Lecture 13 Oesophageal Disorders Flashcards

1
Q

Where does the oesophagus begin and terminate

A

C6 and T11-12

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2
Q

What type of muscle is the upper (3-4cm) and lower muscle

A

Striated

Smooth

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3
Q

What type of cells line the lumen of the oesophagus

A

Stratified squamous

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4
Q

What is the function of the oesophagus

A

Transport of food/liquid from mouth to stomach – active process

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5
Q

How is food propelled to stomach

A

Oesophageal peristalsis produced by oesophageal circular muscles that coordinates with lower oesophageal sphincter relaxation

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6
Q

What nerve mediates the relaxation of the LOS and oesophageal peristalsis

A

Vagus nerve

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7
Q

Describe the structure of the mucosal rosette

A
  • Striated muscle of right crus of diaphragm

* “Mucosal Rosette” formed by acute angle (of His) at GOJ

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8
Q

What is dysphagia

A

• Subjective sensation of difficulty in swallowing foods and/or liquids

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9
Q

What is odynophagia

A

pain with swallowing (may accompany dysphagia)

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10
Q

Name the causes of oesophageal dysphagia

A
  • Benign stricture
  • Malignant structure (oesophageal cancer)
  • Motility disorders:
  • Achalasia:
  • Presbyoesophagus
  • Eosinophilic oesophagitis
  • Extrinsic compression (lung cancer)
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11
Q

Name Oesophageal Disease: Investigations

A
OGD
UGIE
Contrast radiology: barium swallow
Nasal Catheter containing pH sensors 
Manometry
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12
Q

What causes Achalasia

A

Degeneration of inhibitory neurons (ganglion cells) in the myenteric plexus in the oesophagus

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13
Q

What is the cardinal feature of Achalasia and what does it result in

A

Failure of LOS to relax

Functional distal obstruction

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14
Q

Symptoms of Achalasia

A
  • progressive dysphagia for solids and liquids
  • weight loss
  • Chest pain (30%)
  • Regurgitation and chest infection
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15
Q

Treatment of Achalasia

A
  • Pharmacological - Nitrates, calcium Channel blockers
  • Endoscopic - Botulinum Toxin, Pneumatic balloon dilation
  • Radiological - Pneumatic balloon dilation
  • Surgical - Myotomy (involves cutting away some of the outer layers of tissue from the lower oesophagus to allow food and liquids to pass into the stomach more easily)
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16
Q

What are the complications of Achalasia

A

Aspiration pneumonia and lung disease

Increased risk of squamous cell oesophageal carcinoma

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17
Q

What are the causes of gastro-oesophageal disease

A

Increase in Transient relaxations of the LOS
– Hypotensive LOS
– Delayed gastric emptying
– Delayed oesophageal emptying
– Decrease in Oesophageal acid clearance
– Decrease in Tissue resistance to acid/bile
- Hiatus Hernia

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18
Q

Define Barrett’s Oesophagus

A

Intestinal metaplasia related to prolonged acid exposure in distal oesophagus. This causes a change from squamous to mucin secreting columnar cells

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19
Q

What is Barrett’s Oesophagus a precursor to

A

Adenocarcinoma

20
Q

Treatment of Barrett’s Oesophagus

A

– Endoscopic Mucosal Resection (EMR)
– Radio-Frequency Ablation (RFA)
– Oesophagectomy rarely (mortality ~10%)

21
Q

What are the 2 types of oesophageal cancer

A

Squamous and Adenocarcinoma

22
Q

What type of cancer is more common in Western Europe/USA

A

Adenocarcinoma

23
Q

What type of oesophageal cancer is more common in the rest of the world

24
Q

Whats the presentation of oesophageal cancer

A
  • Progressive dysphagia (90%)
  • Anorexia and Weight loss (75%)
  • Odynophagia- pain when swallowing
  • Chest pain
  • Cough
  • Pneumonia (tracheo-oesophageal fistula)
  • Vocal cord paralysis
  • Haematemesis- vomiting of blood
25
Where is the common location for squamous cell carcinoma
proximal and middle third of oesophagus
26
What precedes squamous cell carcinoma
Dysplasia and carcinoma in situ
27
What are significant risk factors for squamous cell carcinoma
Alcohol and Tobacco
28
What is the common location for adenocarcinoma
Distal oesophagus (due to link with Barretts)
29
What are predisposing factors for adenocarcinoma
Obesity, male, middle age, caucasian
30
What does the lack of peritoneum around the oesophagus mean
Tumour invasion of adjacent structures are more likely
31
What are the metastatic locations for adenocarcinoma
Liver, bone, brain, pulmonary
32
Investigations for Oesophageal Cancer
Endoscop & Biopsy | Staging: CT, EUS, PET, Bone
33
What investigation would be needed if there was suspected peritoneal spread
Laparoscopy
34
T1 staging
Tumour invades lamina propria
35
T2 staging
Tumour invades muscular propria
36
T3 Staging
Tumour invades adventitia
37
T4 staging
Tumour invades adjacent structures
38
N1 Staging
Regional LN metastasis
39
M1 staging
Distant metastasis
40
Stage I
T1N0M0
41
Stage IIa
T2T3/N0M0
42
Stage IIb
T1T2/N1M0
43
Stage III
T3N1M0, T4, any N, M0
44
Stage IV
M1
45
Treatment for oesophageal cancer
surgical oesophagectomy +/- adjuvant (after) or neoadjuvant (before) chemotherapy • Radiotherapy • Brachytherapy (form of radiotherapy where a sealed radiation source is placed inside or next to the area requiring treatment) Endoscopic stent, laser, PEG
46
What is Eosinophiic Oesophagitis
• Chronic immune-/allergen-mediated condition defined clinically by symptoms of oesophageal dysfunction, and pathologically by an eosinophilic infiltration of the oesophageal epithelium
47
Who is Eosionophilic Oesophagitis commonly seen in
Males | Children and young adults