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Alimentary System > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

What is heartburn a consequence of?

A

Acid and/or bilous gastric content reflux into the oesophagus

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2
Q

What causes gastro-oesophageal reflux disease?

A

Reduction in lower oesophageal sphincter pressure resulting in persistent reflux and heartburn

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3
Q

What percentage of adults experience daily GORD symptoms?

A

7%

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4
Q

What is the typical presentation of GORD?

A

Heartburn
Cough
Water brash
Sleep disturbance

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5
Q

What are the risk factors for GORD?

A 
Pregnancy 
Smoking 
Obesity 
Drugs lowering LOS pressure 
Alcoholism 
Hypomotility
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6
Q

Typical reflux syndrome can be diagnosed on the basis of

A

characteristic symptoms, without diagnostic testing

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7
Q

Why is endoscopy a poor diagnostic test for GORD?

A

Most patients with reflux (>50%) will have no visible evidence of oesophageal abnormality on endoscopy

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8
Q

Under what circumstances should an endoscopy be performed in reflux disease?

A

In the presence of alarm features suggestive of malignancy

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9
Q

What is the aetiology of GORD?

A

Increased transient relaxations of LOS, LOS hypotension, delayed gastric and oesophageal emptying, decreased oesophageal acid clearance and tissue resistance to acid/bile

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10
Q

What is the aetiology of GORD due to hiatus hernia?

A

Anatomical distortion of the OG junction

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11
Q

What is the pathophysiology of GORD?

A

Mucosa exposed to acid, pepsin and bile, increased cell loss and inflammation, erosive oesophagitis

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12
Q

What are the possible complications of GORD?

A

Ulceration
Stricture
Glandular metaplasia
Carcinoma

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13
Q

What are the treatment options for GORD?

A

Lifestyle changes
Pharmacological - alginates and proton pump inhibitors
Anti-reflux surgery for refractory disease

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14
Q

What are the two types of hiatus hernia?

A

Sliding

Para-oesophageal

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15
Q

What are the risk factors for a hiatus hernia?

A

Obesity

Increasing age

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16
Q

What happens in Barrett’s Oesophagus?

A

Intestinal metaplasia due to prolonged acid exposure in the distal oesophagus - change from squamous to mucin-secreting columnar epithelial cells

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17
Q

What two conditions can develop from Barrett’s oesophagus?

A

Dysplasia

Adenocarcinoma

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18
Q

What are the treatment options for Barrett’s oesophagus?

A

Endoscopic mucosal resection
Radio-frequency ablation
Oesophagectomy (rarely)

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19
Q

What is dysphagia?

A

Difficulty swallowing foods and/or liquids

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20
Q

What is odynophagia?

A

Pain when swallowing

21
Q

What are the two types of dysphagia?

A

Oropharyngeal

Oesophageal

22
Q

What are the symptoms associated with dysphagia?

A

Weight loss
Regurgitation
Cough

23
Q

What are the causes of oesophageal dysphagia?

A 
Benign stricture 
Malignant stricture 
Motility disorders 
Eosinophilic oesophagus 
Extrinsic compression
24
Q

Give an example of a motility disorder which might cause oesophageal dysphagia

A

Achalasia

Presbyoesophagus

25
Q

What investigations would you do in oesophageal disease?

A

Oesophago-gastro-duodenoscopy
Upper GI endoscopy
Contrast radiology
Oesophageal pH and manometry

26
Q

What are the symptoms of hypermotility?

A

Severe episodic chest pain

Dysphagia

27
Q

What would be seen in manometry of hypermotility?

A

Uncoordinated, exaggerated hypertonic contractions

28
Q

What is hypermotility?

A

Diffuse oesophageal spasm

29
Q

What conditions is hypomotility associated with?

A

Connective tissue disease
Diabetes
Neuropathy

30
Q

What is caused by hypomotility?

A

Failure of the lower oesophageal sphincter mechanism leading to heartburn and reflux

31
Q

What is achalasia?

A

Functional loss of the inhibitory neutrons in the myenteric plexus ganglion cells in the distal oesophagus and lower oesophageal sphincter

32
Q

At what age is the usual onset of achalasia?

A

30-50 years

33
Q

What is the cardinal feature of achalasia?

A

Failure of the lower oesophageal sphincter to relax

34
Q

What does achalasia result in?

A

Functional distal obstruction of the oesophagus

35
Q

What are the symptoms of achalasia?

A 
Progressive dysphagia 
Weight loss 
Chest pain 
Regurgitation 
Chest infection
36
Q

What are the possible treatments for achalasia?

A

Pharmacological - nitrates and CCBs
Endoscopic - Botulinum Toxin
Radiological - pneumatic balloon dilation
Surgical - myotomy

37
Q

What are the possible complications of achalasia?

A

Aspiration pneumonia and lung disease

Squamous cell oesophageal carcinoma

38
Q

What are the most common histological types of oesophageal carcinoma?

A

Squamous cell carcinoma

Adenocarcinoma

39
Q

What is the 5 year survival of oesophageal carcinoma?

A

< 10%

40
Q

What are the possible presentations of oesophageal cancer?

A 
Progressive dysphagia 
Anorexia and weight loss 
Odynophagia 
Chest pain 
Cough 
Pneumonia 
Vocal cord paralysis 
Haematemesis
41
Q

What are the typical characteristics and location of squamous cell oesophageal cancer?

A

Usually large, exophytic, occluding tumours

Occur in proximal and middle thirds of oesophagus

42
Q

What are the major risk factors for squamous cell oesophageal carcinoma?

A

Smoking

Alcohol abuse

43
Q

What is squamous cell oesophageal cancer associated with?

A

Achalasia
Caustic strictures
Plummer-Vinson syndrome

44
Q

In what part of the oesophagus does adenocarcinoma typically occur?

A

Distal third

45
Q

What is oesophageal adenocarcinoma associated with?

A

Barrett’s oesophagus

46
Q

What are the risk factors for oesophageal adenocarcinoma?

A

Obesity
Male sex
Middle age
Caucasian

47
Q

What investigations would be done for oesophageal carcinoma?

A

Endoscopy and biopsy

Staging: CT, EUS, PET scan, bone scan

48
Q

What are the treatment options for oesophageal carcinoma?

A

Oesophagectomy +/- adjuvant/neoadjuvant chemotherapy - only potentially curative option
Combined chemo and radiotherapy
Palliative care

49
Q

What options are there for palliative care of oesophageal carcinoma?

A 
Endoscopic stent 
APC 
PEG 
chemo/radiotherapy 
brachytherapy

Alimentary System (29 decks)

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