Oesophageal Disease Flashcards
How would you diagnose allergic oesphagitis?
Endoscopy - corrugated appearance
Blood test for eosinophils
5 common causes of GORD
Incompetent LOS Poor oesophageal motility Barrier function/visceral sensitivity Stress Increased abdo pressure - obesity/pregnancy
Symtpoms of GORD (8)
LOTS COMPLAIN WORSE AT NIGHT Heartburn Reflux Waterbrash Dysphagia, odynophagia Weight loss Chest pain Hoarseness Coughing
First line investigation/ treatment for GORD
PPI trial for 4-6 weeks
If PPI trial negative in suspected case of GORD what investiagtions would you look at?
Endoscopy
Barium swallow
pH studies
Could be something more ominous
3 complications of GORD
Ulceration
Stricture
Barrets
What lifetsyle changes can be used to help GORD? (4)
Sit up when sleep
Smoking cessation
Avoid alcohol/acidic food
Weight loss
Define the cell change behind Barret’s
Stratifed squmous epi. -> simple columnar epi with goblet cells
What would make you think a patient had Barretts
Haematemesis and long history of GORD
On endoscopy of patient with Barretts what would you see?
Stripes of Red velvety sections (columnar epi) and lighter pink sections (striated squamous epi) - biopsy red sections
What kind of cancer is Barrett’s a precursor of?
Adenocarcinoma - in bottom 1/3 of oesophagus
What two kinds of cancer are found in the oesophagus and where are they found and what is the biggest risk factor for each
SSC - upper 2/3 - smoking and alchol
Adenocarcinoma - low 1/3 - obesity/ Barrett’s/GORD
In what condition would a bird beak appearnce be seen on a barium swallow study?
Achalasia
How do you treat achlasia?
Na+ blockers and nitrates for more defnitive surgery
Young = Heller’s myotomy (cardiomyotomy)
Old = balloon dilation
What are the ALARMS symptoms?
What would you do if someone had these symptoms?
Anaemia Loss of weight Anorexia Recent onset of PROGESSIVE symtpoms Masses and melena/haematsis Swallowing difficulties
OR
> 55
Upper GI endoscopy
If a patient has allergic oesphagitis/ eosinophilic oesphagitis what is their response going to be to PPIs?
Failed course - nothing to do with acid
What is the treatment for allergic oesphagitis?
Removal of allergen
Steroids
Cromoglycate
Name 2 causes of acute and 2 of chronic oesphagitis
Acute:
Infection in immunocomprimised e.g. HSV, candidiasis
Chronic:
GORD
Crohns (less common)
What antacids would be prescribed for GORD?
PPIs = omeprazole, lansoprazole
H2 anatgonists = cimetidine, ranitidine
How is Barret’s managed based on levels of dysplasia?
No dysplasia - regular surveillance
Low grade dysplasia - endoscopic radiofrequency ablation
High grade dysplasia - oesphagectomy/ endoscopic radiofrequency ablation/ endoscopic mucosal resection
Where is oesphageal cancer likely to spread?
Direct invasion of laryngeal nerve - causes change in voice
Lympathatic spread
Liver, lung, bone and brain
How would you treat oesphageal cancer
Oesophagectomy Alongisde neoadjuvant (pre surgery) or adjuvant chemo (post surgery)
What is achlasia?
Oesphogeal motitilty disorder
Achalasia is defined as “failure of smooth muscle relaxation of LOS”. What 3 things can cause this?
Increased LOS tone
Lack of peristlaisis
Degeneration of the myenteric plexus = inadequate relaxation of LOS
How would a patient with achalasia present? (3)
Dysphagia to BOTH food and drink
Regurgitation of undigested food
Chest pain
What is a peptic stricture and how will a patient present?
Narrowing of oesphagus due to continual damage (acid reflux etc.) Progressive dysphagia (often with the sensation of "food sticking")
How would you treat a severe peptic stricture?
PPIs
Balloon dilation following benign biopsy
Patient presents with oesophageal stricture with food bolus (progressive dysphagia) how do you manage and what is used to investigate?
IV fluids + nil by mouth
OGD
What is manometry?
Test to see pressure and function in LOS lumen and stomach
For what condition can small amounts of fizzy juice be used to treat?
Oesophageal stricture with food bolus
What oesphageal cancer is more common?
Adenocarcinoma
