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Alimentary System > Lecture 13 Oesophageal Disorders > Flashcards

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

A

Squamous

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
Q

Where is the common location for squamous cell carcinoma

A

proximal and middle third of oesophagus

26
Q

What precedes squamous cell carcinoma

A

Dysplasia and carcinoma in situ

27
Q

What are significant risk factors for squamous cell carcinoma

A

Alcohol and Tobacco

28
Q

What is the common location for adenocarcinoma

A

Distal oesophagus (due to link with Barretts)

29
Q

What are predisposing factors for adenocarcinoma

A

Obesity, male, middle age, caucasian

30
Q

What does the lack of peritoneum around the oesophagus mean

A

Tumour invasion of adjacent structures are more likely

31
Q

What are the metastatic locations for adenocarcinoma

A

Liver, bone, brain, pulmonary

32
Q

Investigations for Oesophageal Cancer

A

Endoscop & Biopsy

Staging: CT, EUS, PET, Bone

33
Q

What investigation would be needed if there was suspected peritoneal spread

A

Laparoscopy

34
Q

T1 staging

A

Tumour invades lamina propria

35
Q

T2 staging

A

Tumour invades muscular propria

36
Q

T3 Staging

A

Tumour invades adventitia

37
Q

T4 staging

A

Tumour invades adjacent structures

38
Q

N1 Staging

A

Regional LN metastasis

39
Q

M1 staging

A

Distant metastasis

40
Q

Stage I

A

T1N0M0

41
Q

Stage IIa

A

T2T3/N0M0

42
Q

Stage IIb

A

T1T2/N1M0

43
Q

Stage III

A

T3N1M0, T4, any N, M0

44
Q

Stage IV

A

M1

45
Q

Treatment for oesophageal cancer

A

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
Q

What is Eosinophiic Oesophagitis

A

• Chronic immune-/allergen-mediated condition defined clinically by symptoms of oesophageal dysfunction, and pathologically by an eosinophilic infiltration of the oesophageal epithelium

47
Q

Who is Eosionophilic Oesophagitis commonly seen in

A

Males

Children and young adults

Alimentary System (39 decks)

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