Oesophageal Disease Flashcards
Is variceal bleeding a life threatening emergency?
Yes
Immediate treatment of oesophageal varices
Rupesuscitate
Urgent band liganding
Give 2mg terlipressin
Omelrazole may also help prevent stress ulceration
Treatment of oesophageal varices if band liganding not working
Sengstaken-Blakemore tube
2 types of oesophageal cancer
Adenocarcinoma
Squamous cell carcinoma
Clinical presentation of oesophageal cancer
Dysphagia Odynophagia Haematemesis Regurgitation Dysphonia Weight loss Heptomegaly Paraneoplastic syndrome
Signs on physical examination of oesophageal cancer
Weight loss
Lymph nodes
Hepatomegaly
Investigation for suspected oesophageal cancer
ENDOSCOPY & BIOPSY
Imaging studies for gastric cancer
Barium meal
CT scan of chest and abdomen
Bronchoscopy
First line treatment of oesophageal cancer
Surgery
Contraindications to surgery for oesophageal cancer
Direct invasion of adjacent structures
Fixed cervical lymph nodes
Widespread metastases
Poor medical condition
Other treatment options in operable oesophageal cancer
Radiotherapy
Intubation/stents
Palliative
What is GORD?
Reflux of acidic stomach contents into oesophagus causing problems usually oesophagitis
Causes of GORD
Hiatus hernia
Loss of oesophageal peristalsis
Obesity
Risk factors for GORD
Obesity Smoking Alcohol Pregnancy Over eating Surgery in achalasia
Symptoms of GORD
Heartburn relieved by antacids
Belching
Acid/water brash
Odynophagia
Complications of GORD
Oesophagitis
Ulcers
Barrett’s oesophagus (future malignancy)
Investigations for GORD
Endoscopy Barium swallow (may show hiatus hernia)
When is it suggested that a patient gets an endoscopy for GORD?
If symptoms > 4 weeks
Non-pharmacological treatment of GORD
Raising bed head
Weight loss
Avoid drugs that affect oesophageal motility
(Nitrates, Ca2+ channel blockers (relax LOS))
Pharmacological treatment of GORD
Antacids or alginates
For oesophagitis try PPI (better than H2 blockers)
What are the 2 types of hiatus hernia?
Rolling
Sliding
Best diagnostic test for hiatus hernia?
Barium swallow
