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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
Q

How does the oesophagus appear in achalasia?

A

Dilated - Rats tail

26
Q

Symptoms of achalasia?

A 
Progressive dysphagia
Weight loss
Chest pain
Regurgitation
Chest infetion
27
Q

Treatment of achalsia

A

Calcium channel blockers and nitrates
Botulinum and Pneumatic balloon dilation
Radio - pneumatic balloon
Surgical - Myotomy

28
Q

What conditions are associated with achalasia?

A

Aspiration
Lung disease
Squamous carcinoma

29
Q

Symptoms of GORD

A 
ASYMPTOMATIC
Heartburn
Cough
Water brash
Sleep disturbance
30
Q

ERisk factors for GORD

A 
Pregnancy
Obesity
Drugs lowering LOS pressure
Smoking
Alcohol
Hypomotility
31
Q

When is endosocopy indicated?

A

Only if ALARM features of malignancy

32
Q

Complications of GORD

A

Ulceration
Stricture
Glandular metaplasia
Carcinoma

33
Q

Describe changes in Barrett’’s oesophagus

A

Prolonged acid exposure leads to intestinal metaplasia

Precursor to dyplasia –> adenocarcinoma

34
Q

Treatment of Barrett’s oesophagus

A

Endoscopic mucosal resection
Radiofrequency ablation
Oesophagectomy

35
Q

Treatment of GORD

A 
Lifestyle factors addressed
Alginates - Gaviscon
H2RA- Ranitidine
PPI- Omeprazole, Lanzoprazole
Anti reflux suregery - FUNDOPLICATION
36
Q

Types of tumour in oesophageal cancer

A

Squamous cell carcinoma

Adenocarcinoma

37
Q

Presentation of oesophageal cancer

A 
Progressive dysphagia
Weight loss
Anorexia
Odynophagia
Chest pain
Cough
Pneumonia
Tracheo oesophageal fistula
Vocal cord paralysis
Haematemesis
38
Q

Squamous cell carcinomas occur in which part of the oesophagus

A

Proximal and middle 1/3

39
Q

Where has the highest incidence of SCC in oesophagus?

A

Southern Africa
China
Iran

40
Q

What increases the risk of SCC of the oesophagus?

A

Smoking
Alcohol
Possibly vitamin deficiency

41
Q

Consequences of SCC in oesophagus

A

Achalasia
Caustic strictures
Plummer-Vinson syndrome

42
Q

Where in the oesophagus does adenocarcinoma occur?

A

Distal oesophagus

43
Q

What condition is associated with adenocarcinoma of the oesophagus?

A

Barrett’s

44
Q

Predisposing risk factors for adenocarcinoma of the oesophagus

A

Obesity
Male
Middle age
Caucasian

45
Q

Why is surgery limited in adenocarcinoma of the oesophagus>

A

No serosal layer leads to local invasion of the trachea, heart and aorta

46
Q

Where does adenocarcinoma of the oesophagus tend to metastasise?

A

Liver, brain, bones, lungs

47
Q

Prognosis of oesophageal cancer

A

5 year survival less than 10%

48
Q

Investigation of oesophageal cancer

A 
Endoscopy and biopsy
CT
EUS
PET scan
Bone scan
TNM
49
Q

Management of oesophageal cancer

A

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
Q

Palliative treatment of oesophageal cancer

A

Endoscopic stent/;aser/APC/PEG
Chemo and Radiotherapy
Brachytherapy

51
Q

What is eosinophilic oesophagitis?

A

Chronic immune/allergen mediated condition
Eosinophilic infiltration
Rings, furrows, white patches in mucosa
Fragile - scope can strip lining

52
Q

Treatment of eosinophilic oesophagitis

A

Topical/oral corticosteroids
Dietary elimination
Endoscopic dilatation if multiple strictures - be wary of iatrogenic damage

53
Q

Side effects of laparoscopic hiatus hernia repair and fundoplication

A 
Dysphagia
Difficulty to belch and vomit
Gas bloating
Excess flatulence
Diarrhoea
54
Q

Type of hiatus hernia leading to GORD

A

Sliding

Paraoesophageal

55
Q

Types of approach to oesophagectomy

A

Ivor Lewis
Transhiatal
Left thoraco abdominal

56
Q

Conduits used in oesophagectomy

A

Stomach

Colon

57
Q

Morbidity and mortality of oesphagectomy

A

20-30%

5% mortality

58
Q

Investigations for antireflux surgery

A

Endoscopy

Oesophageal pH and Manometry

59
Q

Side effects of laparoscopic hiatus hernia repair and fundoplication

A 
Dysphagia
Difficulty to belch and vomit
Gas bloating
Excess flatulence
Diarrhoea

GI (8 decks)

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