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GI Anatomy > Oesophageal conditions > Flashcards

Oesophageal conditions Flashcards

1
Q

What is gastro-oesophageal reflux disease (GORD)

A

Reflux of acid-pepsin and bile into LOWER OESOPHAGUS

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2
Q

Causes of GORD (2)

A

LOS malfunction - only relaxes for short time, delays oesophageal emptying so less acid clearance

Hiatus hernia (stomach moves up into chest through opening in diaphragm) - sliding or paraoesophagheal

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3
Q

Pathophysiology of GORD

A

Mucosa exposed to EXCESS acid-pepsin –> thickening of squamous epithelium –> increased cell loss and inflammation –> ulceration if reflux is severe

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4
Q

GORD risk factors (6)

A

Family history of GORD
Obesity
Older age
Hiatus hernia

Drugs lowering LOS pressure, e.g. CCBs
Smoking
Alcohol

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5
Q

GORD symptoms (2)

A

Symptoms:
Dyspepsia - heartburn
Acid regurgitation/reflux –> water brash (acidic taste in back of mouth)

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6
Q

GORD investigations (4)

A

PPI trial

UGIE (only if alarm features)
Oesophageal manometry and pH
Barium swallow

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7
Q

GORD treatment

  • lifestyle changes (2)
  • medical (3)
  • surgery + when this is indicated
A

Lifestyle changes
-weight loss, avoid late night eating

Antacids
PPI - omeprazole
Hydrogen receptor blocker/antagonist - if PPI insufficient

Nissen fundoplication if not responsive to medication

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8
Q

Complications of GORD (4)

A

Oesophageal ulcer
Oesophageal stricture (due to healing by fibrosis)
Barrett’s oesophagus
Oesophageal carcinoma

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9
Q

What is Barrett’s oesophagus + cause

A

Pre-malignant condition caused by GORD, usually in lower oesophagus

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10
Q

Pathophysiology of Barrett’s oesophagus

A

Glandular metaplasia:

normal squamous epithelium changes to intestinal glandular columnar epithelium because it’s more resistant to acid

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11
Q

Barrett’s oesophagus risk factors (3)

A

Male
GORD
Older age

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12
Q

Barrett’s oesophagus symptoms (2)

A

Dyspepsia - heartburn

Acid regurgitation

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13
Q

Barrett’s oesophagus investigations (1)

A

Endoscopy + biopsy

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14
Q

Barrett’s oesophagus treatment

  • for non-dysplastic (2)
  • dysplastic (3)
A

If non-dysplastic: PPI + radio frequency ablation (RFA)

If dysplastic:
PPI
RFA
Endoscopic mucosal resection

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15
Q

Complications of Barrett’s oesophagus

A

Adenocarcinoma of oesophagus

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16
Q

Causes of squamous cell carcinoma of oesophagus (less common than adenocarcinoma of oesophagus)

A

Carcinogens:

  • Polycyclic aromatic hydrocarbons & nitrosamines from smoking
  • Acetaldehyde from alcohol inhibits DNA repair
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17
Q

Pathophysiology of squamous cell carcinoma on oesophagus + what part of oesophagus it affects

A

Due to preceding dysplasia and carcinoma in situ

Affects proximal 2/3 oesophagus

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18
Q

Squamous cell carcinoma of oesophagus risk factors (4)

A

Smoking
Alcohol
Non white race
Family history of oesophageal cancer

Male - not specific to SCC, also applies for oesophageal adenocarcinoma

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19
Q

Oesophageal cancer (squamous and adenocarcinoma) symptoms (3) + signs (1)

A

Symptoms:
Progressive dysphagia
Odynophagia
Hoarse voice (only in upper tumours compressing recurrent laryngeal n)

Signs:
Weight loss

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20
Q

Oesophageal cancer investigations (5 - 1 definitive investigation + 4 staging investigations)

A

Endoscopy + biopsy (at least 8 biopsies)

Staging :
CT thorax/ abdomen (for M staging)
MRI thorax/abdomen (for M staging)
EUS (for T/N staging)
PET (for M staging) - done before EUS
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21
Q

Oesophageal cancer treatment

  • surgical candidate (2)
  • non-surgical candidate (2)
A

Surgical

  • Endoscopic resection of tumour +/- ablation (if early stage)
  • Oesophagectomy

If not surgical candidate:

  • chemoradiotherapy or radiotherapy alone (only radiotherapy alone if can’t tolerate both)
  • endoscopic ablation +/- stent for SYMPTOM RELIEF
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22
Q

Cause of adenocarcinoma of oesophagus

A

Metaplasia due to GORD –> barrett’s oesophagus

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23
Q

Pathophysiology of adenocarcinoma of oesophagus + what part of oesophagus it affects

A

Usually in distal third of oesophagus

Metaplastic cells become dysplastic due to activation of oncogenes and inhibition of tumour suppressor genes

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24
Q

Adenocarcinoma of oesophagus risk factors (5)

A 
Male
Barrett's oesophagus
GORD
Hiatus hernia
Obesity
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25
Q

3 ways that oesophageal cancer spreads + what 4 places can it spread to

A

Direct
Lymphatic
Blood

Liver, lung, brain, bone

26
Q

How does the fact that the oesophagus lacks a serosal layer affect prognosis

A

It means that local tumour invasion into adjacent structures (heart, trachea, aorta) is easier so limits surgery

27
Q

The lamina propria (mucosa) of the oesophagus is rich in lymphatics compared to the rest of the GIT where lymphatics are mainly submucosal, what does this mean in terms of metastases

A

lymph node metastases therefore occur earlier in oesophageal tumours

28
Q

What are the 3 oesophageal motility disorder categories

A

Hypermotility
Hypomotility
Achalasia

29
Q

What is an example of an oesophageal hypermotility disorder

A

Diffuse oesophageal spasm

30
Q

Pathophysiology of oesophageal hypermotility disorders

A

Idiopathic
Muscles are over-reactive –> spasm
Confused with angina/MI

31
Q

Diffuse oesophageal spasm symptoms (2)

A

Episodic chest pain

Dysphagia

32
Q

Oesophageal motility disorders (hypermotility/ hypomotility/ achalasia) investigations

A

UGIE
Oesophageal manometry - KEY FOR ACHALASIA
Barium swallow

33
Q

Pathophysiology of oesophageal hypomotility disorders

A

Failure of LOS mechanism –> reflux and heartburn symptoms

34
Q

Oesophageal hypomotility disorders symptoms (2)

A

Heartburn

Acid regurgitation –> waterbrash

35
Q

What is achalasia

A

Functional distal oesophageal obstruction affecting motility due to failure of LOS to relax to allow food to get into stomach

36
Q

Pathophysiology of achalasia

A

Functional loss of myenteric plexus ganglion cells in distal oesophagus and LOS –> failure of LOS muscle to relax after swallowing so it’s continuously closed and unable to open when necessary –> so obstructing distal oesophagus

37
Q

Achalasia risk factors (2)

A

Allgrove syndrome

Herpes and measles viruses

38
Q

Achalasia symptoms (3) and signs (2)

A

Symptoms:
Dysphagia
Retrosternal pain
Regurgitation

Signs:
Weight loss
Recurrent chest infection

39
Q

Achalasia treatment

  • pharmacological (2)
  • endoscopic therapy (2)
  • surgical
A

Pharmacological:

  • Nitrates
  • CCBs

Endoscopic therapy:

  • Botulinum toxin injection
  • Pneumatic balloon dilation

Surgical:
-Myotomy (cutting muscles of LOS to allow it to relax )

40
Q

Complications of achalasia (3)

A

Aspiration pneumonia
GORD
Increased squamous cell carcinoma risk

41
Q

What is a sliding hiatus hernia

A

Fundus of stomach moves up diaphragmatic hiatus and up through oesophagus

42
Q

What is a para-oesophageal hiatus hernia

A

Fundus of stomach moves up diaphragmatic hiatus then alongside oesophagus

43
Q

Biggest risk factor of hiatus hernia

A

Obesity

44
Q

Hiatus hernia treatment

A

Fundoplication

45
Q

Oesophageal cancer prognosis

A

5 yr survival less than 15%

46
Q

What is eosinophilic oesophagitis

A

Chronic immune/allergen mediated inflammation of oesophagus from inappropriate response to unharmful allergens

47
Q

Pathophysiology of eosinophilic oesophagitis

A

Eosinophilic infiltration of oesophageal epithelium as a response to an allergen –> oesophageal dysfunction

48
Q

Eosinophilic oesophagitis risk factors (3)

A

Male
Atopic disease
Family history of it

49
Q

Eosinophilic oesophagitis symptoms (2) + signs (1)

A

Symptoms:
DYSPHAGIA
Heartburn/chest discomfort

Signs:
Avoiding eating/changing the way they eat (e.g. chewing more throroughly/more slowly, drinking lots while eating; to prevent food from getting stuck)

50
Q

Eosinophilic oesophagitis treatment (3)

  • medical
  • lifestyle change
  • surgical
A

Corticosteroid
Dietary elimination therapy - a specific diet
Endoscopic dilation

51
Q

Eosinophilic oesophagitis investigations (2)

A 
UGIE + biopsy (at least 2 biopsies from 2 different locations)
PPI trial (to see if it's GORD)
52
Q

2 types of oesophageal carcinomas

A

Adenocarcinoma

Squamous carcinoma

53
Q

Local effects of oesophageal cancer (3)

A

Oesophageal obstruction –> dysphagia
Ulcer
Perforation

54
Q

Causes of dysphagia (5)

A 
Benign stricture (narrowing)
Malignant stricture (from oesophageal tumour)
Motility disorders - achalasia
Eosinophilic oesophagitis
Extrinsic compression
55
Q

Investigations of general oesophageal disease

A

Endoscopy - only indicated for ALARM features

Barium swallow

Oesophageal pH and manometry

56
Q

2 types of hiatus hernia

A

Sliding

Para-oesophageal

57
Q

Main type of drug used to treat GORD

A

PPI

58
Q

When is an oesophagectomy indicated

A

If fit and no metastases

59
Q

Name a type of oesophagectomy

A

Ivor Lewis approach - first stomach is mobilised and oesophagus is resected then stomach is anastomosed

60
Q

Most appropriate investigation of hiatus hernia

A

Barium meal

61
Q

Achalasia increases the risk of adenocarcinoma or squamous cell carcinoma of the oesophagus

A

SCC

GI Anatomy (21 decks)

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