clinical overview gastro-oesophageal disease Flashcards

1
Q

what are the three physiological constrictions of the oesophagus ?

A

cricopharynxgeus
aortic arch
hiatus

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2
Q

what is the lining of the oesophagus ?

A

stratified squamous epithelium

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3
Q

what is the general clinical presentation of oesophageal disorders ?

A

dysphagia with or without pain n
regurgitation/ drooling
malnutrition

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4
Q

what are the investigations for oesophageal disorders?

A
contrast radiology 
endoscopy 
and special tests such as:
pH meter (GERD) 
Motility study (Achalasia)
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5
Q

what is the nature of the stricture of post corrosive oesophageal stricture ?

A

tight
long segment
multiple ( esoph, stomach)
marked proximal dilatation

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6
Q

what are the most common cases associated with PCOS ?

A

mostly children , with adults its mainly a suicidal attempt or a psychotic patient

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7
Q

what is the management for PCOS?

A

endoscopy after 2 weeks of insult then :

dilatation or resection

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8
Q

when do we perform a resection on a PCOS patient ?

A

if the dilatation failed
if there is a tight stricture
if there is a malignancy

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9
Q

when can we start considering a carcinoma with PCOS ?

A

if we performed dilatation and the patient still has dysphagia

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10
Q

what is achalasia ?

A

a motility disorder characterized by failure of relaxation of the lower oesophageal sphincter

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11
Q

what is the nature of the stricture in achalasia ?

A

distal ( less than LES)
short ( less than 5 cm)
smooth mucosa
centric lumen

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12
Q

what does the body of the oesophagus look like in achalasia ?

A
  • enormous proximal dilatation with oesophageal fluid/air trap
  • a-peristaltic
  • absent gastric air bubble
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13
Q

what are the manometry results in achalasia ?

A

hypertesive and long LES

and no peristalsis

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14
Q

what does the position of the stricture indicate in achalasia ?

A

if its below the cupula of the diaphragm - most likely not carcinoma
above the cupula of the diaphragm- rat tail appearance (carcinoma)

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15
Q

what is the radiological finding with long standing achalasia ?

A

bird beak appearance (elongation and dilation)

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16
Q

what are the three types of diverticula formation ?

A
  • pharyngeoesophgeal
  • mid-esophgeal
  • epiphrenic
17
Q

what is Zinker’s diverticulum ?

A

a pharyngeooesphgeal diverticula characterized by the incoordination between the cricopharyngeus muscle contraction and upper eosophgeal relaxation inducing luminal hypertension

18
Q

how do we treat and managed Zinker’s diverticulum ?

A

diverteculetomy then

treat the spasm with a transverse myotomy

19
Q

where are pharyngoesophgeal diverticulum more common in?

A

more in males
in elderly
in the left posterior triangle usually

20
Q

what are the three types of hiatal hernias ?

A
sliding cardia (type I)
rolling fundus (type II)
combined (type III)
21
Q

what is the initiating process in sliding hernias?

A

in type 1 HH :

GERD

22
Q

what is the presentation of rolling hernias?

A

3D syndrome :
dysphagia
dyspepsia
dyspnea

23
Q

when can we suspect Barrets oesophagus on endoscopy?

A

disturbed z-line

24
Q

what does metaplasia predispose to ?

A

adenocarcinoma

25
Q

what is a leimyoma ?

A

benign smooth muscle tumor

26
Q

what are the features of a leimyoma ?

A

may be large
regular contour
intact mucosa
60% distal third

27
Q

what radiological feature is specific to carcinomas?

A

mural thickening

28
Q

what differentiates a carcinoma from a leiomyoma ?

A
mural thickening 
eccentric lumen 
wide prevertebral space 
shouldering 
mucosal irregularity
29
Q

what are the types of gastric outlet obstruction ?

A

lumenal
mural
extrinsic

30
Q

what is bouveret syndrome ?

A

gall stone obstruction in the lumen of the stomach

31
Q

what are the two types of volvulus ?

A

organo-axial : joining of the cardia along with the pylorus

mesenterico-axial: joining the lesser and greater omentum together

32
Q

what is the clinical presentation of organo-axial volvulus ?

A

acute abdominal pain
vomiting
abdominal distention
shock

33
Q

what is the cause of GIST ?

A

mutation in PDGFRA and KIT genes

34
Q

what is the treatment for GIST ?

A

in resectable regions:

and tyrosine kinase inhibitors after the resection

35
Q

what is the lesion is non resectable in GIST ?

A

use TKI drugs until it becomes resectable

36
Q

what is an example of a TKI ?

A

imatinib