Oesophageal Disorders Flashcards
where does the oesophagus begin?
C6
what is heartburn a consequence of?
reflux of acid or biliary gastric contents into the oesophagus
what associating symptoms can accompany heart burn?
> waterbrash
> cough
how do certain drugs or food lead to heartburn?
they reduce the los pressure resulting in increased reflux/heartburn
what can persistent reflux lead to?
gastro-oesophageal reflux disease
define dysphagia
difficulty in swallowing foods/liquids
define odynophagia
pain with swallowing (can accompany dysphagia)
what can cause oesophageal dysphagia?
> benign stricture > malignant stricture > motility disorders > eosinophilic oesophagitis > extrinsic compensation
what is eosinophilic oesophagitis?
an inflammatory allergic disorder
what investigations can be carried out in oesophageal disease?
> endoscopy
barium swallow (contrast radiology)
oesophageal pH and manometry
how may the oesophagus appear on a barium swallow in hypermotility?
corkscrew appearance
what symptoms are associated with hypermotility syndromes?
> severe episodic chest pain
> dysphagia
what will a manometry show in hypermotility?
exaggerated, uncoordinated, hypertonic contractions
what diseases are hypomotility associated with?
> connective tissue disease
diabetes
neuropathy
what does hypomotility of the oesophagus lead to?
failure if the los mechanism leading to heartburn and reflux symptoms
what is lost in achalasia?
the functional capacity of myenteric plexus ganglion cells in distal oesophagus and los
what is the cardinal feature of achalasia?
failure of the los to relax (resulting in functional distal obstruction of the oesophagus as there is an absence of useful peristaltic contraction)
what are the symptoms of achalasia?
> progressive dysphagia for solids and liquids
weight loss
chest pain
regurgitation and chest infection
what pharmacological treatment options are there for achalasia?
> nitrates
> calcium channel blockers
what endoscopic treatment options are there for achalasia?
> botulinum toxin
> pneumatic dilation
what radiological treatment options are there for achalasia?
pneumatic balloon dilation
what surgical treatment options are there for achalasia?
myotomy, longitudinal incision made over the sphincter releasing the pressure allowing food to go down
what complications can arise from achalasia?
> aspiration pneumonia and lung disease
> increased risk of squamous cell oesophageal carcinoma
what are the symptoms of gastro-oesophageal reflux disease?
> heartburn
cough
water brash
sleep disturbance
what are the risk factors for Gastro-Oesophageal Reflux Disease?
> pregnancy > obesity > smoking > alcoholism > hypomotility > drugs lowering los pressure > man
when must an endoscopy be carried out in Gastro-Oesophageal Reflux Disease?
if there are alarm features present that are suggestive of malignancy
describe the aetiology of GORD where there is no abnormal anatomy
> increased los relaxation (hypotensive)
delayed gastric and oesophageal emptying
decreased acid clearance
decreased tissue resistance to acid/bile
describe a para-oesophageal hernia
hiatus hernia where the fundus of the stomach moves proximally through the diaphragmatic hiatus
describe the pathophysiology of GORD
> mucosa exposed to acid-pepsin and bile
increased cell loss and inflammation
erosive oesophagitis
what complications can arise from GORD?
> ulcer
stricture
glandular metaplasia
carcinoma
what is the morphological change that occurs in barretts oesophagus?
from squamous to mucin secreting columnar
what is the treatment for barretts oesophagus with high grade dysplasia?
> endoscopic mucosal resection
radio-frequency ablation
oesophagectomy (rarely)
what is the treatment for GORD in the absence of alarm features?
> lifestyle measures
> pharmacological - alginates (gaviscon), H2RA (ranitidine), PPIs (e.g. lanzoprazole)
what is the treatment for GORD following investigation?
anti-reflux surgery: fundoplication, full or partial wrap
how does oesophageal cancer present?
> progressive dysphagia > weight loss > odynophagia > chest pain > cough > pneumonia > vocal cord paralysis > haematemesis
where in the oesophagus do squamous cancers occur?
the proximal or middle third
what are significant risk factors for squamous cell carcinomas?
tobacco and alcohol
what diseases/conditions are associated with squamous cell carcinomas?
> achalasia
caustic strictures
plummer-vinson syndrome
where do adenocarcinomas occur?
the distal oesophagus
what are the predisposing factors for adenocarcinomas of the oesophagus?
> obesity
male
middle aged
Caucasian
where does oesophageal cancer metastasise to?
> liver
brain
lungs
bone
what is the survival rate of oesophageal cancer?
5yr < 10%
what are the diagnostic investigations for oesophageal cancer?
> endoscopy
> biopsy
what investigations are carried out to stage oesophageal cancer?
> CT scan
endoscopic ultrasound
PET scan
bone scan
what is the only potential cure for oesophageal cancer?
surgical oesophagectomy with adjuvant/neoadjuvant chemotherapy
what can be offered to oesophageal cancer patients who have inoperable cancer?
combined chemo and radiotherapy can improve long term survival (>1year)
