph, stomach)
marked proximal dilatation
what are the most common cases associated with PCOS ?
mostly children , with adults its mainly a suicidal attempt or a psychotic patient
what is the management for PCOS?
endoscopy after 2 weeks of insult then :
dilatation or resection
when do we perform a resection on a PCOS patient ?
if the dilatation failed
if there is a tight stricture
if there is a malignancy
when can we start considering a carcinoma with PCOS ?
if we performed dilatation and the patient still has dysphagia
what is achalasia ?
a motility disorder characterized by failure of relaxation of the lower oesophageal sphincter
what is the nature of the stricture in achalasia ?
distal ( less than LES)
short ( less than 5 cm)
smooth mucosa
centric lumen
what does the body of the oesophagus look like in achalasia ?
- enormous proximal dilatation with oesophageal fluid/air trap
- a-peristaltic
- absent gastric air bubble
what are the manometry results in achalasia ?
hypertesive and long LES
and no peristalsis
what does the position of the stricture indicate in achalasia ?
if its below the cupula of the diaphragm - most likely not carcinoma
above the cupula of the diaphragm- rat tail appearance (carcinoma)
what is the radiological finding with long standing achalasia ?
bird beak appearance (elongation and dilation)
what are the three types of diverticula formation ?
- pharyngeoesophgeal
- mid-esophgeal
- epiphrenic
what is Zinker’s diverticulum ?
a pharyngeooesphgeal diverticula characterized by the incoordination between the cricopharyngeus muscle contraction and upper eosophgeal relaxation inducing luminal hypertension
how do we treat and managed Zinker’s diverticulum ?
diverteculetomy then
treat the spasm with a transverse myotomy
where are pharyngoesophgeal diverticulum more common in?
more in males
in elderly
in the left posterior triangle usually
what are the three types of hiatal hernias ?
sliding cardia (type I) rolling fundus (type II) combined (type III)
what is the initiating process in sliding hernias?
in type 1 HH :
GERD
what is the presentation of rolling hernias?
3D syndrome :
dysphagia
dyspepsia
dyspnea
when can we suspect Barrets oesophagus on endoscopy?
disturbed z-line
what does metaplasia predispose to ?
adenocarcinoma
what is a leimyoma ?
benign smooth muscle tumor
what are the features of a leimyoma ?
may be large
regular contour
intact mucosa
60% distal third
what radiological feature is specific to carcinomas?
mural thickening
what differentiates a carcinoma from a leiomyoma ?
mural thickening eccentric lumen wide prevertebral space shouldering mucosal irregularity
what are the types of gastric outlet obstruction ?
lumenal
mural
extrinsic
what is bouveret syndrome ?
gall stone obstruction in the lumen of the stomach
what are the two types of volvulus ?
organo-axial : joining of the cardia along with the pylorus
mesenterico-axial: joining the lesser and greater omentum together
what is the clinical presentation of organo-axial volvulus ?
acute abdominal pain
vomiting
abdominal distention
shock
what is the cause of GIST ?
mutation in PDGFRA and KIT genes
what is the treatment for GIST ?
in resectable regions:
and tyrosine kinase inhibitors after the resection
what is the lesion is non resectable in GIST ?
use TKI drugs until it becomes resectable
what is an example of a TKI ?
imatinib
