Oesophageal disorders Flashcards
what level does the osephage start at
c6
what level does the oesphagus end at
t11/t12
what lines the eosphagus
stratified squamous epitheilum
what nerve control osephagel swallowing
vagus
what level of resting pressure is n the lower oesophagl shincter
high
what are teh symptoes of osephgal disesae
heart burn, waterbrash- bad taste in mouth, cough
what food/ drinks make reflux worse
, alchol nicotine due to reduded los pressure
what are teh symptoms of oesophageal dysphagia
difficulty swallowing certain flood adn liquids
what is the location of osephagl dysphai
oropharyngeal or oesophageal
what to ask about osephagl dysphagia
type of food, pattern, ascoaced symptoms (weightlso, reguarataion, cough)
what are teh causes of oesophagus disease
benign strucres, malignatn strucies, motility disorders (achalsaia, presbyosepgus, eosphilic oesphagits, extrins compression (lung cancer)
investigon for oesophagel disase
endocops either upper gi endocopy
or
oesophago gastro duodenscopy
contrast radiobly - barium swallow
oesophagla ph metry ( sensor with ph messauerement) can be over 48 hr
osephagle manomenty (measere the movement of the oesphage
examples of hypermotilty osepgal disoeres
diffuse oespagel spasm
examples of hypomotiily disorders
ct disease, diabetes neurooyr
effect of diffusre osep;gal spasm
sever episoic chest pain whihc could be confused with mi
hypertrophic structures
uncorodeanted smooth muscles control
what does hypermovbily look like on a barium swallow
corkscrew apparance
what fialures in hypo mobility
los
what is achalasia
loso of fuciton of teh myenteric pleus gangion in the oespalga nd los, meaning los will not relax
when does achalasi normally occur
3rd to 5th decade
what are the sympoms of achalasia
progressive dysphagia for solids and liquids
weight loss
chest pain
regurgitation and chest infection
what are the treat ment for achalmisa
phacologica - nitrates, ccb,
endoscopic
endoscopic, botox pnuatic ballow dilati;on
radiloc pnumait baloown dilation
surgical myotomy
complicaitons of aschlasion
asopirational pneumonia and lung disease
incraed risk of squamous cell oesophageal carcinoma
what percent of adults hae gord
7%
what are teh symptoms of gord
heartburn, cough, water brash, sleep disturbance
what are the risk factors for gord
pregnacy, obesity, drugs lowering los pressure, smoking, alcholism, hypomotility
what gender and ethnicyt does gord mainly effect
men and cuacation and black ethnicty
does gord need diganosic testing to be diagnosed
no
will endoscopy show evidnece of gord
not in almostalll cases
what are the alarm features of gord
weight loss, vomminting, dysphargia
what physiological things can cause gord
transient relaxitoin of los
hypotensive los
delayed gastic tempting
osepgal acid clearance is reduced
tissue resiance to acid/ bile is reduced
what anatomical absomailes can cause gord
hiatus herina
what are type 1 and type 2 hiatus hernia
1 - sliding( expansino of bolottom of hiatus) , 2 para osepgal (septarte part of ufncgus is through)
what age is nomrally experice hiatus hernia
over 50 years old
what are the complication of gord
ulceration
stricutre
glandular metaplaseia
carcinoma
what is barretts spaghsus
damage to the disatla end as a reuslt to prolonged acid exposure
what chagne is seen in barretts oesophagus
squamous to mucin sequcion columnar cells nthe lower oespghaus
what is a risk of barretss oespaghsu
substancly higher likleyhood of developig osephagul cancer
what is the treatment for barretss oesphagus
endoscopic mucosal reseciton ( using laser to remove part of osepahgsu surface)
ratio frequcly ablaton
oseophagluly (removing part or all of oesophagus)
what is the treatment for gord
lifestyle measure e.g. lose weight, reduce caffeine,
pharmacological,
alginates e.g. gaviscaon
h2 receptor antageon e.g. ranitidine
proton pump inhibtors e.g omeprazole and lansoprazole
anti reflux surgery
how commmon is oesphagul cancer
5th ranced in cancer moroatly ranked
what type of cancer is the most common in western world
adenocarcinam then squamous
what type of cancer is most common in developing word
squamou then adenocarcima
what are the sympoms of osepahg cancer
anorexia and weighloss
progressive dysphagia
odynophagia (painful swallowing)
chest pain
cough
pnumia
vocal cord paralysh
haematomesis (vomiting blood)
squamous cell carcinoma location on oepshaus
proximal and middl ethrid of oesphaus
what are risk factors for squamous cell caricnoma
toacco, alchol, and possibly vitamen deficenty
what other symphtoms are there with squamous cell carcinoma
achalasia, caustic strictures, plummer vinson syndrome
what is the apperance of squamous cell carinoma
large exophytic occluding tumours
where are adenocarcona often foudn
distal oesophaugs
what are adenocarcinoma associed with
barreets oesophaugs
what is the prognos of oesphagus cancer
5 year srvivcal less than 10%
what is the investigatio for oesphagel cancer
endocpy and bi[ys
stadging
- ct
endoscopic ultrasound
pet scan
bone scan
tnm classification for staging
what is the metasions of osepahgul cancer
fast progresioin
due to no serosla linging in mesiaum it can inveate heart tracheal and aorat
meatai in hepatic, brain, pulmonary and bone
what are the treatement opitons for oesphagul cancer
surgical oesophagectomybefore and after chemothearphyy (high mobidy (10%))
nutrionla support
chemo and radiotherapy inpove surpval after 1 year
radio therapy
brachylytherpy
what is eospillic oshgaics
chronci immune allergen mediated contion defiend by clinclly by spomy of oepshagl dysction and pathology by eosinophulllinc filgtation in the abscenf of secionary causes
what is teh teratment for eospillic oespgis
corticosteraiod
dieteary elination
endocpoic dilation
