Disorders of Upper GI Tract Flashcards
what is deglutition
swallowing
when does the lower oesophageal sphincter relax
as soon as swallow is initiated
common oeosphageal disorder
GORD
oesophageal motility disorders
eosinophilic oesophagitis
oesophageal cancer
common symptoms of oesophageal disease
dysphagia
odynophagia (painful swallowing)
heartburn
acid regurgitation
water brash
what is odynophagia
what is water brash
increased salivation
name for difficulty swallowing
dysphagia
less common symptoms of oesophageal disease
chest pain
food regurgitation
food bolus obstruction
globus
cough
dysphonia
what is globus
unusual sensation that something is stuck in oesophagus but isn’t
what is dysphonia and what is a cause
altered voice due to acid causing irritation of vocal cords
when does oeosphageal cancer tend to present
late
asymptomatic until late stage
how is dysphagia classified
oropharyngeal or oesophageal
learn difference between oropharyngeal and oesophageal dysphagia
signs of oesophageal disease
dental erosion
weight loss
anaemia
lymphadenopathy
which is more common
reflux with transient lower oesophageal relaxations
or
reflux with low lower oesophageal sphincter pressures
reflux with transient lower oesophageal relaxations
which is more severe
reflux with transient lower oesophageal relaxations
or
reflux with low lower oesophageal sphincter pressures
reflux with low lower oesophageal sphincter pressures
cause of daytime reflux
reflux with transient lower oesophageal relaxations
cause of nocturnal reflux
reflux with low lower oesophageal sphincter pressures
someone has daytime reflux, no hiatus hernia and no oesophagitis
what is the cause of their reflux
transient lower oesophageal relaxtions
someone has nocturnal reflux, a large hiatus hernia and severe oeosphagitis
what is the cause of their reflux
low lower oesophageal sphincter pressures
what type of reflux causes Barrett’s
low lower oeosphageal sphincter pressures
investigations in oesophageal disease
endoscopy and biopsy
barium swallow and x-ray
oesophageal function tests
what can be used to determine if the reflux material is acidic or not
oeosphageal function tests (e.g. pH and impedence monitoring)
if oesophageal cancer is suspected what is required
urgent upper GI endoscopy and biopsy
CT
endoscopic ultrasound
what is barrett’s oesophagus
where the squamous epithelium lining the oesophagus is replaced by columnar epithelium
who gets barrett’s most
men
>50
obese
relationship with barrett’s and cancer
barrett’s is premalignant so can progress to adenocarcinoma
most adenocarcinomas arise from barrett’s
treatment of Barrett’s
long term proton pump inhibitor
treatment of GORD
lifestyle (smoking, alcohol, diet, weight reduction)
mechanical (posture, loose clothing, elevate bed-head)
antacids
acid suppression (PPIs, H2RA)
surgical (fundoplication)
example of PPI
omeprazole
example of H2RA
ranitidine
what is oesophageal achalasia
failure the lower oeosphageal sphincter to relax
and absence of peristalsis
presentation of achalasia
dysphagia to liquids and solids
weight loss
chest pain
complications of achalasia
oesophageal dilation
respiratory complications
what does endoscopy show in achalasia
usually normal
cause of achalasia
degenerative lesion of oesophageal innervation
treatment of achalsia
botox - paralyse LOS
endoscopic dilation
surgical myotomy
POEM
what is the down side of botox as treatment for achalasia
it is not long lasting
why is dilated oesophagus a complication of achalsia
due to absence of peristalsis
and tighter sphincter so food gets stuck in oesophagus for longer
food bolus obstruction and dysphagia is a common presentation of
eosinophilic oesophagitis
risk factors for eosinophilic oesophagitis
younger age
male
history of atopy (hayfever and asthma)
diagnosis of eosinophilic oeosphagitis
> 15 eosinophils/pof on biopsy
eosinophilic oesophagitis association with cancer
no association
what is eosinophilic oesophagitis
build up of eosinophils (WBCs) in the lining of the oesophagus in response to food or acid
leads to difficulty swallowing and eventually narrowing of the oeosphagus
what can be seen on endoscopy in eosinophilic oesophagitis
lumps
(strictures, rings, exudates, furrows)
treatment of eosinophilic oesophagitis
diet (elimination of trigger foods)
drugs (PPIs, topical steroids)
dilation (of strictures)
causes of oesophageal strictures
benign - GORD, barrett’s, extrinsic compression, post radiotherapy, post surgery, toxic substance injestion
malignant - cancer
treatment of benign oesophageal sphincter
PPIs
dilation
what types of cancer can occur in oesophagus
adenocarcinoma
squamous cell carcinoma
which part of oesophagus do squamous cell carcinomas occur
upper/mid
which part of oesophagus do adenocarcinomas occur
lower
who gets adenocarcinomas
60s-70s
Barrett’s
obesity
who gets squamous cell carcinomas
80s-90s
smokers
alcohol
what is intermittent dysphagia for liquids and solids suggestive of
motility problem (e.g. achalasia)
intermittent tarry stool is suggestive of
chronic blood loss from upper GI tract
h.pylori treatment
Abx and PPI for 1 week
