Esophageal Disorders Flashcards
What vertebral levels does the esophagus begin and end?
C6 - T11/12
What muscles perform esophageal peristalsis?
Esophageal circular muscles
What is significant about the pressure of the distal smooth muscle of the Lower Esophageal Sphincter?
It has a high resting pressure
What are the 2 most important symptoms of esophageal disease?
Heartburn
Dysphagia
Where anatomically is heartburn felt?
Retrosternally
What is the cause of heartburn?
Reflux of acidic or bilious gastric contents into the esophagus
What does effect does decreasing the pressure of the Lower Esophageal Sphincter have on reflux/heartburn?
It increases reflux/heartburn
Give examples of substances that can reduce Lower Esophageal Sphincter pressure? (3)
Alcohol
Nicotine
Dietary Xanthines (coke, coffee, chocolate)
What condition can persistent heartburn and reflux lead to?
Gastro-oesophageal reflux disease (GORD)
What is Dysphagia?
Difficulty in swallowing
What is Odynophagia?
Pain with swallowing
What are the 5 main causes of oesophageal dysphagia?
Benign stricture (oesophageal web) Malignant stricture (oesophageal cancer) Motility disorders (achalasia) Eosinophilic oesophagitis Extrinsic compression (eg in lung cancer)
What are the 3 types of investigation that could be used to diagnose oesophageal disease?
Endoscopy Contrast radiology (barium swallow) Oesophageal pH and manometry
What are the 2 main endoscopy procedures that can be used to diagnose oesophageal disease?
Oesophago-Gastro-Duodenoscopy (OGD)
Upper GI Endoscopy (UGIE)
An example of a hypermotility oesophageal disorder is “diffuse oesophageal spasm”.
How does this condition appear on a barium swallow image?
Has a corkscrew appearance
What is the clearest indicative symptom of diffuse oesophageal spasm and what symptom could possibly accompany this?
Severe, episodic chest pain (with or without dysphagia)
What 3 conditions is hypomotility of the oesophagus associated with?
Connective tissue disease
Diabetes
Neuropathy
What effect can hypomotility have on the Lower Oesophageal Sphincter?
Causes LOS mechanism failure leading to heartburn, reflux and loose dilated oesophagus
What is Achalasia?
A motility disorder in which there is a degeneration of myenteric plexus ganglion cells in the distal oesophagus and LOS
What is the cardinal feature for Achalasia?
LOS fails to relax
What are 5 symptoms of Achalasia?
Progressive dysphagia Weight loss Chest pain Regurgitation Chest infection
What can Achalasia result in?
Functional obstruction of the oesophagus
What 2 pharmacological treatments can be given to treat Achalasia?
Nitrates
CCBs
What are the 3 interventional treatments that can be taken to treat Achalasia
Botulinum toxin
Pneumatic balloon dilation
Myotomy
What is the Gastro-Oesophageal Reflux Disease usually due to?
Pathological acid and bile exposure in the lower oesophagus
What are 3 symptoms of GORD (Gastro-Oesophageal Reflux Disease)?
Heartburn
Cough
Sleep disturbance
Name a few risk factors for GORD (Gastro-Oesophageal Reflux Disease)? (6 available)
Pregnancy Obesity LOS pressure lowering drugs Smoking Alcoholism Hypomotility
What is important to note symptomatically in the diagnosis of GORD (Gastro-Oesophageal Reflux Disease)?
Many patients are asymptomatic
What is Hiatus Hernia?
When the fundus of the stomach moves proximally through the diaphragmatic hiatus
What are the 2 ain types of Hiatus Hernia?
Sliding
Para-oesophageal
Which oesophageal condition is often due to Hiatus Hernia?
GORD (Gastro-oesophageal reflux disease)
What are the 4 most common complications GORD can lead to?
Ulceration
Stricture
Carcinoma
Glandular metaplasia (Barrett’s oesophagus)
What is Barrett’s esophagus?
Intestinal metaplasia due to prolonged acid exposure in the distal oesophagus
How to cells change in the lower oesophagus due to Barrett’s oesophagus?
Squamous TO Mucin-secreting columnar
What is Barrett’s oesophagus a precursor to?
Adenocarcinoma
What are the 3 methods of treating Barrett’s oesophagus with high grade dysplasia
Endoscopic Mucosal Resection (EMR)
Radio-Frequency Ablation (RFA)
Oesophagectomy
What are the 3 pharmacological treatments for GORD?
Alginates (eg Gaviscon)
H2RA (Ranitidine)
Proton Pump Inhibitor (Omeprazole)
What are the 2 main types of oesophageal cancer?
Squamous Cell Carcinoma
Adenocarcinoma
What symptoms do patients with oesophageal cancer present with? (2 main + 6 additional)
Progressive dysphagia
Anorexia and Weight loss
Chest pain Cough Pneumonia Vocal cord paralysis Haematemesis Odynophagiea
Where do occluding squamous cell tumours often grow on the oesophagus?
On the surface epithelium
What are the 2 most significant risk factors for oesophageal squamous cell carcinoma?
Tobacco
Alcohol
Which are og the oesophagus does squamous cell carcinoma occur?
The proximal and middle third of the oesophagus
What area of the oesophagus does adenocarcinoma occur?
In the distal oesophagus
Where are the 4 most common areas of metastases for oesophageal cancer?
Liver
Brain
Pulmonary
Bone
What is the usual priority in oesophageal cancer treatment?
Symptom palliation
What are the 4 main treatment options for oesophageal cancer?
Endoscopic (i.e. stent or laser)
Chemotherapy
Radiotherapy
Barchytherapy
