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4th year passmedicine by topic > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

Gastro-oesophageal reflux disease (GORD) may be defined as

A

symptoms of oesophagitis secondary to refluxed gastric contents

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2
Q

NICE recommend that GORD which has not been investigated with endoscopy should be treated as per the dyspepsia guidelines

A

true

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3
Q

GORD - poor correlation between symptoms and endoscopy appearance

A

true

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4
Q

Indications for upper GI endoscopy >45 years is an indication

A

FALSE

>55 years

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5
Q

Indications for upper GI endoscopy:

A 
age > 55 years
symptoms > 4 weeks or persistent symptoms despite treatment
dysphagia
relapsing symptoms
weight loss
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6
Q

GORD If endoscopy is negative consider

A

24-hr oesophageal pH monitoring

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7
Q

GORD gold standard test for diagnosis?

A

24-hr oesophageal pH monitoring

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8
Q

Management of Endoscopically proven oesophagitis

A

full dose proton pump inhibitor (PPI) for 1-2 months
if response then low dose treatment as required
if no response then double-dose PPI for 1 month

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9
Q

Management of Endoscopically negative reflux disease

A

full dose PPI for 1 month

if response then offer low dose treatment, possibly on an as-required basis, with a limited number of repeat prescriptions

if no response then H2RA or prokinetic for one month

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10
Q

H2 RA examoles?

A

Ranitidine

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11
Q

Complications of GORD include?

A 
oesophagitis
ulcers
anaemia
benign strictures
Barrett's oesophagus
oesophageal carcinoma
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12
Q

Barrett’s refers to the hyperplasia of the lower oesophageal mucosa

A

false

metaplasia

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13
Q

Barrett’s usual squamous epithelium being replaced by columnar epithelium

A

true

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14
Q

Barrett’s increased risk of oesophageal adenocarcinoma, estimated at 50-100 fold

A

true

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15
Q

Barrett’s can be subdivided into short (<3cm) and long (>3cm). The length of the affected segment correlates strongly with the chances of identifying metaplasia

A

true

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16
Q

Barrets seen in 12% of those undergoing endoscopy for reflux.

A

true

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17
Q

Barrets Histological features

A

the columnar epithelium may resemble that of either the cardiac region of the stomach or that of the small intestine (e.g. with goblet cells, brush border)

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18
Q

Barretts risk factors

A

gastro-oesophageal reflux disease (GORD) is the single strongest risk factor
male gender (7:1 ratio)
smoking
central obesity

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19
Q

alcohol does not seem to be an independent risk factor for Barrett’s

A

true

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20
Q

Barretts mx

A

endoscopic surveillance with biopsies

high-dose proton pump inhibitor - evidence base that this reduces the change of progression to dysplasia or induces regression of the lesion is limited

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21
Q

Endoscopic surveillance in barretts is for patients with ? endoscopy is recommended every ? years

A

for patients with metaplasia (but not dysplasia) endoscopy is recommended every 3-5 years

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22
Q

Barretts If dysplasia of any grade is identified what is offered.

A

If dysplasia of any grade is identified endoscopic intervention is offered.
endoscopic mucosal resection
radiofrequency ablation

23
Q

Achalasia is

A

Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter (LOS) due to degenerative loss of ganglia from Auerbach’s plexus i.e. LOS contracted, oesophagus above dilated

24
Q

Achalasia typically presents in

A

middle-age and is equally common in men and women.

25
Q

Achalasia symptoms

A

dysphagia of BOTH liquids and solids
typically variation in severity of symptoms
heartburn
regurgitation of food
may lead to cough, aspiration pneumonia etc

26
Q

Achalasia malignant change in small number of patients

A

true

27
Q

Achalasia ix oesophageal manometry shows?

A

excessive LOS tone which doesn’t relax on swallowing

28
Q

Achalasia ix barium swallow shows?

A

shows grossly expanded oesophagus, fluid level

‘bird’s beak’ appearance

29
Q

Achalasia ix chest x-ray shows?

A

wide mediastinum

fluid level

30
Q

What si considered the most important diagnostic test in achalasia?

A

oesophageal manometry

31
Q

Achalasia mx recurrent or persistent symptoms?

A

surgical intervention with a Heller cardiomyotomy

32
Q

Achalasia mx first-line option

A

pneumatic (balloon) dilation

33
Q

Achalasia mx high surgical risk

A

intra-sphincteric injection of botulinum toxin

34
Q

most common type of oesophageal cancer

A

Adenocarcinoma in UK/US

squamous cell most common in developing world

35
Q

The majority of adenocarcinomas are located near

A

gastroesophageal junction

36
Q

squamous cell tumours are most commonly found

A

in the upper two-thirds of the oesophagus.

37
Q

Risk factors Adenocarcinoma

A 
GORD
Barrett's oesophagus
smoking
achalasia
obesity
38
Q

Risk factors Squamous cell cancer

A 
smoking
alcohol
achalasia
Plummer-Vinson syndrome
diets rich in nitrosamines
39
Q

Oesophageal cancer - Features

A

dysphagia: the most common presenting symptom
anorexia and weight loss
vomiting
other possible features include: odynophagia, hoarseness, melaena, cough

40
Q

Oesophageal cancer - diagnosis

first line test

A

Upper GI endoscopy

41
Q

Oesophageal cancer - diagnosis

Staging

A

CT scanning of the chest, abdomen and pelvis.

If CT does not show metastatic disease, then local stage may be more accurately assessed by use of endoscopic ultrasound

Staging laparoscopy is performed to detect occult peritoneal disease. PET CT is performed in those with negative laparoscopy.

42
Q

Oesophageal cancer - treatment

A

surgical resection- vor- Lewis type oesophagectomy

In addition to surgical resection many patients will be treated with adjuvant chemotherapy.

43
Q

Oesophageal cancer - biggest surgical challenge

A

anastomotic leak, with an intrathoracic anastomosis this will result in mediastinitis. With high mortality

44
Q

Upper gastrointestinal bleeding - most likely diagnosis?
Small volume of fresh blood, often streaking vomit. Malaena rare. Often ceases spontaneously. Usually history of antecedent GORD type symptoms.

A

Oesophagitis

45
Q

Upper gastrointestinal bleeding - most likely diagnosis?

small volume of blood, symptoms of dysphagia and constitutional symptoms

A

Cancer

46
Q

Upper gastrointestinal bleeding - most likely diagnosis?
Typically brisk small to moderate volume of bright red blood following bout of repeated vomiting. Malaena rare. Usually ceases spontaneously.

A

Mallory Weiss Tear

47
Q

Upper gastrointestinal bleeding - most likely diagnosis?
Usually large volume of fresh blood. Swallowed blood may cause malaena. Often associated with haemodynamic compromise. May stop spontaneously but re-bleeds are common until appropriately managed.

A

Varices

48
Q

history of HIV or other risk factors such as steroid inhaler use suggests

A

Oesophageal candidiasis

49
Q

posteromedial herniation between thyropharyngeus and cricopharyngeus muscles is

A

Pharyngeal pouch

50
Q

Pharyngeal pouch sx

A

dysphagia, regurgitation, aspiration and chronic cough. Halitosis may occasionally be seen
large then a midline lump in the neck that gurgles on palpation

51
Q

Globus hystericus features

A

history of anxiety
Symptoms are often intermittent and relieved by swallowing
Usually painless

52
Q

Dysphagia ix

A

upper GI endoscopy
Motility disorders may be best appreciated by undertaking fluoroscopic swallowing studies.

A full blood count should be performed.

Ambulatory oesophageal pH and manometry studies will be required to evaluate conditions such as achalasia and patients with GORD being considered for fundoplication surgery.

53
Q

Neurological dysphagia causes

A 
CVA
Parkinson's disease
Multiple Sclerosis
Brainstem pathology
Myasthenia Gravis

4th year passmedicine by topic (96 decks)

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