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Gastro > Oesaphagus > Flashcards

Oesaphagus Flashcards

1
Q

Achlasia def

A

Progressive destruction of the ganglion cells of the myenteric plexus in the oesophageal wall the inability of the sphincter to relax and a loss of peristalsis of the distal end therefore it will dilate the distal oesophagus

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2
Q

Signs of achlasia

A

Dysphagia heartburn regurgitation of non-acidic food reflux weight loss chest pain that is unresponsive to ant acids
Halitosis

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3
Q

Function of upper oesaphageal sphincter

A
  1. Prevent air from coming into oesophagus during breathing
  2. Prevents aspiration into the lungs
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4
Q

Causes

A
  1. Neurological
  2. Hsv-1
  3. Antibodies against plexus (people at risk for autoimmune disorders )
  4. Neurological problem
  5. Chagas’ disease t.cruzi can cause toxic oesaphagus
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5
Q

What is almost 100 percent found in achlasia people

A

Antibodies and hsv1 infection

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6
Q

Diagnosis

A

Barium swallow will show proximal dilated and gtypical bird beak appearance endoscopy dilated wall and will see food and saliva

Chest x ray- no air in stomach

Manometey

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7
Q

Pseudo achlasia

A
  1. Tumour - gastric or gullet cancer
  2. Scleroderma
  3. Ischemix stricture
    4.
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8
Q

What are achlasia at risk for

A

Autoimmune disorders
Squamous cell carcinoma > 10 years

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9
Q

Tx achlasia

A

Goal to decrease pressure and relief pressure

  1. Botulinum toxin (causes less ach) If that does work can try calcium channel blockers
  2. Surgery to cut the sphincter oesaphagomyotomy
  3. Dilate the LES with a ballon
  4. Calcium channel blockers - ca2+ blockers and nitrates
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10
Q

Complications achlasia

A

Pneumonia from aspiration
Weight loss
Pain
Squamous cell carcinoma

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11
Q

Symptoms of hiatal hernia

A

Dysphasia, odonophagia
Regurgitation
Chest pain
S.o.b
Chronic cough
Signs when lying flat (same as achlasia )

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12
Q

Diagnosis of hiatal

A

Same as achlasia

Chest x ray will show- mass

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13
Q

Tx hiatal her is

A

Lifestyle advice

  1. Don’t eat straight away before bedtime
    avoid alcohol(makes GERD worse) and acidic foods
    avoid smoking because nicotine relaxes the lES just sphincter
    certain foods such as chocolate peppermint coffee fatty foods also can relax

Medications like calcium Chanel blockers and nitrates (same as achlasia)

pPI for the reflex- 1st line in essay

Surgery- Nissens fundoplicatioj

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14
Q

What is nissen fundiplication

A

It’s a Surgery to correct gastro-oesophageal reflux disease because it tightens the junction between the oesophagus and the stomach. The fund is is wrapped around the lower end of eospahagus

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15
Q

Gold standard diagnosis hiatal hernia

But quesmed says it’s a barium swallow as a hiatal hernia can’t be confirmed 100 percent by endoscopy

A

Oesaphago- gastro- duodeno scopy

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16
Q

When is surgery indicated for hiatal hernia

A

Despite conservative management symptoms Persist

Patient is loosing too much weight

Acute abdomen in the case of rolling hernia

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17
Q

Types of surgery in haital

A

Cruroplasty - prevents reherniation and also helps the reflux

Nissens fundiplication

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18
Q

Barret oespahgus

A

Change from lower third of espahgus metaplasic change from squamous epithelium to columnar epithelium with goblet cells which are only present small and large intestine

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19
Q

How do u diagnose barret

A

Endoscopy and you can take a sample

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20
Q

Clasificayion of barret (wiki)

A
  1. Non dysplastix
  2. Low grade dysolasia
    3.high grade dysplasia
  3. Frank carcinoma
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21
Q

What can we do in the early stages of Barry oesophagus

A

Endoscopic reception or radio frequency ablation

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22
Q

rF for cancer of gullet

A

Hot foods
Smoking
Having achlasia- squamous

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23
Q

Types of gullet cancer

A

Squamous - usually top 2/3rds
Adenocarcinoma - lower third - associated with obesity +GERD

small cell carcinoma- very rare

24
Q

rf gullet cancer

A

Smoking
GERD and therefore also obesity
Alcohol
Diet: betal nuts, nitrosamines - smoked fish and meats
Hot beverages
Achlasia
Zenkers
Oesophageal web-
Plummer-Vinson syndrome.

25
Q

Signs of gullet carcinoma

A
  1. Dysphasia - which is progressive!!! Solids first then liquids unlike motility where both are from the start
  2. Odonophagia
  3. Hoarsenessof voice if recurrent laryngeal nerve involved
  4. Weight loss - 2nd most common

fistulas causing coughing

26
Q

Why is gullet cancer diagnosed late

A

Because dysphagia only happens when more than 2/3 of the lumen is included

27
Q

Initial investigation when you suspect is off of your cancer

A

Endoscopy - take a Sample then stage with CT and other methods

28
Q

What type of cancer subtype is barret more likely to progress to

A

Adenocarxiboma

29
Q

Achlasia and barret what types of cancer are they associated with

A

Achlasia : sCC- irritation of oespaggus because of food

Barret- adenocarcinoma
hence why you find goblet cells in the lower third

30
Q

Borchard’s triad- what does it show

A

Severe Epigastric pain
Retching without vomiting
Inability to pass an NG tube

stomach volvulus

31
Q

oesophageal webs

A

Its main symptoms are pain and difficulty in swallowing
membranes of normal esophageal tissue consisting of mucosa and submucosa that can partially protrude/obstruct the esophagus. They can be congenital or acquired. Congenital webs commonly appear in the middle and inferior third of the esophagus, and they are more likely to be circumferential with a central or eccentric orifice. Acquired webs are much more common than congenital webs and typically appear in the cervical area (postcricoid).[citation n

32
Q

most common risk factor for squamous

A

smoking and alcohol

33
Q

rf gerd

A

RF: age, obesity, male, alcohol, smoking, caffeine, fatty and spicy food

34
Q

true diverticula

false

A

true - traction - all 3 layers rare , associated with perioesaphgeal inflammation

false- pulsion , more common only contains mucosa and submucosa

34
Q

true diverticula

false

A

true - traction - all 3 layers rare , associated with perioesaphgeal inflammation

false- pulsion , more common only contains mucosa and submucosa

35
Q

what muscle is associated with zenkers

A

cricipharygeus as it forms part of the upper oesapageal sphicter

36
Q

killians triangle

A

lies between the inferior pharyngeal constrictors and the cricopharyngeus muscle - its a potential area of weakness

36
Q

killians triangle

A

lies between the inferior pharyngeal constrictors and the cricopharyngeus muscle - its a potential area of weakness

37
Q

epiphrenic diverticula

A

happnes in the distal esoagus (last 10 cm) also classed as pseudo as not all the layers so its a pulsion force associated with underlyinh motilty

37
Q

epiphrenic diverticula

A

happnes in the distal esoagus (last 10 cm) also classed as pseudo as not all the layers so its a pulsion force associated with underlyinh motilty

38
Q

classic triad of achlasia - nov

A

dysphagia, regurgtiion , wieght loss

38
Q

classic triad of achlasia - nov

A

dysphagia, regurgtiion , wieght loss

39
Q

4 criteria of achlasai

A
  1. increased intraesophageal pressure
  2. a lES that does not open in response to food
  3. a high pressure of the LES
  4. absence of peristalsis
40
Q

what is the most effective no surgical option of achlasia

A

pneumatic dilation - endocscopically

41
Q

definitve tx achlasia

A

hellers myotomy

42
Q

whats more likelt to be worse acids or alkalis

A

alkalis cause more damage

43
Q

3 sites of injury pron to caustic damage

A
  1. proximal near uES
  2. mid oesapgahus just where the aorta abts the left mainstream bronchus
  3. distal near LES
43
Q

3 sites of injury pron to caustic damage

A
  1. proximal near uES
  2. mid oesapgahus just where the aorta abts the left mainstream bronchus
  3. distal near LES
44
Q

acid on the oesapgaus

A

causes cagulative necorsis forming an eshar

45
Q

alkaline

A

liquiefactive necrosis so deeper penetration

46
Q

how to treat oesapageal stricture

A

dilation with a baloon

47
Q

3 gross patterns of oesapgeal cancer

A

ulcerating type fungating type and infiltrative type

48
Q

local staging of cancer and regional

A

L- ENODLUMINAL US SCAN
R: CT SCARN

48
Q

local staging of cancer and regional

A

L- ENODLUMINAL US SCAN
R: CT SCARN

49
Q

IVOR LEWis procedure is what

A

THOROCOABDOMIANAL ESOPHAGETCTOMY

he esophageal tumor is removed through an abdominal incision and a right thoracotomy (a surgical incision of the chest wall). The esophagogastric anastomosis (reconnection between the stomach and remaining esophagus) is located in the upper chest.

50
Q

Transhiatal Esophagectomy

A

only s cervical incsion unlike ivor lewis

then you rbing the rest of the stomach to the neck

Gastro (8 decks)

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