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GASTRO-INTESTINAL MEDICINE AND HEPATOLOGY > DISORDERS OF THE OESOPHAGUS > Flashcards

DISORDERS OF THE OESOPHAGUS Flashcards

1
Q

Which group of patients are most at risk of developing oesophagitis due to gastro-oesophageal reflux disease?

A

Pregnant ladies

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2
Q

What are the symptoms associated with reflux oesophagitis?

A

Dyspepsia:
Upper abdominal pain
Belching
Heartburn

Retrosternal chest pain
Pain on swallowing (odynophagia)
Haematemesis
Fatigue - Anaemia
Nocturnal cough
Early morning bronchospasm
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3
Q

What is odynophagia?

A

Pain on swallowing

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4
Q

What is the name of the sphincter that normally prevents gastric reflux?

A

Cardiac sphincter (lower oesophageal sphincter)

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5
Q

What are the risk factors for developing GORD?

A

Loss of tone of cardiac sphincter caused by:
Hiatus hernia
Chronic cough
Obesity
Eating too much fat (cholecystokinin secretion reduces sphincter tone)
Smoking
Pregnancy
Scleroderma and systemic sclerosis (can feature esophageal dysmotility)

Increased acid production:
Medication (such as steroids)
Infection with H.pylori
Zollinger-Ellison syndrome (overproduction of gastrin)
Hypercalcaemia (overproduction of gastrin)

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6
Q

What are the causes of oesophagitis?

A 
GORD (loss of LOS tone or hiatus hernia)
Drugs with anti-cholinergic effects
NSAIDs
Infection
Chemical poisoning
Alcohol
Radiation therapy
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7
Q

What are the complications of oesophagitis and GORD?

A 
Oesophagitis
Mucosal erosions/ulceration
Haemorrhage +/- haematemesis/melaena
Stricture formation
Barrett's oesophagus
Cancer of the oesophagus - squamous cell carcinoma
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8
Q

What investigations should be ordered for someone who presents with the signs and symptoms consistent with oesophagitis?

A

Endoscopy - cannot rule out GORD
24 hour intraluminal pH monitoring - most accurate investigaton
Barium swallow - looking for free reflux of barium

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9
Q

What are the conservative treatment options for someone with oesophagitis?

A

Weight reduction
Cessation of smoking
Cessation of alcohol

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10
Q

What are the medical options for someone with oesophagitis?

A
  1. Antacids - such as Gaviscon
  2. H2 antagonists such as Nizatidine or Ranitidine
  3. PPI such as Omeprazole or Lansoprazole
  4. Prokinetic drugs - Domperidone
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11
Q

What surgical procedures can be used to treat someone with oesophagitis?

A

Tightening of the LOS by wrapping the fundus of the stomach around it.

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12
Q

What is Barrett’s oesophagus?

A

Metaplasia of the distal oesophageal mucosa due to prolonged irritation. Epithelium goes from squamous epithelial cells into columnar epithelial cells. It is a protective mechanism, however, it predisposes the patient to cancer.

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13
Q

What is the incidence of Barrett’s oesophagus in patients with prolonged GORD?

A

15%

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14
Q

What are the clinical features of Barrett’s oesophagus?

A

Initially report symptoms consistent with oesophagitis but symptoms may diminish due to decreased sensation in metaplastic area.

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15
Q

What are the complications of Barrett’s oesophagus?

A

40 fold increase of adenocarcinoma of the oesophagus

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16
Q

How might a patient with Barrett’s oesophagus be diagnosed?

A

Endoscopy - looking for change of colour from pink to slightly orange
Biopsy for confirmation of diagnosis

17
Q

How would you manage someone with Barrett’s oesophagus?

A

PPI - Omeprazole
Endoscopic surveillance of dysplasia
High grade - indication for oesophagectomy - often found to already have adenocarcinoma

18
Q

What are oesophageal strictures?

A

A narrowing or tightening of the oesophagus that causes swallowing difficulties as a result of scarring and fibrosis.

19
Q

What are the causes of oesophageal stricture?

A

Long standing acid reflux
Ingestion of caustic (acid or alkali) substance
Radiotherapy
Sclerotherapy (for oesophageal varices)

20
Q

What are the clinical features of oesophageal strictures?

A

Dysphagia - progresses from solids to liquids as well
Weight loss
History of reflux - with symptoms having now disappeared

21
Q

What investigations would you order in someone who presented with suspected oesophageal strictures?

A

Endoscopy and biopsy (to exclude malignant disease)
Barium swallow
Endoluminal ultrasound or CT (again to exclude malignant infiltration)

22
Q

What are the complications associated with oesophageal strictures?

A

Increased incidence of malignancy

Aspiration

23
Q

What is the prognosis of someone with an oesophageal stricture?

A

Once formed it is likely to stay there for life without surgical treatment

24
Q

What are the treatment options for someone with an oesophageal stricture?

A

Dilatation undertaken endoscopically with graduated tubes of increasing size
Surgical reconstruction

25
Q

What is a pharyngeal pouch?

A

Diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle (i.e. above the upper sphincter of the esophagus). It is a false diverticulum as it does not involve all layers of the oesophageal wall.

26
Q

What is another name for a pharyngeal pouch?

A

Zenker’s diverticulum

27
Q

What is an oesophageal diverticulum?

A

Similar to a pharyngeal pouch but sits in the mid oesophagus (traction diverticulum) or just above the lower oesophageal sphincter (epiphrenic diverticulum)

28
Q

What are the clinical features of pharyngeal pouches or oesophageal diverticulae?

A

Bad breath
Regurgitation of food
Dysphagia

29
Q

What investigations would you do in someone with suspected pharyngeal pouch or oesophageal diverticulum?

A

Barium swallow

30
Q

How pharyngeal pouches and oesophageal diverticulae treated?

A

Surgical resection of problematic pouches. Treatment of bad breath.

31
Q

What is achalasia?

A

Muscles of the lower part of the oesophagus fail to relax, preventing food from passing into the stomach.

32
Q

What are the clinical features of achalasia?

A

Intermittent sudden dysphagia - where both solids and liquids are unable to pass
Regurgitation - may result in aspiration
Chest pain - due to non-peristaltic contraction of the oesophageal muscles.

33
Q

What investigations would you order for someone with the signs and symptoms of achalasia?

A 
Chest X-ray
Barium swallow
Endoscopy - resistance to scope
Motility studies
Endoscopic ultrasound
34
Q

What might be seen on the barium swallow of someone with achalasia?

A

Dilatation of the oesophagus with narrowed lower portion

Called ‘beak appearance’

35
Q

What might be seen on the chest x ray of someone with achalasia?

A

Pneumonia

Double cardiac shadow signifying fluid build up behind heart

36
Q

Why might you do endoscopic ultrasound in someone with achalasia?

A

Exclude submucosal malignant infiltration

37
Q

What are the complications of achalasia?

A

Increased risk of developing carcinoma

Reflux oesophagitis after treatment

38
Q

What are the treatment options for someone diagnosed with achalasia?

A

Dilatation with high pressure balloons
Surgical division of muscles
Calcium antagonists - only 10% benefit
Botulinum toxins - injected into the LOS

GASTRO-INTESTINAL MEDICINE AND HEPATOLOGY (24 decks)

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