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GI > Oesophageal Disease > Flashcards

Oesophageal Disease Flashcards

1
Q

How would you diagnose allergic oesphagitis?

A

Endoscopy - corrugated appearance

Blood test for eosinophils

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2
Q

5 common causes of GORD

A 
Incompetent LOS
Poor oesophageal motility
Barrier function/visceral sensitivity 
Stress
Increased abdo pressure - obesity/pregnancy
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3
Q

Symtpoms of GORD (8)

A 
LOTS COMPLAIN WORSE AT NIGHT 
Heartburn
Reflux
Waterbrash
Dysphagia, odynophagia
Weight loss
Chest pain
Hoarseness
Coughing
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4
Q

First line investigation/ treatment for GORD

A

PPI trial for 4-6 weeks

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5
Q

If PPI trial negative in suspected case of GORD what investiagtions would you look at?

A

Endoscopy
Barium swallow
pH studies
Could be something more ominous

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6
Q

3 complications of GORD

A

Ulceration
Stricture
Barrets

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7
Q

What lifetsyle changes can be used to help GORD? (4)

A

Sit up when sleep
Smoking cessation
Avoid alcohol/acidic food
Weight loss

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8
Q

Define the cell change behind Barret’s

A

Stratifed squmous epi. -> simple columnar epi with goblet cells

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9
Q

What would make you think a patient had Barretts

A

Haematemesis and long history of GORD

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10
Q

On endoscopy of patient with Barretts what would you see?

A

Stripes of Red velvety sections (columnar epi) and lighter pink sections (striated squamous epi) - biopsy red sections

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11
Q

What kind of cancer is Barrett’s a precursor of?

A

Adenocarcinoma - in bottom 1/3 of oesophagus

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12
Q

What two kinds of cancer are found in the oesophagus and where are they found and what is the biggest risk factor for each

A

SSC - upper 2/3 - smoking and alchol

Adenocarcinoma - low 1/3 - obesity/ Barrett’s/GORD

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13
Q

In what condition would a bird beak appearnce be seen on a barium swallow study?

A

Achalasia

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14
Q

How do you treat achlasia?

A

Na+ blockers and nitrates for more defnitive surgery
Young = Heller’s myotomy (cardiomyotomy)
Old = balloon dilation

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15
Q

What are the ALARMS symptoms?

What would you do if someone had these symptoms?

A 
Anaemia
Loss of weight
Anorexia
Recent onset of PROGESSIVE symtpoms
Masses and melena/haematsis 
Swallowing difficulties

OR

> 55

Upper GI endoscopy

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16
Q

If a patient has allergic oesphagitis/ eosinophilic oesphagitis what is their response going to be to PPIs?

A

Failed course - nothing to do with acid

17
Q

What is the treatment for allergic oesphagitis?

A

Removal of allergen
Steroids
Cromoglycate

18
Q

Name 2 causes of acute and 2 of chronic oesphagitis

A

Acute:
Infection in immunocomprimised e.g. HSV, candidiasis

Chronic:
GORD
Crohns (less common)

19
Q

What antacids would be prescribed for GORD?

A

PPIs = omeprazole, lansoprazole

H2 anatgonists = cimetidine, ranitidine

20
Q

How is Barret’s managed based on levels of dysplasia?

A

No dysplasia - regular surveillance

Low grade dysplasia - endoscopic radiofrequency ablation

High grade dysplasia - oesphagectomy/ endoscopic radiofrequency ablation/ endoscopic mucosal resection

21
Q

Where is oesphageal cancer likely to spread?

A

Direct invasion of laryngeal nerve - causes change in voice
Lympathatic spread
Liver, lung, bone and brain

22
Q

How would you treat oesphageal cancer

A 
Oesophagectomy 
Alongisde neoadjuvant (pre surgery) or adjuvant chemo (post surgery)
23
Q

What is achlasia?

A

Oesphogeal motitilty disorder

24
Q

Achalasia is defined as “failure of smooth muscle relaxation of LOS”. What 3 things can cause this?

A

Increased LOS tone
Lack of peristlaisis
Degeneration of the myenteric plexus = inadequate relaxation of LOS

25
Q

How would a patient with achalasia present? (3)

A

Dysphagia to BOTH food and drink
Regurgitation of undigested food
Chest pain

26
Q

What is a peptic stricture and how will a patient present?

A 
Narrowing of oesphagus due to continual damage (acid reflux etc.) 
Progressive dysphagia (often with the sensation of "food sticking")
27
Q

How would you treat a severe peptic stricture?

A

PPIs

Balloon dilation following benign biopsy

28
Q

Patient presents with oesophageal stricture with food bolus (progressive dysphagia) how do you manage and what is used to investigate?

A

IV fluids + nil by mouth

OGD

29
Q

What is manometry?

A

Test to see pressure and function in LOS lumen and stomach

30
Q

For what condition can small amounts of fizzy juice be used to treat?

A

Oesophageal stricture with food bolus

31
Q

What oesphageal cancer is more common?

A

Adenocarcinoma

GI (26 decks)

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