Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Second Year Systems > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

What are the properties of low oesophageal sphincter?

3

A

High resting pressure in smooth muscle
Striated muscle of right crus of diagram
Mucosal rosette formed by acute angle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are symptoms of oesophageal disease?

A

Heartburn

Dysphagia

Odynophagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is heartburn

A

Retrosternal discomfort/burning
Due to reflux of acid/gastric contents into oesophagus

persistent relfux->GORD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is dysphagia

Location?

What do we need to enquire?

A

Difficulty swallowing
Enquiries:
-Type of food
-Pattern
-Associated features
Location:
Oropharyngeal/Oesophageal

Odynophagia- pain with swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the causes of oesophageal dysphagia?

A

-benign stricture
- malignant stricture (oesophageal cancer)
- motility disorders (eg achalasia, presbyoesophagus)
- eosinophilic oesophagitis
- extrinsic compression (eg in lung cancer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are investigations for oesophageal disease?

A
  • Oesophago-Gastro-Duodenoscopy (OGD)
  • Upper GI Endoscopy (UGIE)

Contrast radiology - barium swallow

Oesophageal pH and manometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When is endoscopy used in oesophageal disease?

A

In oesophageal disease used in investigation of dysphagia or reflux symptoms with alarm features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is manometry used for?

A

Used in investigation of dysphagia / suspected motility disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does manometry measure?

A

-assesses sphincter tonicity, relaxation of sphincters and oesophageal motility.
checks if oesophagus contracting and relaxing properly

pH studies – used in investigation of refractory heartburn/reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the motility disorders of the oesophagus?

A

Hypermotility

Hypomotility

Achalasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What portion of motility is controlled by the vagus nerve?

A

Contraction in the oesophageal body and relaxation of the LOS is mediated by the vagus nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the appearace of hypermotility on a barium swallow?

A

Corckscrew appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is hypermotility often confused with and why?

A

Angina/MI becaue of episodic chest pain (with or without dysphagia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is hypomotility associated with?

A

Associated with connective tissue disease,

diabetes, neuropathy

Causes failure of the LOS and therefore causes reflux symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What causes achalasia?

A

Functional loss of myenteric plexus ganglion cells in distal oesophagus and LOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is teh cardinal feature of achalasia?

A

failure of LOS to relax and therefore distal obstruction of the oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are symptoms of achalasia?

A
  • progressive dysphagia for solids and liquids
  • weight loss
  • Chest pain (30%)
  • Regurgitation and chest infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the treatment for achalasia?

A

Pharmacological - Nitrates,

Calcium Channel blockers

Endoscopic - Botulinum Toxin

Pneumatic balloon dilation

Radiological - Pneumatic balloon

dilation

Surgical - Myotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the complications of achalasia?

A

Aspiration pneumonia and lung disease

nIncreased risk of squamous cell oesophageal carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What causes GORD?

A

Presence of acid and bile exposure in the lower oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the symptoms of GORD?

A

Many may not experience any symptoms at all

Symptoms include: heartburn, cough, water brash, sleep disturbance

Waterbrash: a sudden flow of saliva associated with indigestion.

22
Q

What are the risk factors for GORD?

A

Pregnancy, obesity, drugs lowering LOS pressure (alcohol, nicotine, dietary xanthines), smoking, alcoholism, hypomotility

23
Q

Why is endoscopy a poor test for GORD?

A

Most patients (>50%) with reflux symptoms have no visible evidence of oesophageal abnormality when endoscopy is performed

24
Q

When must endoscopy be performed for GORD?

A

In the presence of alarm features eg dysphagia, weight loss, vomiting

25
Q

What are the aetiologies of GORD with normal anatomy?

A

–­ Increasing Transient relaxations of the LOS

–Hypotensive LOS

–Delayed gastric emptying

–Delayed oesophageal emptying

– Decreased Oesophageal acid clearance

– Decreased Tissue resistance to acid/bile

26
Q

What are the 2 main types of hiatus hernia?

A

Sliding and para-oesophageal

27
Q

What part of the stomach moves proximally through the diaphtragmatic hiatus?

A

Fundus

28
Q

What are two risk factors for hiatus hernia?

A

Age and obesity

29
Q

What is the mucosa exposed to in GORD?

A

Acid-pepsin and bile

30
Q

What are the complications associated with GORD?

A

Ulceration (5%)

Stricture (8-15%)

Glandular metaplasia (Barrett’s oesophagus)

Carcinoma

31
Q

What is the change in epithelium in barrett’s oesophagus?

A

Change from squamous to mucin-secreting columnar (ie gastric type) epithelial cells in lower oesophagus

32
Q

What is barretts oesophagus the precursor for?

A

Precursor to dysplasia/ adenocarcinoma

Dysplasia: Abnormal cells in a tissue which may signify a stage preceding the development of cancer.

33
Q

What is treatment for Barretts oesphagus?

A

–Endoscopic Mucosal Resection (EMR)

–Radio-Frequency Ablation (RFA)

–Oesophagectomy rarely (mortality ~10%)

34
Q

Without alarm features what is the treatment of GORD?

A
  1. Lifestyle measures
  2. Pharmacological

Alginates (Gaviscon)

H2RA (Ranitidine)

Proton Pump Inhibitor (e.g. Omeprazole, Lansoprazole)

For refractory disease following investigation

Anti-reflux surgery (fundoplication)

35
Q

What is the incidence of benign tumours?

A

They are rare

36
Q

What are the two common types of oesphageal cancer?

A

Squamous Cell Carcinoma

Adenocarcinoma

37
Q

What is the prevalence of adenocarcinoma and squamous cell carcinoma in Western europe / USA?

A

Western Europe/USA Adenocarcinoma > Squamous

Rest of World Squamous >> Adenocarcinoma

38
Q

What is the presentation of oesophageal cancer?

A

Progressive dysphagia (90%)

Anorexia and Weight loss (75%)

Odynophagia

Chest pain

Cough

Pneumonia (tracheo-oesophageal fistula)

Vocal cord paralysis

Haematemesis

39
Q

Where does squamous normally occur in the oespohagus?

A

In the proximal and middle third of the oesophagus

40
Q

What are the risk factors for squamous cell carcinoma?

A

High incidence in Southern Africa, China, Iran

Tobacco and alcohol significant risk factors

Diet related (vitamin deficiency)

Associated with Achalasia, Caustic strictures, Plummer-Vinson Syndrome

41
Q

Where does adenocarcinoma often occur in the oesophagus?

A

Occurs in distal oesophagus

42
Q

What are risk factors for adenocarcinoma?

A

Associated with Barrett’s oesophagus (progresses through dysplasia to cancer)

Predisposing factors: obesity, male sex, middle age, caucasian

43
Q
A
44
Q

Where do oesophageal cancers often spread?

A

To regional lymph nodes and or liver at

No peritoneal (serosal) lining in mediastinum – local invasion (heart, trachea, aorta) often limits surgery

Metastases - Hepatic, brain, pulmonary, bone

45
Q

Why does tumour invasion into adjacent structures occur more easily in the oesophagus?

A

Oesophagus lacks a serous layer

46
Q

Why does lymph node involvement occur early in oesophageal tumours?

A

Oespohagus lymphatic vessels are mucosal (lamina propria)

Vs

Rest of the GIT lymphatic vessels are mainly submucosal

47
Q

How do we diagnose oesphageal cancer?

A
48
Q

How do we stage oesphageal cancer?

A

–CT Scan

–Endoscopic ultrasound

–PET Scan

–Bone Scan

Disease stagin by TNM classification

49
Q

TNM classification

A

TNM staging

T1- Tumor invades lamina propria or submucosa
(a-lamina propria, b-submucosa)
T2- Tumor invades muscularis propria
T3- Tumor invades adventitia
T4- Tumor invades adjacent structures
N1- Regional lymph node metastasis
M1- Distant metastasis

Stage I- T1N0M0
Stage IIa- T2T3/N0M0
Stage IIb- T1T2/N1M0
Stage III- T3N1M0, T4, any N, M0
Stage IV- M1

50
Q

What is treatment for oesophageal cancer?

A

Only potential cure is surgical oesophagectomy +/- adjuvant (after) or neoadjuvant (before) chemotherapy

Limited to patients with localised disease, without co-morbid disease, usually <70 years of age

Significant morbidity and mortality assoc with oesophagectomy (mortality ~ 10%)

Long post operative recovery

Require nutritional support

Combined chemo and radiotherapy now offer some prospect of improved long-term survival (ie > 1year) in patients with locally advanced inoperable disease - ? may ultimately offer non-surgical “cure”

51
Q

What is treatment for incurable disease? (most have incurable disease at presentation)

A

Symptom pallation (dysphagia) is often overriding priority

OPTIONS:

Endoscopic

(stent, laser/APC, PEG)

Chemotherapy

Radiotherapy

Brachytherapy

Second Year Systems (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions