Oesophageal Disorders Flashcards
What is the most common symptom of oesophageal disease?
Heartburn
Where is heartburn felt?
Retrosternal chest pain
What is dysphagia?
Difficulty swallowing food or fluids
What is odynophagia?
Painful swallowing
What is important to ask about if a patient presents with dysphagia?
-The type of food or fluid which causes difficulty as this could provide an indication to the severity of the obstruction.
-The pattern, if it’s infrequent or progressive
-Associated features like weight loss, cough, regurgitation
What is the commonest cause of oesophageal dysphagia?
Benign stricture
What are some other causes of oesophageal dysphagia?
Malignant stricture
Motility disorders
Oeosinophilic oesophagitis
Extrinsic compression, like lung cancer
Which investigations are common in those with oesophageal disease?
OGD- Oesophago-Gastro-Duodenoscopy
Upper GI Endoscopy
Which type of imagining might be used in those with oesophageal disease?
Contrast imaging using a barium swallow
How can the pH of the stomach be measured?
Using pH-mentry
What does manometry measure?
The pressure waves of the oesophagus
What are the two subdivions of motility disorders?
Hypermotility
Hypomotility
In those with hypermotility, if they did a barium swallow, what would the oesophagus look like?
Corkscrew appearance
What is the presentation of hypermotility oesophageal disorder?
Severe chest pain +/- dysphagia
Can often be mistaken for angina
What would manometry show in those with hypermotility oesophageal disorder?
Exaggerated, uncoordinated, hypertonic contractions
What is the treatment for hypermotility oesophageal disorders?
Smooth muscle relaxants like calcium channel blockers or nitrates
Name a common important hypomotility disorder.
Achalasia
What are the symptoms of achalasia?
Progressive dysphagia for solids and liquids
Chest pain
Weight loss
Regurgitation
Chest infections
What are some of the pharmalogical treatments for achalasia?
Nitrates
Calcium channel blockers
What are some of the endoscopic treatments for achalasia?
Botox
Pneumatic balloon dilation
What is one surgical treatment for achalasia?
Myotomy- affected muscle is cut to allow better passage of solids and liquids from the oesophagus to the stomach
What are some of the long term complications of untreated achalasia?
Aspiration pneumonia and lung disease
Increased risk of squamous cell oesophageal carcinoma
What is the most common oesophageal disease?
Gastro-Oesophageal Reflux Disease
What causes GORD?
Acid and bile exposure to the lower oesophagus from the stomach
What are some of the symptoms for GORD?
Heartburn
Waterbrash (too much saliva so combines w stomach acid and backs up into throat)
Cough
Sleep disturbance
What are some of the risk factors for GORD?
Pregnancy
Obesity
Drugs lowering LOS pressure
Smoking
Alcoholism
Hypomotility
Who are most likely to be affected by GORD>?
Men> women
Caucasian > Black > Asian
Why is endoscopy a poor diagnostic test for GORD?
Patient often has no oesophageal abnormality
When would an endoscopy be performed in someone with GORD?
When alarm symptoms are present e.g. weight loss, dysphagia, vomiting).
Which other problem can cause GORD?
Hiatus hernia
What are the two types of hiatus hernia?
Sliding
Para-oesophageal
What happens in a hiatus hernia?
Fundus of stomach moves proximally through the diaphragmatic hiatus.
What are some of the complications of GORD?
Ulceration
Stricture
Carcinoma
Barrett’s oesophagus- glandular metaplasia
Describe what happens in Barrett’s oesophagus.
Squamous epithelium changes to mucus-secreting columnar epithelium in the lower oesophagus in response to acid exposure.
What is Barrett’s oesophagus a precursor for?
Dysplasia/adenocarcinoma
What are some possible treatments for Barrett’s oesophagus?
Endoscopic mucosal resection
Radio-Frequency Ablatic
Rarely but sometimes oesophagectomy
Which drug is the main drug used to help treat GORD after dealing with any lifestyle changes?
Proton pump inhibitors.
What are the two types of oesophageal cancer?
Squamous cell
Adenocarcinoma
What is the presentation for oesophageal cancer?
Progressive dysphagia
Anorexia and weight loss
Odynophagia
Chest pain
Cough
Pneumonia
Vocal cord paralysis
Haematemesis
Describe a squamous cell carcinoma.
Often large exophytic, occluding tumours
Where in the oesophagus would a squamous cell carcinoma occur?
First 2/3 of oesophagus
What are two significant risk factors for an oesophageal squamous cell carcinoma?
Smoking and alcohol
Where in the oesophagus would an adenocarcinoma occur?
Distal end, last 1/3
What are some predisposing factors for an oesophageal adenocarcinoma?
Male
Obesity
Middle aged
Caucasian
Which condition is an oesophageal carcinoma associated with?
Barrett’s oesophagus
Which investigation helps to diagnose oesophageal cancer?
Endoscopy
Which investigations can be useful in the staging of oesophageal cancer?
CT scan
PET scan
Bone scan
Endoscopic ultrasound
What is the only potential cure for oesophageal cancer?
Oesophagectomy +/- chemotherapy
Which patients can get an oesophagectomy?
Those <70 with localised disease
As most patients with oesophageal cancer present late, what treatment can be offered?
Palliative treatment
In those with incurable oesophageal cancer, what is the main priority?
To get rid of the dysphagia
How can patients w incurable oesophageal cancer be treated of their dysphagia?
Endoscopic insertion of stent
Name the condition-
Chronic immune/allergy related condition
Affects children and young adults more
Incidence and prevelance are increasing
Symptoms of oesophageal dysfunction
Eosinophillic Oesophagitis
What’s the presentation of Eosinophillic Oesophagitis?
Dysphagia and food bolus obstruction
What is the treatment for Eosinophillic Oesophagitis?
Topical/swallowed costisteroids
Dietary elimination
Endoscopic dilatation
