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Jamie GI > Esophageal Disorders > Flashcards

Esophageal Disorders Flashcards

1
Q

What vertebral levels does the esophagus begin and end?

A

C6 - T11/12

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2
Q

What muscles perform esophageal peristalsis?

A

Esophageal circular muscles

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3
Q

What is significant about the pressure of the distal smooth muscle of the Lower Esophageal Sphincter?

A

It has a high resting pressure

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4
Q

What are the 2 most important symptoms of esophageal disease?

A

Heartburn

Dysphagia

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5
Q

Where anatomically is heartburn felt?

A

Retrosternally

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6
Q

What is the cause of heartburn?

A

Reflux of acidic or bilious gastric contents into the esophagus

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7
Q

What does effect does decreasing the pressure of the Lower Esophageal Sphincter have on reflux/heartburn?

A

It increases reflux/heartburn

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8
Q

Give examples of substances that can reduce Lower Esophageal Sphincter pressure? (3)

A

Alcohol
Nicotine
Dietary Xanthines (coke, coffee, chocolate)

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9
Q

What condition can persistent heartburn and reflux lead to?

A

Gastro-oesophageal reflux disease (GORD)

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10
Q

What is Dysphagia?

A

Difficulty in swallowing

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11
Q

What is Odynophagia?

A

Pain with swallowing

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12
Q

What are the 5 main causes of oesophageal dysphagia?

A 
Benign stricture (oesophageal web)
Malignant stricture (oesophageal cancer)
Motility disorders (achalasia)
Eosinophilic oesophagitis
Extrinsic compression (eg in lung cancer)
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13
Q

What are the 3 types of investigation that could be used to diagnose oesophageal disease?

A 
Endoscopy
Contrast radiology (barium swallow)
Oesophageal pH and manometry
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14
Q

What are the 2 main endoscopy procedures that can be used to diagnose oesophageal disease?

A

Oesophago-Gastro-Duodenoscopy (OGD)

Upper GI Endoscopy (UGIE)

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15
Q

An example of a hypermotility oesophageal disorder is “diffuse oesophageal spasm”.
How does this condition appear on a barium swallow image?

A

Has a corkscrew appearance

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16
Q

What is the clearest indicative symptom of diffuse oesophageal spasm and what symptom could possibly accompany this?

A

Severe, episodic chest pain (with or without dysphagia)

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17
Q

What 3 conditions is hypomotility of the oesophagus associated with?

A

Connective tissue disease
Diabetes
Neuropathy

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18
Q

What effect can hypomotility have on the Lower Oesophageal Sphincter?

A

Causes LOS mechanism failure leading to heartburn, reflux and loose dilated oesophagus

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19
Q

What is Achalasia?

A

A motility disorder in which there is a degeneration of myenteric plexus ganglion cells in the distal oesophagus and LOS

20
Q

What is the cardinal feature for Achalasia?

A

LOS fails to relax

21
Q

What are 5 symptoms of Achalasia?

A 
Progressive dysphagia
Weight loss
Chest pain
Regurgitation
Chest infection
22
Q

What can Achalasia result in?

A

Functional obstruction of the oesophagus

23
Q

What 2 pharmacological treatments can be given to treat Achalasia?

A

Nitrates

CCBs

24
Q

What are the 3 interventional treatments that can be taken to treat Achalasia

A

Botulinum toxin
Pneumatic balloon dilation
Myotomy

25
Q

What is the Gastro-Oesophageal Reflux Disease usually due to?

A

Pathological acid and bile exposure in the lower oesophagus

26
Q

What are 3 symptoms of GORD (Gastro-Oesophageal Reflux Disease)?

A

Heartburn
Cough
Sleep disturbance

27
Q

Name a few risk factors for GORD (Gastro-Oesophageal Reflux Disease)? (6 available)

A 
Pregnancy
Obesity
LOS pressure lowering drugs
Smoking
Alcoholism
Hypomotility
28
Q

What is important to note symptomatically in the diagnosis of GORD (Gastro-Oesophageal Reflux Disease)?

A

Many patients are asymptomatic

29
Q

What is Hiatus Hernia?

A

When the fundus of the stomach moves proximally through the diaphragmatic hiatus

30
Q

What are the 2 ain types of Hiatus Hernia?

A

Sliding

Para-oesophageal

31
Q

Which oesophageal condition is often due to Hiatus Hernia?

A

GORD (Gastro-oesophageal reflux disease)

32
Q

What are the 4 most common complications GORD can lead to?

A

Ulceration
Stricture
Carcinoma
Glandular metaplasia (Barrett’s oesophagus)

33
Q

What is Barrett’s esophagus?

A

Intestinal metaplasia due to prolonged acid exposure in the distal oesophagus

34
Q

How to cells change in the lower oesophagus due to Barrett’s oesophagus?

A

Squamous TO Mucin-secreting columnar

35
Q

What is Barrett’s oesophagus a precursor to?

A

Adenocarcinoma

36
Q

What are the 3 methods of treating Barrett’s oesophagus with high grade dysplasia

A

Endoscopic Mucosal Resection (EMR)
Radio-Frequency Ablation (RFA)
Oesophagectomy

37
Q

What are the 3 pharmacological treatments for GORD?

A

Alginates (eg Gaviscon)
H2RA (Ranitidine)
Proton Pump Inhibitor (Omeprazole)

38
Q

What are the 2 main types of oesophageal cancer?

A

Squamous Cell Carcinoma

Adenocarcinoma

39
Q

What symptoms do patients with oesophageal cancer present with? (2 main + 6 additional)

A

Progressive dysphagia
Anorexia and Weight loss

Chest pain
Cough
Pneumonia
Vocal cord paralysis
Haematemesis
Odynophagiea
40
Q

Where do occluding squamous cell tumours often grow on the oesophagus?

A

On the surface epithelium

41
Q

What are the 2 most significant risk factors for oesophageal squamous cell carcinoma?

A

Tobacco

Alcohol

42
Q

Which are og the oesophagus does squamous cell carcinoma occur?

A

The proximal and middle third of the oesophagus

43
Q

What area of the oesophagus does adenocarcinoma occur?

A

In the distal oesophagus

44
Q

Where are the 4 most common areas of metastases for oesophageal cancer?

A

Liver
Brain
Pulmonary
Bone

45
Q

What is the usual priority in oesophageal cancer treatment?

A

Symptom palliation

46
Q

What are the 4 main treatment options for oesophageal cancer?

A

Endoscopic (i.e. stent or laser)
Chemotherapy
Radiotherapy
Barchytherapy

Jamie GI (12 decks)

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