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gastro > Oesophageal conditions > Flashcards

Oesophageal conditions Flashcards

1
Q

what are the two main ways which cause oesophageal conditions ?

A

mechanical obstruction
mucosal disruption

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2
Q

what is oesophageal varies ?

A

when you get abnormal enlarged veins in the oesophagus

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3
Q

why does oesophageal varices occur and what is the main cause of it ?

A

due to portal hypertension
mainly caused by liver cirrhosis

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4
Q

what is portal hypertension ?

A

shunting of blood in anastomoses

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5
Q

what are clinical features pf oesophageal varices ?

A

cirrhosis/chronic liver disease
rupture haematemesis
large volumes of dark red blood

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6
Q

how would you diagnosis oesophageal varices ?

A

endoscopy

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7
Q

how would you manage ruptured oesophageal varices ?

A

ABC + correct clotting (before endoscopy)

Terlipressin (vasoactive)

endoscopic variceal bad ligation

sengtaken - Blakemore (tube)

TIPS (shunt)

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8
Q

what is Mallory-Weiss tear ?

A

tear of tissue of the tissue of the lower oesophagus

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9
Q

what is Mallory-Weiss caused by ?

A

prolonged and vigorous retching and vomiting

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10
Q

who is a risk factor for Mallory-Weiss tear ?

A

alcoholics

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11
Q

what are clinical features of Mallory-Weiss tear ?

A

haematemesis (vomiting blood) after an episode of forceful or recurrent retching, vomiting, coughing or straining

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12
Q

how would you diagnose mallory-Weiss tear ?

A

upper GI endoscopy

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13
Q

how would you manage Mallory-Weiss tear ?

A

mostly self limiting so treatment is generally supportive

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14
Q

What is GORD and what does it stand for ?

A

Gastro-esophageal reflux disease

back flow of acid and stomach contents into esophagus

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15
Q

what is GORD mostly caused by ?

A

an incomponent lower oesophageal sphincter ( where sphincter fails to close)

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16
Q

what are clinical features of GORD?

A

heartburn (epigastric pain) , nausea with or without vomiting, dysphagia

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17
Q

how would you investigate for GORD (4) ?

A

endoscopy
barium swallow (esophagogram test)
oesophageal manometry
24 hr pH monitoring

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18
Q

how would you manage GORD?

A

antacids e.g. gaviscon (over the counter)
Proton Pump Inhibitor - 1st line
H2-receptor antagonists - 2nd line

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19
Q

what complications can GORD cause ?

A

strictures
oesophagitis
Barretts oesophagus

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20
Q

what are main PPI ?

A

(end in -zole)
lansoprazole
omeprazole

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21
Q

what are the main H2-receptor antagonists ?

A

(end in -tidine)
nizatidine
famotidine

22
Q

what is achalasia ?

A

failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter

23
Q

what causes achalasia ?

A

degenerative loss of ganglia from aurbach’s plexus

24
Q

what are clinical features of achalasia ?

A

heartburn
nausea with or vomiting
dysphagia (food and liquid)

25
Q

how would you investigate achalasia ?

A

oesophageal manometry (confirms)
barium swallow would show BIRD BEAK APPEARANACE

26
Q

how would you manage achalasia ?

A

pneumatic (ballon) dilation - 1st line
Heller cardiomyopathy - 2nd line ( or recurrent/persistent symptoms)

27
Q

what is oesophageal manometery ?

A

a tube that measure LOS pressure while patient sips water

28
Q

what is esophagitis ?

A

inflammation that may damage damage tissue of the oesophagus

29
Q

what causes esophagitis (4) ?

A

infection
reflux
allergic (eosinophilic)
drug induced

30
Q

what are the symptoms of esophagitis ?

A

painful swallowing (odynophagia)
difficult swallowing (dysphagia)
chest pain (heartburn)

31
Q

what are the two types of esophagitis ?

A

reflux oesophagitis
esophagitis (eosinophilic)

32
Q

how do you diagnose reflux oesphagitis and what would it show ?

A

upper endoscopy
shows signs of erosion

33
Q

how would you manage reflux oesophagitis ?

A

PPI - 1st line

34
Q

what are main complications of reflux oesophagitis ?

A

ulceration
stricture
barretts oesophagus

35
Q

what is esophagitis (eosinophilic) associated with ?

A

asthma
atopic dermatitis
food allergies

36
Q

how would you diagnose esophagitits ( eosinophillic) and what does it show ?

A

upper endoscopy with biopsy
shows presence of eosinophils and signs of trachealization

37
Q

how would you manage esophagitis (eosinophilic) ?

A

PPI + dietary advice

38
Q

what is the main complication of eosophagitis (eosinophilic) ?

A

stricture

39
Q

what is barretts oesophagus ?

A

metaplasia (transformation) of the lower oesophageal mucosa

40
Q

what causes barretts oesophagus and what is a big risk factor ?

A

chronic oesophageal injury from chronic reflux of gastric content
GORD is a big risk factor

41
Q

what are clinical features of Barrett’s oesophagus ?

A

often asymptomatic
patients often have coexistent GORD symptoms

42
Q

how would you investigate for Barretts oesophagus and what does it show ?

A

endoscopy

it would show columnar epithelium (with goblet cells)

43
Q

how would you manage Barretts oesophagus ?

A

PPI
endoscopic surveillance

44
Q

what would you do if Barretts oesophagus has a dysplastic change ?

A

radio frequency ablation

45
Q

what are the two main types of oesophageal cancer ?

A

squamous cell carcinoma (upper/middle) - 90%
adenocarcinoma (lower)

46
Q

what are social risk factors for oesophageal cancer ?

A

smoking, alcohol, hot drinks

47
Q

what are associated conditions of oesophageal cancer ?

A

GORD
Barretts oesopphagus
metabolic syndrome

48
Q

what are clinical features of oesophageal cancer ?

A

hallmark feature is dyshagia
weight loss
hoarseness
haematemesis

49
Q

how would you investigate for oesophageal cancer ?

A

upper GI endoscopy with biopsy

50
Q

how would manage oesophageal cancer ?

A

surgical resection

51
Q

what is the main cancer type associated with Barretts ?

A

adenocarcinoma

gastro (6 decks)

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