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GI > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

What spinal level does the oesophagus run along?

A

C6 to T11-12

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2
Q

Which type of muscle is present in the oesophagus?

A

Striated in upper 3-4cm

Smooth

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3
Q

Which tye of epithelium lines the oesophagus?

A

Stratified squamous epithelium

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4
Q

Function of the lower Oesophageal sphincter

A

Physiological sphincter
High resting pressure in distal smooth muscle
Striated muscle of right crus of diaphragm
Mucosal rosette formaed by acute angle at Gastro Oesophageal Junction

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5
Q

Symptoms of oesophageal disease

A

Heartburn

Dysphagia

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6
Q

What symptoms may accompany heartburn?

A

Waterbrash

Cough

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7
Q

Causes of heartburn

A

Reflux of acidic/bilious gastric contents

Drugs and foods can lower the LOS pressure causing increased reflux

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8
Q

Which drugs and food can increase reflux?

A

Alcohol
Nicotine
Dietary xanthines (coffee, tea, chocolate)

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9
Q

Persistent reflux can lead to which disease?

A

GastroOesophageal Reflux Disease

GORD

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10
Q

Term for pain with swallowing

A

Odynophagia

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11
Q

What should be asked about in a history of dysphagia?

A

Type of food (solid or liquid)
Pattern (progressive, intermittent)
Associated features - weight loss, regurgitation, cough
Location - oesophageal or oropharyngeal

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12
Q

Causes of dysphagia

A 
Benign stricture
Malignant stricture
Motility disorder - alchalasia, presbyoesophagus
Eosinophilic oesophagitis
Extrinsic compression
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13
Q

Invesitgations of oesophageal symptoms

A

Oesophago Gastro Duodenoscopy (OGD)
Upper GI Endoscopy

Endoscopy
Contrast radiology
Opesophageal pH and manometry

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14
Q

Describe the investigations of oesophageal pH and manometry

A

Nasogastric tube or catheter containing multiple pressure and pH sensors is inserted into oesophagus
Probes at UOS and LOS

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15
Q

Manometry is used to investigate..?

A

Dysphagia
Motility
Sphincter tonicity

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16
Q

pH studies are used to investigate…

A

Refractory heartburn

Reflux

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17
Q

2 types of oesophageal motility disorders

A

Hypermotility

Hypomotility

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18
Q

Hypermotility in the oesophagus gives rise to what kind of symptoms

A

Diffuse oesophageal spasm
Severe episodic chest pain
Dysphagia

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19
Q

What sign is present on Barium swallow in hypermotility of the oesophagus?

A

Corkscrew appearance

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20
Q

Which condition can oesophageal hypermotility mimic?

A

Angina

MI

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21
Q

What are the findings on manometry in hypermotility of the oesophagus?

A

Exaggerated, uncoordinated, hypertonic contractions

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22
Q

Treatment of oesophageal hypermotility

A

Relaxants - Nitrates

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23
Q

Hypomotility of the oesophagus is associated with what other conditions?

A

Connective tissue diseases
SLE
Diabetes
Neuropathy

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24
Q

Why does the LOS fail to relax in achalasia?

A

Inhibitory neurons of the myenteric plexus have degenerated

Leads to a function distal obstruction of the oesophagus

25
How does the oesophagus appear in achalasia?
Dilated - Rats tail
26
Symptoms of achalasia?
``` Progressive dysphagia Weight loss Chest pain Regurgitation Chest infetion ```
27
Treatment of achalsia
Calcium channel blockers and nitrates Botulinum and Pneumatic balloon dilation Radio - pneumatic balloon Surgical - Myotomy
28
What conditions are associated with achalasia?
Aspiration Lung disease Squamous carcinoma
29
Symptoms of GORD
``` ASYMPTOMATIC Heartburn Cough Water brash Sleep disturbance ```
30
ERisk factors for GORD
``` Pregnancy Obesity Drugs lowering LOS pressure Smoking Alcohol Hypomotility ```
31
When is endosocopy indicated?
Only if ALARM features of malignancy
32
Complications of GORD
Ulceration Stricture Glandular metaplasia Carcinoma
33
Describe changes in Barrett''s oesophagus
Prolonged acid exposure leads to intestinal metaplasia | Precursor to dyplasia --> adenocarcinoma
34
Treatment of Barrett's oesophagus
Endoscopic mucosal resection Radiofrequency ablation Oesophagectomy
35
Treatment of GORD
``` Lifestyle factors addressed Alginates - Gaviscon H2RA- Ranitidine PPI- Omeprazole, Lanzoprazole Anti reflux suregery - FUNDOPLICATION ```
36
Types of tumour in oesophageal cancer
Squamous cell carcinoma | Adenocarcinoma
37
Presentation of oesophageal cancer
``` Progressive dysphagia Weight loss Anorexia Odynophagia Chest pain Cough Pneumonia Tracheo oesophageal fistula Vocal cord paralysis Haematemesis ```
38
Squamous cell carcinomas occur in which part of the oesophagus
Proximal and middle 1/3
39
Where has the highest incidence of SCC in oesophagus?
Southern Africa China Iran
40
What increases the risk of SCC of the oesophagus?
Smoking Alcohol Possibly vitamin deficiency
41
Consequences of SCC in oesophagus
Achalasia Caustic strictures Plummer-Vinson syndrome
42
Where in the oesophagus does adenocarcinoma occur?
Distal oesophagus
43
What condition is associated with adenocarcinoma of the oesophagus?
Barrett's
44
Predisposing risk factors for adenocarcinoma of the oesophagus
Obesity Male Middle age Caucasian
45
Why is surgery limited in adenocarcinoma of the oesophagus>
No serosal layer leads to local invasion of the trachea, heart and aorta
46
Where does adenocarcinoma of the oesophagus tend to metastasise?
Liver, brain, bones, lungs
47
Prognosis of oesophageal cancer
5 year survival less than 10%
48
Investigation of oesophageal cancer
``` Endoscopy and biopsy CT EUS PET scan Bone scan TNM ```
49
Management of oesophageal cancer
Surgical oesophagectomy - adjuvant or neoadjuvant chemo Only in localised disease, no comorbidities and less than 70 years of age Long recovery and nutritional support needed
50
Palliative treatment of oesophageal cancer
Endoscopic stent/;aser/APC/PEG Chemo and Radiotherapy Brachytherapy
51
What is eosinophilic oesophagitis?
Chronic immune/allergen mediated condition Eosinophilic infiltration Rings, furrows, white patches in mucosa Fragile - scope can strip lining
52
Treatment of eosinophilic oesophagitis
Topical/oral corticosteroids Dietary elimination Endoscopic dilatation if multiple strictures - be wary of iatrogenic damage
53
Side effects of laparoscopic hiatus hernia repair and fundoplication
``` Dysphagia Difficulty to belch and vomit Gas bloating Excess flatulence Diarrhoea ```
54
Type of hiatus hernia leading to GORD
Sliding | Paraoesophageal
55
Types of approach to oesophagectomy
Ivor Lewis Transhiatal Left thoraco abdominal
56
Conduits used in oesophagectomy
Stomach | Colon
57
Morbidity and mortality of oesphagectomy
20-30% | 5% mortality
58
Investigations for antireflux surgery
Endoscopy | Oesophageal pH and Manometry
59
Side effects of laparoscopic hiatus hernia repair and fundoplication
``` Dysphagia Difficulty to belch and vomit Gas bloating Excess flatulence Diarrhoea ```

GI (8 decks)

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