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Year 1: Gastrointestinal > GI: Conditions of the Oesophagus > Flashcards

GI: Conditions of the Oesophagus Flashcards

1
Q

What are the symptoms of oesophageal disease?

A

Dysphagia
Heartburn
Regurgitation
Painful swallow

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2
Q

What is dysphagia?

A

DIFFICULTY swallowing

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3
Q

What does a short history of progressive dysphagia first to solids and then liquids suggest? What is the most appropriate investigation?

A 
Mechanical stricture
Urgent ODG (endoscopy)
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4
Q

What does a long history of slow onset dysphagia to both solids and liquids suggest? What is the most appropriate investigation?

A

Motility disorder

Barium swallow

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5
Q

What is heartburn?

A

Retrosternal/Epigastric burning sensation due to acid reflux.
Pain is made worse by lying down

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6
Q

What is regurgitation? What conditions does it occur in?

A

Reflux of oesophageal contents into the mouth/pharynx

Occurs in reflux disease + oesophageal strictures

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7
Q

What is odynophagia? What condition does it indicate?

A

Painful swallow

Oesphagitis caused by GORD/infection

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8
Q

What is the major symptom of GORD?

A

Heartburn. May also present with regurgitation + odynophagia.

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9
Q

How is the diagnosis of GORD made?

A

The history

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10
Q

When is an endoscopy indicated?

A

In patients with new onset of heart burn over 55 years old or patients with ALARM Symptoms

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11
Q

What are the ALARM Symptoms?

A 
Anaemia
Loss of weight
Anorexia
Recent onset of progressive symptoms
Malena or haematemesis 
Swallowing difficulty
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12
Q

What non-pharmacological management is indicated in GORD?

A

Weight loss
Smoking cessation
Avoidance of aggravating foods + excess alcohol

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13
Q

What is the first line treatment for mild GORD?

A

Antacids, e.g. gavascon

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14
Q

What is the first line treatment for severe GORD or patients with complications?

A

PPIs e.g. omeprazole

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15
Q

What do H2 receptor antagonists do?

A

Relieve the symptoms of GORD. e.g. ranitidine

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16
Q

What are some of the complications of GORD?

A

Stricture formation
Barret oesophagus
Schatski ring

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17
Q

How is an oesophageal stricture treated?

A

PPIs + endoscopic dilatation

18
Q

What is Barrets oesophagus?

A

Metaplastic change from squamous epithelium to columnar epithelium. It is an irreversible premalignant change

19
Q

How is Barrets oesophagus treated?

A

PPIs + endoscopic surveillance

20
Q

What is a schatski ring?

A

Localised mucosal stricture at the gastro-oesophageal junction

21
Q

What is achalasia?

A

Failure of the lower oesophageal sphincter to relax, preventing food from passing into the stomach

22
Q

What is the buzz word seen on a barium swallow for achalasia?

A

Birds beak oesophagus

23
Q

What else does a barium swallow show that indicates achalasia?

A

Dilatation of the oesophagus + no peristalsis

24
Q

What investigation confirms achalasia?

A

Oesophageal manometry

25
Q

What is the pathology behind achalasia?

A

Degeneration of the vagus nerve

26
Q

How do you treat achalasia?

A

NO CURE
endoscopic dilation can improve symptoms but is contraindicated in frail, elderly patients
Nitrates/Ca channel blockers (nifedipine) can be given to relax LOS

27
Q

What is an oesophageal spasm?

What is seen on a barium swallow?

A

Simultaneous contractions in the distal oesophagus

CORKSREW OESOPHAGUS

28
Q

What is a nutcracker oesophagus?

A

High amplitude peristaltic waves

29
Q

How do dysmotility disorders, e.g. oesophageal spasm, present?

A

Dysphagia + chest pain

30
Q

What is allergic eosinophilic oesophagits?

A

Inflammation of the oesophagus caused by reaction to food. Immune complex mediated + eosinophilic infiltrates present

31
Q

What causes oesophageal perforation?

A

Iatrogenic- after endoscopic dilatation

Traumatic- chest trauma or forceful vomiting

32
Q

How does oesophageal perforation present? How is it diagnosed?

A 
Severe chest pain
Fever
Hypotension
Emphysema
Diagnosis: CXR + CT
33
Q

What are the most common malignant oesophageal tumours and where do they occur?

A

Squamous cell - usually middle 3rd of oesophagus

Adenocarcinoma- usually lower 3rd of oesophagus

34
Q

What are the risk factors for Squamous cell carcinoma?

A

Smoking, Alcohol, Achalasia, Coeliac disease

35
Q

What causes adenocarcinoma?

A

Barrets oesophagus.

Smoking + obesity are also risk factors

36
Q

How does oesophageal cancer present?

A

Progressive dysphagia to solids then liquids.

Weight loss

37
Q

How is oesophageal cancer diagnosed?

A

Endoscopy + tumour biopsy

38
Q

What is the treatment for oesophageal cancer?

A

Surgery

39
Q

Are benign oesophageal tumours common or rare?

A

Rare

40
Q

What is the most common benign oesophageal tumour?

A

Squamous papilloma

Year 1: Gastrointestinal (14 decks)

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