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Alimentary System > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

where does the oesophagus begin?

A

C6

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2
Q

what is heartburn a consequence of?

A

reflux of acid or biliary gastric contents into the oesophagus

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3
Q

what associating symptoms can accompany heart burn?

A

> waterbrash

> cough

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4
Q

how do certain drugs or food lead to heartburn?

A

they reduce the los pressure resulting in increased reflux/heartburn

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5
Q

what can persistent reflux lead to?

A

gastro-oesophageal reflux disease

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6
Q

define dysphagia

A

difficulty in swallowing foods/liquids

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7
Q

define odynophagia

A

pain with swallowing (can accompany dysphagia)

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8
Q

what can cause oesophageal dysphagia?

A 
> benign stricture
> malignant stricture
> motility disorders
> eosinophilic oesophagitis
> extrinsic compensation
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9
Q

what is eosinophilic oesophagitis?

A

an inflammatory allergic disorder

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10
Q

what investigations can be carried out in oesophageal disease?

A

> endoscopy
barium swallow (contrast radiology)
oesophageal pH and manometry

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11
Q

how may the oesophagus appear on a barium swallow in hypermotility?

A

corkscrew appearance

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12
Q

what symptoms are associated with hypermotility syndromes?

A

> severe episodic chest pain

> dysphagia

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13
Q

what will a manometry show in hypermotility?

A

exaggerated, uncoordinated, hypertonic contractions

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14
Q

what diseases are hypomotility associated with?

A

> connective tissue disease
diabetes
neuropathy

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15
Q

what does hypomotility of the oesophagus lead to?

A

failure if the los mechanism leading to heartburn and reflux symptoms

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16
Q

what is lost in achalasia?

A

the functional capacity of myenteric plexus ganglion cells in distal oesophagus and los

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17
Q

what is the cardinal feature of achalasia?

A

failure of the los to relax (resulting in functional distal obstruction of the oesophagus as there is an absence of useful peristaltic contraction)

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18
Q

what are the symptoms of achalasia?

A

> progressive dysphagia for solids and liquids
weight loss
chest pain
regurgitation and chest infection

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19
Q

what pharmacological treatment options are there for achalasia?

A

> nitrates

> calcium channel blockers

20
Q

what endoscopic treatment options are there for achalasia?

A

> botulinum toxin

> pneumatic dilation

21
Q

what radiological treatment options are there for achalasia?

A

pneumatic balloon dilation

22
Q

what surgical treatment options are there for achalasia?

A

myotomy, longitudinal incision made over the sphincter releasing the pressure allowing food to go down

23
Q

what complications can arise from achalasia?

A

> aspiration pneumonia and lung disease

> increased risk of squamous cell oesophageal carcinoma

24
Q

what are the symptoms of gastro-oesophageal reflux disease?

A

> heartburn
cough
water brash
sleep disturbance

25
Q

what are the risk factors for Gastro-Oesophageal Reflux Disease?

A 
> pregnancy
> obesity
> smoking
> alcoholism
> hypomotility
> drugs lowering los pressure
> man
26
Q

when must an endoscopy be carried out in Gastro-Oesophageal Reflux Disease?

A

if there are alarm features present that are suggestive of malignancy

27
Q

describe the aetiology of GORD where there is no abnormal anatomy

A

> increased los relaxation (hypotensive)
delayed gastric and oesophageal emptying
decreased acid clearance
decreased tissue resistance to acid/bile

28
Q

describe a para-oesophageal hernia

A

hiatus hernia where the fundus of the stomach moves proximally through the diaphragmatic hiatus

29
Q

describe the pathophysiology of GORD

A

> mucosa exposed to acid-pepsin and bile
increased cell loss and inflammation
erosive oesophagitis

30
Q

what complications can arise from GORD?

A

> ulcer
stricture
glandular metaplasia
carcinoma

31
Q

what is the morphological change that occurs in barretts oesophagus?

A

from squamous to mucin secreting columnar

32
Q

what is the treatment for barretts oesophagus with high grade dysplasia?

A

> endoscopic mucosal resection
radio-frequency ablation
oesophagectomy (rarely)

33
Q

what is the treatment for GORD in the absence of alarm features?

A

> lifestyle measures

> pharmacological - alginates (gaviscon), H2RA (ranitidine), PPIs (e.g. lanzoprazole)

34
Q

what is the treatment for GORD following investigation?

A

anti-reflux surgery: fundoplication, full or partial wrap

35
Q

how does oesophageal cancer present?

A 
> progressive dysphagia
> weight loss
> odynophagia
> chest pain
> cough
> pneumonia
> vocal cord paralysis
> haematemesis
36
Q

where in the oesophagus do squamous cancers occur?

A

the proximal or middle third

37
Q

what are significant risk factors for squamous cell carcinomas?

A

tobacco and alcohol

38
Q

what diseases/conditions are associated with squamous cell carcinomas?

A

> achalasia
caustic strictures
plummer-vinson syndrome

39
Q

where do adenocarcinomas occur?

A

the distal oesophagus

40
Q

what are the predisposing factors for adenocarcinomas of the oesophagus?

A

> obesity
male
middle aged
Caucasian

41
Q

where does oesophageal cancer metastasise to?

A

> liver
brain
lungs
bone

42
Q

what is the survival rate of oesophageal cancer?

A

5yr < 10%

43
Q

what are the diagnostic investigations for oesophageal cancer?

A

> endoscopy

> biopsy

44
Q

what investigations are carried out to stage oesophageal cancer?

A

> CT scan
endoscopic ultrasound
PET scan
bone scan

45
Q

what is the only potential cure for oesophageal cancer?

A

surgical oesophagectomy with adjuvant/neoadjuvant chemotherapy

46
Q

what can be offered to oesophageal cancer patients who have inoperable cancer?

A

combined chemo and radiotherapy can improve long term survival (>1year)

Alimentary System (33 decks)

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