oesophageal disorders Flashcards
spinal level that oesophagus begins
C6 (level of cricoid cartilage)
spinal level oesophagus ends
T11-12
heartburn as a symptom
retrosternal discomfort/burning
may be assoc w waterbrash, cough
consequence of reflux of acidic and/or billious gastric contents
dysphagia
subjective sensation of difficulty in swallowing foods and/or liquids
causes of oesophageal dysphagia
benign stricture malignant stricture motility disorders e.g. achalasia eosinophilic oesophagitis extrinsic compression e.g. lung Ca
motility disorders: hypermotility
e.g. diffuse oesophageal spasl
corkscrew appearance on Ba swallow
severe epidsodic chest pain +/- dysphagia
exaggerated, uncoordinated, hypertonic contractions
management of hypermotility
smooth muscle relaxants
motility disorders: hypomotility
assoc with CTD, diabetes, neuropathy
causes failure of LOS leading to heartburn and reflux
achalasia
functional loss of myenteric plexus ganglion cells in distal oesophagus and LOS
failure of LOS to relax –> functional distal obstruction of oesophagus
achalasia symptoms
progressive dysphagia weight loss chest pain regurgitation chest infection
treatment of achalasia
nitrites, CCB
botox
pneumatic balloon dilation
myotomy
complications of achalasia
aspirtation pneumonia
lung disease
inc risk of squamous cell oesophageal cancer
GORD
due to pathological acid (and bile) exposure in lower oesophagus
GORD symptoms
heartburn
cough
waterbrash
sleep disturbance
GORD risk factors
pregnancy obesity drugs lowering LOS pressure smoking alcoholism hypomitility
when is endoscopy performed in GORD
prescence of ‘alarm features’
- dysphagia
- weight loss
- vomiting
GORD aetiology: normal anatomy
- inc transient relaxation LOS
- hypotensive LOS
- delayed gastric emptying
- delayed oesophageal emptying
- dec oesphageal acid clearance
- dec tissue resistance to acid/bile
GORD aetiolgy: abnormal anatomy
Hiatus hernia
anatomical distortion of the OG junction
hiatus hernia
2 types: sliding and para-oesophageal
fundus of stomach moves proximally through diaphragmatic hiatus
GORD pathophysiology
mucosa exposed to acid-pepsin and bile
inc cell loss and regenerative activity (inflammation)
erosive oesophagitis
GORD complications
ulceration
stricture
glandular metaplasia - Barrett’s oesophagus
-carcinoma
Barrett’s oesophagus
inestinal metaplasia related to prolonged acid exposure in distal oesophagua
change from squamous to mucin secreting columnar epithelium
precursor to dysplasia/adenocarcinoma
pharmacological treatment of GORD
alginates (gaviscon)
H2RA (ranitidine)
proton pump inhibitor (omepazole)
surgical treatment GORD
fundoplication
oesophageal cancer types
squamous cell carcinoma
adenocarcinoma
oesophageal cancer presentation
progressive dysphagia weight loss odynophagia chest pain cough pneunonia vocal cord paralysis haematemesis
squamous cell carcinoma
occur in proximal and middle third of oesophagus
tobacco and alcohol as risk factors
adenocarcinoma
occurs in distal oesophagus
barrett’s oesophagus, obesity, male
oesphageal cancer diagnosing it
endoscopy and biopsy
oesophageal Ca - staging investigations
CT
endoscopic USS
PET Scan
bone scan
oesophageal Ca treatment
oesophagectomy +/- adjuvant/neoadjuvant chemotherapy
eosinophilic eospaphagitis
chronic immune/allergen-mediated condition
oespphageal dysfunction and eosinophilic infiltration of the oesophageal epithelium
eosinophilic oesophagitis presentation
dysphagia
food bolus obstruction
eosinophilic oesophagitis treatment
topical/oral steroids
dietary elimination
endoscopic dilatation
