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Laura's GI Pathology > GORD, Barrett's and dysmotility of oesophagus and stomach inc. oesophageal pathology > Flashcards

GORD, Barrett's and dysmotility of oesophagus and stomach inc. oesophageal pathology Flashcards

1
Q

Define GORD

A

Any symptomatic condition, anatomic alteration or both that results from the reflux of noxious material from the stomach into the oesophagus.

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2
Q

What makes up the noxious material in GORD?

A

Mainly gastric acid but can be pepsin and bile acids in more severe cases

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3
Q

What are the defence against GOR?

A

LOS
Surface mucosa
Bicarbonate ions
Oesophageal clearance

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4
Q

Symptoms of GORD?

A

Heartburn
Acid reflux
Chest pain
Dysphagia

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5
Q

Alarm features of GORD

A

Weight loss
anaemia
recurrent vomiting
dysphagia

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6
Q

Risk factors for GORD

A 
Age 
FH
Smoking, caffeine, alcohol (relax LOS) 
As BMI increases, so does chance of GORD 
Hiatus hernia
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7
Q

Complications of GORD

A 
Oesophagitis 
stricture 
haemorrhage 
barretts oesophagus
adenocarcinoma
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8
Q

What is the main investigation for GORD?

A

Often not required

Gastroscopy

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9
Q

Conservative management for GORD

A

stop smoking, lose weight, avoid large meals late at night, avoid alcohol, avoid fatty foods, elevate head of bed

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10
Q

Pharmacological management for GORD

A

Antacids - Gaviscon, Maalox
PPIs - Omeprazole
H2RA - Ranitidine
Surgery of no drugs work - fundoplication

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11
Q

Describe fundoplication

A

Hiatus hernia fixed, stomach partially wrapped around LOS to stop reflux

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12
Q

Treatment for a benign oesophageal stricture

A

Dilation at endoscopy - short term - risk of severe bleeding/ perforation (risk increased if malignant stricture)
High dose PPI - long term

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13
Q

Describe Barrett’s oesophagus

A

Metaplasia of oesophageal non-keratinized squamous epithelium to gastric columnar epithelium (with extensive tubular secretory glands)

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14
Q

What is Barrett’s?

A

Complication of severe long term GORD
premalignant condition whihc predisposes the pt to oesophageal adenocarcinoma
Protective response for faster regeneration

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15
Q

Management for Barrett’s

A

Surveillance for dysplasia using endoscopy

PPI - Omeprazole

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16
Q

Dysplasia management

A 
More frequent surveillance 
Optimise PPI dose 
Surgery - Endoscopic mucosal resection 
              - Radiofrequency ablation 
Argon gas - tube down oesophagus and argon gas pumped through to remove barrett's lining
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17
Q

What happens in Achalasia?

A

LOS does not relax very well so there is a loss of muscle tone of peristalsis which leads to a dilated oesophagus

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18
Q

How is the oesophagus in achalasia described?

A

“birds beak” oesophagus

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19
Q

What do physical signs in a pt with achalasia show?

A

anaemia or malnutrition

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20
Q

What is the #1 investigation for achalasia?

A

oesophageal manometry

21
Q

Symptoms of achalasia

A 
regurgitation of food
cough 
dysphagia (solids and liquids)
chest pain which may increase post-prandial (may be felt in back, neck and arms)
heartburn 
unintentional weight loss
22
Q

Complications of achalasia

A

Aspiration pneumonia

oesophageal perforation

23
Q

Treatment for achalasia

A

Botox injections - relax LOS muscles
Long acting nitrates or CaCB - relax LOS
Dilation at endoscopy

24
Q

What is gastroparesis?

A

Delayed gastric emptying but no physical obstruction

25
Q

Causes of gastroparesis?

A 
Idiopathic
cannabis use 
opiates and anti-cholinergics 
Diabetes mellitus 
Systemic sclerosis
26
Q

Symptoms of gastroparesis

A 
Feeling of fullness 
nausea and vomiting 
weight loss 
upper abdominal pain 
(very non-specific symptoms)
27
Q

Investigations for gastroparesis

A

endoscopy first

gastric emptying studies (type of nuclear test)

28
Q

Management for gastroparesis

A 
removal of precipitating factors 
liquid/sloppy diet 
eat a little and often 
low fat diet 
promotility agents - Domperidone and Metoclopramide (to speed up gastric emptying)
29
Q

What is reflux oesophagitis?

A

Inflammation of oesophagus due to refluxed low pH gastric content

May also be caused by defective sphincter mechanism +/- Hiatus hernia
, Abnormal oesophageal motility, Increased intra-abdominal pressure (pregnancy)

30
Q

Histological changes in reflux oesophagitis

A

Basal zone epithelial expansion and lengthening of papillae

Intraepithelial neutrophils, lymphocytes and eosinophils

31
Q

In Barrett’s oesophagus, how is the mucosa described?

A

Red velvety mucosa in lower oesophagus

32
Q

What is allergic/ eosinophilic oesophagitis?

A

Corrugated (feline) or ‘spotty/wrinkled’ oesophagus
Food gets stuck in oesophagus - not dysphagia - abnormal oesophageal motility
Large numbers of intraepithelial eosinophils
pH probe is negative for reflux

33
Q

What is the treatment for allergic oesophagitis?

A

steroids
chromoglycate
montelukast

34
Q

What is the most common kind of benign oesophageal tumour?

A

squamous papilloma

35
Q

Where does squamous cell carcinoma of the oesophagus arise from?

A

Squamous cell epithelium

36
Q

Where does adenocarcinoma of the oesophagus arise from?

A

dysplasia in oesophagus

37
Q

Is squamous cell carcinoma more common in females or males?

A

Males

38
Q

Causes of squamous cell carcinoma

A 
Vitamin A, Zinc deficiency
Tannic acid/ Strong tea
Smoking, Alcohol
HPV
Oesophagitis
Genetic
39
Q

What do squamous cell carcinoma cause?

A

Obstruction and dysphagia

40
Q

Is Adenocarcinoma more common in males or females?

A

males

41
Q

Which part of the oesophagus is adenocarcinoma most common in?

A

Lower 1/3rd

42
Q

How do oesophageal cancers spread?

A
  • direct invasion
  • lymphatic permeation
  • vascular invasion
43
Q

How do oesophageal cancers present?

A

dysphagia - due to tumour obstruction
odynophagia
haematemesis
general symptoms of malignancy (anaemia, weight loss, loss of energy)
Paraneoplastic syndrome (hypercalcaemia and inappropriate hormone production)

44
Q

How are oesophageal cancers diagnosed?

A

Upper Gi edoscopy and biopsy #1
barium meal
CT/MRI scan of chest and abdomen
bronchoscopy (can infiltrate to trachea)

45
Q

Surgical treatment of oesophageal cancer

A

Removal of oesophagus and lymph nodes

only 50% of pts are suitable

46
Q

Contraindications to oesophageal cancer surgery

A
  • Direct invasion of adjacent structures
  • Fixed cervical lymph nodes – too advanced
  • Widespread metastases – far too advanced
  • Poor medical condition
47
Q

Other forms of treatment for oesophageal cancer

A

radiotherapy
intubations/ stents (only liquid food as no peristalsis)
canalisation
terminal care

48
Q

Prognosis of oesophageal cancer

A

dismal prognosis
majority die within a year
5 year survival 11%

49
Q

Give 3 drugs which are recognised causes of oesophageal injury

A

tetracycline
catopril
slow release theophylline

Laura's GI Pathology (13 decks)

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