oesophageal diseases Flashcards
what can cause acute oesophagitis (inflammation)
corrosive chemicals, infection in immunocompromised patients eg candidiasis/ herpes
what are common causes of chronic oesophagitis (GORD)
inflammation from stomach acid: hiatus hernia, abnormal motility (Sphincters don’t work), pregnancy (rare)
what is allergic oesophagitis, how do you treat it
allergic response to food, eosinophillic, common with asthma. steroids and CysLt1
what can cause GORD (reflux disease)
incompetent LOS, barrier function, poor oesophageal clearance
what are the symptoms of GORD
heartburn (worse when lying down), regurgitation, odynophagia, coughing
what investigations would you do for GORD
endoscopy (OGD), Ba swallow, manometry, pH and nuclear studies
what are alarm symptoms of GORD
dysphagia, weight-loss, anaemia, vomiting, peptic ulcers, cancer, Barrett’s
what lifestyle advice would you give for someone with GORD
stop smoking, cut back alcohol, lose weight, prop up bed
what medications can be used for symptoms relief of GORD
antacids
name a H2 antagonist used for relief and one for preventing relapse
cimetide, ranitidine
name a PPI and what it is for
omeprazole, for healing and relief
what is Barrett’s oesophagus
replacement of stratified squamous epithelium to columnar epithelium (metaplasia). from persistent reflux
how can barrett’s progress to cancer
unstable cells can progress to adenocarcinoma
how does adenocarcinoma metastases
direct invasion –> lymphatic –> vascular
what are complications of GORD
ulceration/ bleeding, scarring and barretts
what cancers are more common in oesophagus benign or malignant
malignant
what is the most common benign cancers
squamous papilloma
name the 2 most common cancers and where they are found
adenocarcinoma, bottom part of oesophagus, squamous top 2/3rds
what are risk factors for adenocarcinoma
males, smoking + alcohol, obesity, low fruit + veg
what is the investigations for cancer
endoscopy, Ba swallow, CT for staging
what is the management for cancer
surgery or palliative
what is achalasia
oesophageal aperistalsis, impaired relaxation of sphincter
If Barrett’s and GORD can’t be treated with drugs what can you do next
surgery
what can be done to treat Barrett’s
optimise PPI, endoscopic mucosal resection, radio-frequency ablation
what is gastroparesis
delayed gastric emptying with no physical obstruction
what are the symptoms of gastroparesis
feeling full, nausea, vomiting weight loss, upper epigastric pain
what studies would you oo
gastric emptying studies
what management would you do for gastropareisis
liquid diet, eat little and often, gastric pacemaker, pro-motility agents
what is achalasia
reduced oesophagus motility, leading to dysphagia and regurge
how do you investigate achalasia
Ba swallow (birds beak), manometry and OGD
