Oesophageal Disorders Flashcards
Where does the oesophagus begin and end in terms of vertebra?
Begins at C6
Terminates at T11-12
What propels food down the oesophagus in peristalsis and what nerve innervates the muscle?
Circular muscles surrounding the oesophagus
Vagus nerve
How is the “Mucosal Rosette” formed?
The acute angle at the gastroesophageal junction (GOJ)
What symptoms can retrosternal discomfort or burning be associated with?
Waterbrash
Cough
What are symptoms of oesophageal disease?
Reflux
LOS pressure decreased to cause increased reflux
Persistent reflux and heartburn leads to GORD
How do you define between oropharyngeal and oesophageal disease?
Oropharyngeal is high dysphagia and may have a more sinister cause e.g. Laryngeal tumour
What are the causes of dysphagia?
Benign/Malignant structure
Motility disorder e.g. Achalasia
Eosinophilic oesophagitis
Extrinsic compression e.g. Lung cancer
Dysphagia investigations?
Endoscopy
Barium swallow
Oesophageal pH and manometry
What is oesophageal manometry?
Assessing sphincter tonicity, relaxation of sphincters and oesophageal motility
How does hypermotility appear on x-rays?
Corkscrew appearance due to severe muscle spasm with an unclear cause
Often confused with Angina/MI
What does hypomotility cause?
A failure of the LOS mechanism leading to heartburn and reflux symptoms
What is hypomotility associated with?
Connective tissue disease
Diabetes
Neuropathy
What is achalasia?
The functional loss of myenteric plexus ganglion cells in the distal oesophagus and LOS
What does achalasia result in?
A functional distal obstruction of the oesophagus - Food cannot enter the stomach
What often surrounds achalasia?
Lymphocytes
What are the symptoms of achalasia?
Progressive dysphagia
Weight loss
Chest pain (30%)
Regurgitation & Chest infection
How high is the pressure in the LOS and what does it fail to do after swallowing?
Above 45mmHg
Relax
Achalasia investigations?
CXR
Manometry
OGD
Barium swallow
Achalasia treatment?
Nitrate and Calcium blockers
Endoscopic
Radiological - Pneumatic balloon dilatation
Surgical - Myotomy
What is GORD and how does it occur?
Gastro-Oesophageal Reflux Disease
Acid (and bile) exposure in the lower oesophagus
GORD symptoms?
Heartburn
Cough
Waterbrash
Sleep disturbance
What are the six GORD risk factors?
Smoking Obesity Alcohol Hypomotility Pregnancy Drugs lowering LOS pressure
What happens when there is GORD without abnormal anatomy?
INcreased relaxations of LOS Hypotensive LOS Delayed gastric emptying Delayed oesophageal emptying Decreased oesophageal acid clearance
What happens when GORD is due to a hiatus hernia?
Their is an anatomical distortion of the OG junction
What are the two types of hiatus hernia?
Sliding
Para-oesophageal
What happens to the stomach fundus in a hiatus hernia?
Moves proximally through the diaphragmatic hiatus
What happens in a sliding hernia?
The hernia moves up and down
What happens in a para-oesophageal hernia?
Fundus moves up and down alongside the oesophagus
What complications arise from GORD?
Ulceration
Stricture
Glandular metaplasia (Barrett’s Oesophagus)
Carcinoma
How does erosive oesophagitis occur?
Mucosa is exposed to acid-pepsin and bile
What are the treatments for GORD?
Lifestyle measures
Pharmacological - Rennis, Gaviscon etc.
Anti-reflux surgery
What are the two types of oesophageal cancer?
Adenocarcinoma
Squamous cell carcinoma
What are the symptoms of oesophageal carcinoma?
Progressive Dysphagia Anorexia & Weight loss Odynophagia Chest pain Cough Pneumonia Vocal cord paralysis Haematemsis
What is odynophagia?
Painful swallowing in the mouth or oesophagus
Can occur with or without dysphagia
What nerve must be affected for vocal cord paralysis to occur?
Recurrent laryngeal nerve
Where does squamous cell carcinoma occur and how does it appear?
Proximal and middle third of oesophagus
Large exophytic tumours preceeded by dysplasia and carcinoma in situ
Where does adenocarcinoma occur?
Distal oesophagus
What are the predisposing factors for adenocarcinoma?
Obesity
Male
Middle ages
Caucasian
Where does direst spread occur and why?
Mediastinum as there is no peritoneal lining there
What does the oesophagus lack?
A serosal layer
What investigations are done for oesophageal cancer?
Endoscopy/Biopsy
Staging - CT/PET scan
How does the staging work for Oesophageal cancer?
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
