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Ailimentary 2 > Oesophageal disease > Flashcards

Oesophageal disease Flashcards

1
Q

Where does the oseophagus begin? and end?

A

The end of the Cricoid cartilage (C6), ends T11-12

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2
Q

What nerve mediates peristalsis?

A

vagus

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3
Q

What is the most common symptom of oesophageal disease?

A

Heart burn

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4
Q

What is heartburn caused by?

A

Acid/alkaline environments in the bottom of the oesophagus, can be due to:
-slower emptying of the stomach/into the stomach
- issues with teh Lower Oesophageal; sphincter

Does occur commonly on swallowing

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5
Q

What is GORD?

A

Gastro-Oesophageal Reflux disease
(long term heart burn)

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6
Q

Whiuch foods etc can affect gord?

A

Anything that might affect the abikity of th eoesophageal sphincter to stay shut:
- alcohol, nicotine, dietary xanthines

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7
Q

Corncernng symptom of oesophagus?

A

Dysphagia - difficulty swallowing

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8
Q

What is Odynopohaia?

A

Pain with swallowing

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9
Q

Presentation of dysphagia, quesions to ask:

A

Food types
Pattern (regular/irregular]
Other esp alarming symptoms: weight loss, regurgitation, cough

Could do with finding out where the difficulty is; oropharyngeal or oesophageal?

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10
Q

What can be the common causes of dysphagia?

A

Strictures (benign/malig)
Motility disorders (eg achalasia)
Eosinophillic Oesophagitis
Extrinsic compression

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11
Q

Oesophageal investigations

A

Primary:
Endoscopy (upper GI (UGIE) or Oesophago-Gastro-Duodenoscopy (OGD)

Barium swallow was an investigation but isn’t used nearly as much now

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12
Q

Is there a small role for contrast radiology? What is it superseeded by?

A

Yes, mainly for dysphagia. Has been superseeded by endoscopy

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13
Q

What is a pH metry?

A

Prope down oesophagus, measures pH.

Nowadays can do with clips wirelessly and patients press when they have symptoms

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14
Q

What doies a manometry measure?

A

Pressure down the oesophagus (contractions) - useful if dysphagia/suspected motility diorder (after endoscopy)

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15
Q

What are he 2 catergories of motility diseases?

A

Hyper and hypo motile

hyper eg spasms - severe chest pain, potentially dysphasia, confused with MI. Treatment smooth muscle relaxants

Hypo - connective tissue disease/neurpothy - heartburn and reflux symptoms

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16
Q

Symptoms of diffuse oesophageal spasm?

A

Severe chest pain +/- dysphagia

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17
Q

Treatment of hypermotility?

A

Smooth muscle relaxants - questionable - apparently they don’t work.

SO: Botox, surgery (cuts), balloon stenting

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18
Q

Most important hypermotality disorder? Causes? Symptoms? Age rang? Gender?

A

Achalasia

Degenaration of inhibitory neurons in myenteric plexus in oesophagus

-progressive dysphagia
-chest pain
-weight loss (rare)
-regurgitation/Chest infection

Late 20s - 50 yo

Male:Female 1:1

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19
Q

Characteristic appearance on barium swallow for Achalasia? Treatment options?

A

Rats tail

Balloon stenting, botox, surgery (myotomy - opens up contracted area)

Pharmacological: Nitrates/CCB (relax smooth muscle

20
Q

Best long term surgery / other tratment options achalisa? Long term complications ?

A

Surgery best long term

Complications: Aspiration pneumonia and increased risk of squamous cell oesophageal carcinoma

21
Q

Most common oesophageal disease?

A

GORD (Gastro - Oesophageal Reflux Disease

22
Q

GORD Causes? SYmptoms? Risk factors: Men or women more common? Ethnic disparity? Does it require a diagnostic test? WHen would you perform an edoscopy?

A

Causes:
Anything thats pathologically going to cause acid and bile exposurein the lower oesophagus… so anything that causes the lower oesophageal sphincter to not work as well.
- Hypotensive LOS, transient relaxations of LOS
-Delayed gastric emptying
-Delayed oesophageal empytying
-hiatus hernia

More common in men

More common in caucasians > black > asian

Does NOT require a diagnostic test unless alarming symptoms (dysphagia, weight loss, vomit etc), in which case you would perform one.

23
Q

What are the 2 types of hiatus hernias?

A

Sliding (stomach slides up through the oesophageal opening)

Para-oesophageal (new hole)

24
Q

What can make you more likely to get a hiatus herna?

A

Obesity and aging

25
Q

What is the most dangerous and least common hiatus hernai?

A

Para-oesophageal

26
Q

GORD complications?

A

Ulceration, stricture, glandular metaplasia (Barrett’s oesophagus), carcinoma

27
Q

What is Barretts oesophagus?

A

Metaplasia of the cells where the damage is occuring (iturn from startified squamous cells into columar cells with mucus glands (more like stomach).

28
Q

What is barrets a precursor for?

A

Dysplasia and cancer

29
Q

What is risk of progression of baretts oesophagus?

A

6%

30
Q

High grade dysplasia treatment

A

Chop out dysplasia nodules (Endoscopic Mucosal Resection (EMR) and burn (radio-frequency ablation (RFA) other parts to stop dysplasia.

Don’t really want ot do an oesophagectomy as there is a high mortality rate (10%)

31
Q

Why is an oesophagectomy rare for high displasia?

A

High mortality

32
Q

If no alarm features what is GORD tratment?

A
  1. Lifestyle measures
  2. meds:
    Antacids (gaviscon)
    Proton pump inhibitor eg Omeprazole

Stubborn disease might do surgery (fundoplication - full/partial wrap)

33
Q

Oesophageal cacers - benign tumours common or rare?

A

rare

34
Q

Men or women more common oesophageal cancer?

A

Men

35
Q

median age?

A

65 but decreasing

36
Q

geopgraphic distribution of adenocarcinoma or squamous cell carcinos?

A

Europe/USA = adenocarcinoma
Rest of world = squamous more common

37
Q

presentation of Oesophageal cancer?

A

dysphasia (progressive)
Anorexia/weight loss
Odynophagia
cough
pheumonia (tracheo-oesophageal fistula)
Vocal chord paralysis
HAematemesis (blood vomit)

38
Q

Where is the squamous cell cancinoma? What does it lead from ?

A

Mid/Upper oesophagus

dysplasia and carcinoma in situ

39
Q

Squamous cell carcinoma risk factors/ diet?

A

ALCOHOL AND TOBACCO!!

Maybe related to diet

40
Q

Where is Adenocarcinoma? Associated with what disease? Risk factors adenocarcinomas?

A

Distal Oesophagus, associated with Barrett’s oesophagus

Risk factors: Obesity, male, middle age, Caucasian

41
Q

Osophageal cancer progonsis, why? Where are metastases

A

Very poor due to late presentation and because it is easy for cancer to spread to the local big organs such as the heart (no peritoneum and close proximity).

Metastases commonly hepatic, brain, pulmonary and bone

42
Q

Oesophageal Cancer investigation and staging by what?

A

Diagnosis by Endoscopy.

Investigation and staging though TNM:
CT
Endoscopic ultrasound
PET scan/Bone scan

43
Q

Oesophageal Cancer treatment

A

If fit and non metastatic (localised) cancer then surgery! (Oesophagectomy) +/- neoadjuvant/adjuvant chemotherapy. High mortality rate. Long recovery.

Can do radical treatment but still progressing.

44
Q

Incurable - palliative measures

A

Stenting, palliative choemo/radio/brachy therapy.

Symptom control

45
Q

What is eosinophilic oesophagitis?

A

Inflammation of the oesophagus due to some sort of allergic reaction - loadsa eosinophils.

46
Q

Eoinophillic osphagitis presentation anc characteristic endoscopic findiungs. What is the treatment?

A

Presentation: Dysphagia and food bolus obstruction. looks like thin stripy strictures down the oesophagus.

Treatment is topical/swallowed corticosteroids, dietry elimination and potentially endoscopic dilatation

Ailimentary 2 (9 decks)

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