disorders of the upper GI tract 1 W7 Flashcards
common oesophageal disorders?
GORD (oesophagitis, Barrett’s oesophagus, benign oesophageal stricture)
oesophageal motility disorders (eg achalasia)
eosinophilic oesophagitis
oesophageal cancer
oesophagus normal function?
deglutition - striated muscle
UOS relaxes
food enters oesophagus
primary peristaltic wave triggered
LOS relaxes as soon as swallow initiated
food into stomach
common symptoms of oesophageal disease?
dysphagia
odynophagia
heartburn
acid regurgitation
waterbrash
dental erosions
what is odynophagia?
painful swallowing
what is waterbrash
hypersalivation secondary to gastro-oesophageal reflux
less common symptoms of oesophageal disease?
chest pain
food regurgitation
food bolus obstruction
globus
cough
dysphonia
what is globus
sensation of something in your throat
what is dysphonia
altered voice
what is dysphagia
difficulty swallowing solids/liquids
why is dysphagia an important symptom
alarm symptom, may be indicative of serious disease
classifications of dysphagia?
oropharyngeal - neuromuscular
oesophageal - mechanical
oesophageal dysphagia features?
discoordination of movement of bolus in oesophagus.
motility disorders.
diabetes, alcoholism, gastroesophageal reflux.
oropharyngeal dysphagia features?
difficulty bringing bolus from mouth to oesophagus
commonly neuro cause - often stroke.
decreased saliva, Alzheimer’s, depression
hints for dysphagia diagnosis - different patient groups?
elderly = neuro causes if long standing. cancer if new and progressive with regurgitation and weight loss.
younger = dysmotility (achalasia or secondary to acid reflux)
young patients with food bolus obstruction = oesophagitis
hints for dysphagia diagnosis - different symptoms?
oesophageal Ca = progressive dysphagia for solids then liquids
dysmotility = dysphagia for liquids as bad as solids
hoarse voice = ENT causes (ear/nose/throat)
regurgitation of food = pharyngeal pouch
investigations in oesophageal disease?
endoscopy and biopsy
barium swallow
oesophageal function tests (manometry, pH, impendence monitoring)
manometry?
measures pressure in the oesphagus
what does GORD stand for?
gastro-oesophageal reflux disease
GORD types?
reflux with transient lower oesophageal relaxations
reflux with low lower oesophageal sphincter pressures
GORD - reflux with transient lower oesophageal relaxations - features?
more common (can happen in anyone)
daytime reflux
small or no HH (hiatus hernia)
often no oesophagitis
GORD - reflux with low lower oesophageal sphincter pressures - features?
less common (20%)
nocturnal reflux
often large hiatus hernia
more severe oesophagitis
Barrett’s
typical symptoms of GORD?
heartburn
acid regurgitation
waterbrash
what is heartburn?
burning discomfort behind the breast bone spreading upwards
acid regurgitation features?
often meal related
postural
GORD endoscopy features?
inflammation and narrowing
treatment of GORD?
lifestyle measures (smoking, alcohol, diet, weight reduction)
mechanical (posture, clothing, elevate bed-head)
antacids
acid suppression (PPIs - omeprazole)
surgical - fundoplication
fundoplication?
reconstruct lower oesophageal sphincter and correct hiatus hernia if present
complications of GORD?
oesophagitis
-> oesophageal stricture (narrowing)
-> Barrett’s oesophagus
->adenocarcinoma
explanation of lifestyle changes for GORD?
small meals = less reflux
caffeine = irritant, affects acid secretion
carbonated drinks = gastric distension, TLOSRs
smoking = affects LOS pressure
alcohol = irritant
weight reduction = less reflux
