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GI System > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

Where does the oesophagus begin and end in terms of vertebra?

A

Begins at C6

Terminates at T11-12

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2
Q

What propels food down the oesophagus in peristalsis and what nerve innervates the muscle?

A

Circular muscles surrounding the oesophagus

Vagus nerve

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3
Q

How is the “Mucosal Rosette” formed?

A

The acute angle at the gastroesophageal junction (GOJ)

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4
Q

What symptoms can retrosternal discomfort or burning be associated with?

A

Waterbrash

Cough

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5
Q

What are symptoms of oesophageal disease?

A

Reflux
LOS pressure decreased to cause increased reflux
Persistent reflux and heartburn leads to GORD

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6
Q

How do you define between oropharyngeal and oesophageal disease?

A

Oropharyngeal is high dysphagia and may have a more sinister cause e.g. Laryngeal tumour

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7
Q

What are the causes of dysphagia?

A

Benign/Malignant structure
Motility disorder e.g. Achalasia
Eosinophilic oesophagitis
Extrinsic compression e.g. Lung cancer

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8
Q

Dysphagia investigations?

A

Endoscopy
Barium swallow
Oesophageal pH and manometry

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9
Q

What is oesophageal manometry?

A

Assessing sphincter tonicity, relaxation of sphincters and oesophageal motility

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10
Q

How does hypermotility appear on x-rays?

A

Corkscrew appearance due to severe muscle spasm with an unclear cause
Often confused with Angina/MI

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11
Q

What does hypomotility cause?

A

A failure of the LOS mechanism leading to heartburn and reflux symptoms

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12
Q

What is hypomotility associated with?

A

Connective tissue disease
Diabetes
Neuropathy

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13
Q

What is achalasia?

A

The functional loss of myenteric plexus ganglion cells in the distal oesophagus and LOS

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14
Q

What does achalasia result in?

A

A functional distal obstruction of the oesophagus - Food cannot enter the stomach

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15
Q

What often surrounds achalasia?

A

Lymphocytes

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16
Q

What are the symptoms of achalasia?

A

Progressive dysphagia
Weight loss
Chest pain (30%)
Regurgitation & Chest infection

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17
Q

How high is the pressure in the LOS and what does it fail to do after swallowing?

A

Above 45mmHg

Relax

18
Q

Achalasia investigations?

A

CXR
Manometry
OGD
Barium swallow

19
Q

Achalasia treatment?

A

Nitrate and Calcium blockers
Endoscopic
Radiological - Pneumatic balloon dilatation
Surgical - Myotomy

20
Q

What is GORD and how does it occur?

A

Gastro-Oesophageal Reflux Disease

Acid (and bile) exposure in the lower oesophagus

21
Q

GORD symptoms?

A

Heartburn
Cough
Waterbrash
Sleep disturbance

22
Q

What are the six GORD risk factors?

A 
Smoking
Obesity
Alcohol
Hypomotility
Pregnancy
Drugs lowering LOS pressure
23
Q

What happens when there is GORD without abnormal anatomy?

A 
INcreased relaxations of LOS
Hypotensive LOS
Delayed gastric emptying
Delayed oesophageal emptying
Decreased oesophageal acid clearance
24
Q

What happens when GORD is due to a hiatus hernia?

A

Their is an anatomical distortion of the OG junction

25
Q

What are the two types of hiatus hernia?

A

Sliding

Para-oesophageal

26
Q

What happens to the stomach fundus in a hiatus hernia?

A

Moves proximally through the diaphragmatic hiatus

27
Q

What happens in a sliding hernia?

A

The hernia moves up and down

28
Q

What happens in a para-oesophageal hernia?

A

Fundus moves up and down alongside the oesophagus

29
Q

What complications arise from GORD?

A

Ulceration
Stricture
Glandular metaplasia (Barrett’s Oesophagus)
Carcinoma

30
Q

How does erosive oesophagitis occur?

A

Mucosa is exposed to acid-pepsin and bile

31
Q

What are the treatments for GORD?

A

Lifestyle measures
Pharmacological - Rennis, Gaviscon etc.
Anti-reflux surgery

32
Q

What are the two types of oesophageal cancer?

A

Adenocarcinoma

Squamous cell carcinoma

33
Q

What are the symptoms of oesophageal carcinoma?

A 
Progressive Dysphagia
Anorexia & Weight loss
Odynophagia
Chest pain
Cough
Pneumonia
Vocal cord paralysis
Haematemsis
34
Q

What is odynophagia?

A

Painful swallowing in the mouth or oesophagus

Can occur with or without dysphagia

35
Q

What nerve must be affected for vocal cord paralysis to occur?

A

Recurrent laryngeal nerve

36
Q

Where does squamous cell carcinoma occur and how does it appear?

A

Proximal and middle third of oesophagus

Large exophytic tumours preceeded by dysplasia and carcinoma in situ

37
Q

Where does adenocarcinoma occur?

A

Distal oesophagus

38
Q

What are the predisposing factors for adenocarcinoma?

A

Obesity
Male
Middle ages
Caucasian

39
Q

Where does direst spread occur and why?

A

Mediastinum as there is no peritoneal lining there

40
Q

What does the oesophagus lack?

A

A serosal layer

41
Q

What investigations are done for oesophageal cancer?

A

Endoscopy/Biopsy

Staging - CT/PET scan

42
Q

How does the staging work for Oesophageal cancer?

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

GI System (38 decks)

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