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The Alimentary Canal > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

Where does oesophagus start and end?

A

Begins at lower level of cricoid cartridge (C6) and terminates at T11-12 where enters stomach

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2
Q

Explain the structure of the oesophagus?

A

Upper 3-4cm is straited muscle then rest is smooth muscle
Stratified squamous epithelial lining

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3
Q

What is the function of the oesophagus?

A

Transport of food/liquid from mouth to stomach - active

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4
Q

Describe physiology of the oesophagus

A

Peristalsis produced by circular muscles and propels materials distally
Coordinates lower oesophageal sphincter relaxation

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5
Q

What is contraction of peristalsis and relaxation of LOS caused by?

A

Mediated by vagus nerve

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6
Q

Describe the lower oesophageal sphincter

A

High resting pressure in distal smooth muscle
Straited muscle of right crus of diaphragm
Mucosal Rosette formed by acute angle at GOJ

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7
Q

Describe heartburn

A

Retrosternal discomfort or burning
Can be associated with waterbrash and cough

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8
Q

What is waterbrash?

A

Acidic taste at back of throat

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9
Q

What is heartburn a consequence of?

A

Reflux of acidic and/or bilious gastric contents into the oesophagus

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10
Q

What can reduce the LOS pressure resulting in heartburn?

A

Certain drugs and foods - alcohol, nicotine and dietary xanthine

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11
Q

What can persistent reflux and heartburn lead to?

A

Gastro-oesophageal reflux disease (GORD) which can lead to long term complications

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12
Q

What is dysphagia?

A

Subjective sensation of difficulty in swallowing foods and/or liquids
Location can be oropharyngeal or oesophageal

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13
Q

What is odynophagia?

A

Pain when swallowing

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14
Q

What are some causes of oesophageal dysphagia?

A

Benign stricture
Malignant stricture
Motility disorders
Eosinophilic oesophagitis
Extrinsic compression

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15
Q

What are 2 types of endoscopy?

A

Oesophageal Gastro-duodenoscopy (OGD)
Upper GI Endoscopy (UGIE)

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16
Q

What are the investigations used for oesophageal diseases?

A

Endoscopy
Contrast radiology - barium swallow
Oesophageal physiology - pH metry and manometry

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17
Q

What is a manometry?

A

Measurement of pressure waves within oesophagus - catheter senses and passed down nose

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18
Q

What is an example of a hypermotility disorder?

A

Diffuse oesophageal spasm

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19
Q

How can you diagnose diffuse oesophageal spasm?

A

Corkscrew appearance on barium swallow
Manometry shows exaggerated and uncoordinated hypertonic contractions

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20
Q

What are the symptoms of diffuse oesophageal spasm?

A

Severe episodic chest pain with dysphagia

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21
Q

What is the cause of diffuse oesophageal spasm?

A

Cause is unclear

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22
Q

What is the treatment for hypermotility disorders?

A

Smooth muscle relaxants

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23
Q

What is hypomotility associated with?

A

Connective tissue disease, diabetes and neuropathy

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24
Q

What does hypomotility cause?

A

Failure of LOS mechanism leading to heartburn and reflux symptoms

25
Q

What is achalasia?

A

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

26
Q

What is the cardinal feature of achalasia?

A

Failure of LOS to relax
Resulting in functional distal obstruction of oesophagus

27
Q

What are the symptoms of achalasia?

A

Progressive dysphagia
Weight loss
Chest pain
Regurgitation and chest infection

28
Q

What is the treatment for achalasia?

A

Pharmacological - nitrates, CCB
Botulinum toxin pneumonic balloon dilation
Myotomy

29
Q

What are the complications of achalasia?

A

Aspiration pneumonia and lung disease
Increased risk of squamous cell oesophageal carcinoma

30
Q

What is gastro-oesophageal reflux disease due to?

A

Pathological acid and bile exposure in lower oesophagus

31
Q

What are the symptoms of gastro-oesophageal reflux disease?

A

Heartburn, cough, water brash and sleep distrubance

32
Q

What are the risk factors for gastro-oesophageal reflux disease?

A

Pregnancy, obesity, drug lowering LOS pressure, smoking, alcoholism and hypomotility

33
Q

How can gastro-oesophageal reflux disease be diagnosed?

A

Can be diagnosed on the basis f characteristic symptoms without diagnostic testing
Most patients have no visible evidence of oesophageal abnormality on endoscopy

34
Q

Explain GORD without abnormal anatomy

A

Increased transient relaxations of the LOS
Hypotensive LOS
Delayed gastric emptying and oesophageal emptying
Decreased acid clearance
Decreased tissue resistance to acid/bile

35
Q

Explain GORD due to hiatus hernia

A

Anatomical distortion of the OG junction

36
Q

What are the 2 main types of hiatus hernia?

A

Sliding and para-oesophageal

37
Q

Explain a hiatus hernia

A

Fundus of the stomach moves proximally through diaphragmatic hiatus
Obesity and ageing predispose
Para-oesophageal is more dangerous

38
Q

Explain the pathophysiology of GORD

A

Mucosa exposed to acid-pepsin and bile
Increased cell loss and regenerative activity - inflammation
Erosive oesophagitis

39
Q

What are some complications of GORD?

A

Ulceration
Stricture
Glandular metaplasia - Barrett’s oesophagus
Carcinoma

40
Q

Explain Barrett’s Oesophagus

A

Intestinal metaplasia related to prolonged acid exposure in distal oesophagus
Change from squamous to mucin secreting columnar epithelial cells in lower oesophagus
Precursor to adenocarcinoma

41
Q

What is the treatment for Barrett’s Oesophagus?

A

Endoscopic Mucosal Resection
Radio-frequency ablation
Oesophagectomy rarely

42
Q

What is the treatment for GORD?

A

Lifestyle measures
Pharmacological
Anti-reflux surgery - fundoplication (stomach wrapped around oesophagus to strengthen)

43
Q

What are the pharmacological treatments for GORD?

A

Alginates - Gaviscon
H2RA - ranitidine
Proton pump inhibitor - omeprazole, lansoprazole

44
Q

Describe oesophageal cancer

A

Can be squamous cell carcinoma or adenocarcinoma
More men than women
Western Europe/USA - adenocarcinoma

45
Q

What is the presentation of a patient with oesophageal cancer?

A

Progressive dysphagia
Anorexia and weight loss
Odynophagia, chest pain, cough, pneumonia, vocal cord paralysis and haematemesis

46
Q

Describe squamous cell carcinoma

A

Occur in proximal and middle third of the oesophagus
Preceded by dysplasia and carcinoma in situ
Often large exophytic occluding tumours

47
Q

What are risk factors for squamous cell carcinoma?

A

Tobacco and alcohol

48
Q

Describe adenocarcinoma of oesophagus

A

Occurs in distal oesophagus
Associated with Barrett’s oesophagus - progression through dysplasia

49
Q

What are some preceding factors for adenocarcinoma?

A

Obesity, male sex, middle age and Caucasian

50
Q

What are some metastases of oesophageal cancer?

A

Hepatic, brain, pulmonary and bone

51
Q

How is oesophageal cancer diagnosed?

A

Endoscopy and Biopsy

52
Q

What is used for staging of oesophageal staging?

A

CT scan, endoscopic ultrasound, PET scan, bone scan

53
Q

What is the treatment for oesophageal cancer?

A

Only potential cure is oesophagectomy and adjuvant or neoadjuvant chemo
But significant morbidity and mortality with surgery and long post op recovery

54
Q

What are the options to help dysphagia in oesophageal cancer?

A

Endoscopic - stent , laser/APC, PEG
Chemo
Radiotherapy
Brachytherapy

55
Q

What is eosinophilic oesophagitis?

A

Chronic immune/allergy mediated condition defined by symptoms of oesophageal dysfunction and pathologically by eosinophilic infiltration of oesophageal epithelium

56
Q

When is eosinophilic oesophagitis more seen?

A

More common in children and young adults
More males than females

57
Q

What is the presentation of eosinophilic oesophagitis?

A

Dysphagia and food bolus obstruction

58
Q

What is seen on endoscopy when eosinophilic oesophagitis?

A

Multiple strictures
Mucosal stripping

59
Q

What is the treatment for eosinophilic oesophagitis?

A

Topical/swallowed corticosteroids
Dietary elimination
Endoscopic dilatation

The Alimentary Canal (33 decks)

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