Oesophageal conditions Flashcards
What is oesophageal hyper motility?
Exaggerated, uncoordinated hypertonic contractions of the oesophagus
What are the symptoms of oesophageal hyper motility?
Severe episodic pain with or without dysphagia
What investigations are done for oesophageal hyper motility?
Barium swallow- corkscrew appearance
Manometry- uncoordinated, exaggerated contractions
What is the management of oesophageal hyper motility?
Smooth muscle relaxants
What is the presentation of globus pharyngus?What is globus pharyngus?
Persistent feeling of a lump in throat without anything being there Dysphagia Intermittent symptoms Relieved by swallowing food or drink Worse swallowing saliva Painless History of anxiety
What is achalasia?
Functional obstruction caused by loss of myenteric plexus ganglion cells in distal oesophagus and lower oesophageal sphincter –> cannot relax
What are the features of achalasia?
Progressive dysphagia- both solids and liquids from stat Weight loss Regurgitation Chest infections Chest pain
What investigations are done for achalasia?
Manometry- excessive LOS tone that doesn’t relax on swallow
Barium swallow- bird’s beak appearance
What is the management principle of achalasia?
Pharm is limited
Endoscopic
Surgical
What pharm management options are available for achalasia?
Limited
Nitrates
CCB
What endoscopic and surgical management options are there for achalasia?
Pneumatic balloon dilatation
Intra-sphenteric botulinum toxin injection
Myotomy
What are the complications of achalasia?
Increased risk SCC
Aspiration and pneumonia
What are the 2 types of causes of GORD?
Functional
Anatomical- hiatus hernia
What can cause functional GORD?
Increased transient relaxations of LOS Hypotensive LOS Delayed gastric empyting Delayed oesophageal emptying Decreased oesophageal acid clearance Decreased tissue resistance to bile
What are the risk factors for GORD?
Pregnancy Obesity Smoking Alcohol Hypomotility Drugs lowering LOS pressure
What is the presentation of GORD?
Heartburn
Cough
Water brash
Sleep disturbance
What are the alarm features in GORD?
Dysphagia
Weight loss
Vomiting
What is the pathophysiology in GORD?
Mucosa exposed to pepsin and bile causing increased cell loss and regenerative activity, and erosive oesophagitis
How is GORD diagnosed?
Characteristic history
What should eb done if there are alarm features in GORD?
Endoscopy
How is GORD managed?
1st- Lifestyle measures
2nd- PPI
3rd- H2RA
Anti-reflux surgery if severe
What are the complications of GORD
Ulceration
Stricture
Barrett’s oesophagus
Carcinoma
What is Barrett’s oesophagus?
Metaplasia of lower oesophageal mucosa- change from start squamous epithelium to simple columnar epithelium with goblet cells
What is the main risk factor for Barrett’s?
GORD
What is the presentation of Barrett’s?
Asymptomatic but patients will likely present with GORD
How is Barrett’s screened?
Endoscopy for males >60 with persistent/treatment resistant GORD
What is the management of Barrett’s?
Endoscopic surveillance every 3-5 years
High dose PPI
What are oesophageal SCCs?
Large exophytic occulting tumours occurring in proximal 2/3 oesophagus
What are oesophageal SCCs preceded by?
Dysplasia and carcinoma in situ
What is oesophageal SCC associated with?
Achalasia
Caustric strictures
Plummer-Vinson syndrome
Smoking and alcohol
What are oesophageal adenocarcinomas?
Change of strat squamous epithelium to glandular columnar epithelium in distal 1/3 oesophagus
What precedes oesophageal adenocarcinoma?
Barrett’s oesophagus
What are the risk factors for oesophageal adenocarcinoma?
GORD!
Male, middle aged, obese
What are the features of oesophageal cancer?
Progressive dysphagia Odynophagia Anorexia and weight loss Chest pain Cough and haematemesis Pneumonia Vocal cord paralysis Typically presents late
How is oesophageal cancer diagnosed?
Endoscopy and biopsy
How is oesophageal cancer staged?
CT
PET
Endoscopic US
What is the curative management of oesophageal cancer?
Oesophagectomy +/- adjuvant and/or neoadjuvant chemo
What options are there for management in oesophageal cancer?
Surgery
Combined chemo and radio- localised but non op disease
Palliative
What palliative options are available for oesophageal cancer?
Chemo Radio Brachytherapy Stent Laser PEG tube
