Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Systems: Alimentary AB > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

Where does the oesophagus begin and end?

A
  • Begins at lower level of cricoid cartilage C6

- Terminates at T11-12 where it enters the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What type of muscle is found in the oesophagus?

A

Upper 3-4cm striated muscle, remainder is smooth muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What type of epithelium is found in the oesophagus?

A

Stratified squamous epithelial lining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the function of the oesophagus?

A

Transport of food/liquid from mouth to stomach which is an active process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is oesophageal peristalsis produced?

A

By oesophageal circular muscles and propels swallowed materials distally into the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does oesophageal peristalsis co-ordinate with?

A

Lower oesophageal sphincter relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is contraction in the oesophageal body and relaxation of the LOS mediated?

A

Via the vagus nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What type of sphincter is the LOS?

A

Physiological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What combination of factors contribute to the integrity of the LOS?

A
  • High resting pressure in distal smooth muscle
  • Striated muscle of right crus of diaphragm
  • Mucosal Rosette formed by acute angle at GOJ
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When should be the only time that the LOS opens?

A

When food or liquid is passed into the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the symptoms of oesophageal disease/

A
  • Heartburn

- Dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is heartburn?

A

Retrosternal discomfort or burning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What may heartburn be associated with?

A
  • Waterbrash

- Cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is heartburn a consequence of?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How can certain foods and drugs increase reflux and heartburn?

A

Reduce the LOS pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What food/drugs can increase reflux

A
  • Alcohol
  • Nicotine
  • Dietary xanthines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does persistent reflux and heartburn lead to?

A

Gastro-oesophageal reflux disease (GORD) which can in turn cause long term complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Dysphagia

A

Subjective sensation of difficulty in swallowing foods and/or liquids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Odynophagia

A

Pain when swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What should enquire about if some presents with dysphagia?

A
  • Type of food
  • Pattern
  • Associated features
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the 2 locations of dysphagia?

A
  • Oropharyngeal

- Oesophageal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the causes of oesophageal dysphagia?

A
  • Benign stricture
  • Malignant disorders
  • Eosinophilic oesophagitis (achalasia, presbyoesophagus)
  • Extrinsic compression (lung cancer)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What investigations are carried out for oesophageal disease?

A
  • Endoscopy
  • Oesophago-gastro-duodenoscopy (OGD)
  • Upper GI endoscopy (UGIE)
  • Contrast radiology
  • Oeosphageal pH and manometry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is involved in oesophageal pH and manometry?

A
  • NG catheter containing multiple pressure and pH sensors is placed in oesophagus
  • Probes at both sphincters
  • Assess sphincter tonicity, relaxation and motility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What motility disorders are there?

A
  • Hypermotility
  • Hypomotility
  • Achalasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What does hypermotility result in?

A
  • Diffuse oesophageal spasms

- Severe, episodic chest pain +/- dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How does hypermotility appear on barium swallow?

A

Corkscrew appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is hypermotility often confused with?

A

Angina/MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the cause of hypermotility?

A

Idiopathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What does manometry of hypermotility show?

A

Exaggerated, uncoordinated hypertonic contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the treatment for hypermotility?

A

Smooth muscle relaxants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is hypomotility associated with?

A
  • Connective tissue disease
  • Diabetes
  • Neuropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What does hypomotility cause?

A

Failure of LOS mechanism leading to heartburn and reflux symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Achalasia

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the prevalence of achalasia?

A
  • 1-2/100,000

- M:F 1:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

When does the onset of achalasia usually occur?

A

3rd to 5th decade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the cardinal feature of achalasia?

A

Failure of the LOS to relax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What does achalasia result in?

A

Functional distal obstruction of oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the symptoms of achalasia?

A
  • Progressive dysphagia for solids and liquids
  • Weight loss
  • Chest pain
  • Regurgitation and chest infection
40
Q

What 2 features are required to make a diagnosis of achalasia?

A
  • Failure of LOS to relax after swallowing

- An absence of useful contractions in the lower oesophagus

41
Q

What is the treatment for achalasia?

A
  • Pharmacological : nitrates, Ca channel blockers
  • Endoscopic: Botulinum toxin, pneumatic balloon dilation
  • Radiological: pneumatic balloon dilation
  • Surgical: myotomy
42
Q

What are the complications of untreated achalasia?

A
  • Aspiration pneumonia and lung disease

- Increased risk of squamous cell oesophageal carcinoma

43
Q

What is GORD due to?

A

Pathological acid and bile exposure in lower oesophagus

44
Q

What is important to note about GORD?

A

Many patients with frequent pathological episodes of acid/bile reflux do not experience any symptoms

45
Q

What are the symptoms of GORD?

A
  • Heartburn
  • Cough
  • Water brash
  • Sleep disturbance
46
Q

What are the risk factors for GORD?

A
  • Pregnancy
  • Obesity
  • Drugs lowering LOS pressure
  • Smoking
  • Alcoholism
  • Hypomotility
47
Q

What is the prevalence of GORD?

A
  • M>F

- Caucasian>Black>Asian

48
Q

What can the typical GORD syndrome be diagnosed on the basis of?

A

Characteristic symptoms without diagnostic testing

49
Q

Why is endoscopy a poor diagnostic test for GORD?

A

Most patients with reflux symptoms have no visible evidence of oesophageal abnormality when endoscopy is performed

50
Q

When must endoscopy be performed in GORD?

A

In the presence of alarm feature suggestive of malignancy

51
Q

What is the aetiology of GORD without abnormal anatomy?

A
  • Increased transient relaxations of the LOS
  • Hypotensive LOS
  • Delayed gastric emptying
  • Delayed oesophageal emptying
  • Decreased oesophageal acid clearance
  • Decreased tissue resistance to bile/acid
52
Q

What is the aetiology of GORD due to hiatus hernia?

A

Anatomical distortion of the OG junction

53
Q

What are the 2 main types of hiatus hernia?

A
  • Sliding

- Para-oesophageal

54
Q

What happens in hiatus hernias?

A

Fundus of stomach moves proximally through the diaphragmatic hiatus

55
Q

What are the predispositions to hiatus hernias?

A
  • Obesity

- Ageing

56
Q

What is the pathophysiology of GORD?

A
  • Mucosa exposed to acid-pepsin and bile
  • Increased cell loss and regenerative activity
  • Erosive oesophagitis
57
Q

What are the complications of GORD?

A
  • Ulceration
  • Stricture
  • Glandular metaplasia (Barretts oesophagus)
  • Carcinoma
58
Q

Barretts oeosphagus

A

Intestinal metaplasia related to prolonged acid exposure in distal oesophagus

59
Q

What happens in Barretts oesophagus?

A

Change from squamous to mucin secreting columnar epithelial cells in lower oesophagus

60
Q

What is Barrett’s oesophagus a precursor to?

A
  • Dysplasia

- Adenocarcinoma

61
Q

What is the prevelance of Barrett’s oesophagus?

A

M»F

62
Q

What is the risk of developing cancer in high grade dysplasia Barrett’s oesophagus?

A

6% per year

63
Q

What is the treatment for high grade dysplasia Barrett’s oesophagus?

A
  • Endosocpic mucosal resection (EMR)
  • Radio-frequency Ablation (RFA)
  • Oesophagectomy rarely
64
Q

What is the treatment for GORD?

A
  • Lifestyle measures

- Pharacological

65
Q

What pharmacological interventions are there for GORD?

A
  • Alginates (Gaviscon)
  • H2RA (Ranitidine)
  • Proton pump inhibitor
66
Q

What treatement is there for GORD following investigation (refractory disease/symptoms)?

A

-Anti-reflux surgery (Fundoplication: full/partial wrap)

67
Q

What are the 2 main types of oesophageal cancer?

A
  • Squamous cell carcinoma

- Adenocarcinoma

68
Q

What is the prevalence of oesophageal cancer?

A

M>W

69
Q

What is the median age of diagnosis for oesophageal cancer?

A

65 and decreasing

70
Q

How does the type of cancer vary internationally?

A
  • Western Europe/USA adenocarcinoma>squamous

- Rest of world squamous>adenocarcinoma

71
Q

How does oesophageal cancer present?

A
  • Progressive dysphagia
  • Anorexia and weight loss
  • Odynophagia
  • Chest pain
  • Cough
  • Pneumonia
  • Vocal cord paralysis
  • Haematemesis
72
Q

What type of tumours often occur with squamous cell carcinomas?

A

Large exophytic occluding tumours

73
Q

Where do squamous cell carcinomas usually occur?

A

Proximal and middle third of oesophagus

74
Q

What is squamous cell carcinoma preceded by?

A

Dysplasia and carcinoma in situ

75
Q

Where is there a high incidence of squamous cell carcinoma?

A
  • Southern Africa
  • China
  • Iran
76
Q

What are significant risk factors in squamous cell carcinomas?

A

Tobacco and alcohol

77
Q

What is squamous cell carcinoma associated with?

A
  • Achalasia
  • Caustic strictures
  • Plummer-Vinson syndrome
78
Q

Where do adenocarcinomas occur?

A

Distal oesophagus

79
Q

What are adenocarcinomas associated with?

A

Barretts oesophagus

80
Q

What are the predisposing factors for adenocarcinomas?

A
  • Obesity
  • male
  • Middle age
  • Caucasian
81
Q

When does oesophageal cancer usually present?

A

Late

82
Q

Why can tumour invasion into adjacent structures occur more easily in the oesophagus?

A

-There is no serosal layer unlike the rest of the GIT

83
Q

Why does lymph node involvement often occur early in oesophageal tumours?

A

The lamina propria has a rich lymphatic supply

84
Q

Where have tumours commonly spread when oesophageal cancer presents?

A

Regional nodes +/- liver

85
Q

Where are the common sites of metastases for oesophageal cancer?

A
  • Liver
  • Brain
  • Lungs
  • Bone
86
Q

What is the prognosis for oesophageal cancer?

A

5 yr survival <10%

87
Q

How is oesophageal cancer diagnosed?

A
  • Endoscopy

- Biopsy

88
Q

How is oesophageal cancer staged?

A
  • CT scan
  • Endoscopic ultrasound
  • PET scan
  • Bone scan
89
Q

What classification is used in the staging of oesophageal cancer?

A

TNM staging

90
Q

What is the only potential cure for oesophageal cancer?

A

Surgical oesophagectomy +/- adjuvant or neoadjuvant chemotherapy

91
Q

Who is surgery for oesophageal cancer limited to?

A

Patients with localised disease without co-morbid disease usually <70 years of age

92
Q

What are the disadvantaged of surgery for oesophageal cancer?

A
  • Significant morbidity and mortality associated with oeosphagectomy
  • Long post operative recovery
  • Requires nutritional support
93
Q

What can be offered to patients with locally advanced inoperable disease to increase life expectancy?

A

Combined chemo and radiotherapy

94
Q

What is often the overriding priority in oesophageal cancer treatment?

A

Symptom palliation

95
Q

What options are there for symptom palliation of oesoopheal cancer?

A
  • Endoscopic (stent, laser/APC, PEG)
  • Chemotherapy
  • Radiotherapy
  • Brachytherapy

Systems: Alimentary AB (37 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions