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Alimentary System: Pathology SA > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

What is the length of the oesophagus and where does it originate and terminate

A

25cm in length

Originate
- the lower level of circoid cartilage
(C6),

Terminates
- Where it enters the stomach
(T11-12)

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2
Q

What is the muscular arrangement of the oesophagus

A

Upper third - skeletal muscle

Lower two thirds smooth muscle

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3
Q

What is the epithelium lining of the oesophagus

A

Stratified squamous

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4
Q

How does the oesophagus perform its function of transporting food/liquid from the mouth to the stomach

A

Oesophageal peristalsis (contraction) propels swallowed materials down towards the stomach

And lower oesophageal sphincter relaxes to allow swallowed material entry into the stomach

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5
Q

What muscular layer of the oesophagus allows the contraction

A

Circular muscles

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6
Q

What mediates the peristalsis and relaxation of the LOS

A

Vagus nevre

- parasympathetic intervention

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7
Q

When should the lower oesophageal sphincter only be open

A

When food and liquid pass into the stomach

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8
Q

What are the factors that contribute to the integrity of the lower oesophageal sphincter to remain contracted

A

Physiological sphincter - relaxes with physiological functions

High resting pressure in distal smooth muscle

Striated muscle of right crus of diaphragm

“Mucosal Rosette” formed by acute angle (of His) at GOJ

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9
Q

What is the symptoms of oesophageal disease

A

Heartburn - retrosternal discomfort/burning

Reflux

Dysphagia

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10
Q

What are the associated symptoms with heartburn

A

Waterbrash - sudden flow of saliva

Cough

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11
Q

What is the cause of heartburn

A

reflux of acid and/or bilious gastric contents into the oesophagus

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12
Q

When and how does reflux occur in oesophageal disease

A

after swallowing certain drugs/food

Which reduces the lower oesophageal spinchter pressure resulting increased reflux

(further causing the symptom of heart burn)

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13
Q

What is the main aetiology behind gastro-oesophgeal reflux disease

A

Persistent reflux and heart burn

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14
Q

Define dysphagia

A

subjective sensation of difficulty in swallowing foods/liquids

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15
Q

What many be accompanied with dysphagia

A

odynophagia - pain with swallowing

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16
Q

What is the associated symptoms of dysphagia

A

Weight loss
Regurgitation
Cough

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17
Q

What is the different patterns of dysphagia

A

Progressive

Intermittent - irregular intervals

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18
Q

What is the two locations of dysphagia

A

Oropharyngeal
- part of the pharynx lies between soft palate and hyoid bone

Oesophageal

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19
Q

What is the aetiology of oesophageal dysphagia

A
  • benign stricture
  • malignant stricture (oesophageal cancer)
  • motility disorders

eosinophilic oesophagitis

-extrinsic compression (eg in lung cancer)

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20
Q

What iseosinophilic oesophagitis

A

An allergic inflammatory condition of the esophagus that involves eosinophils, a type of white blood cell

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21
Q

What are the investigations for Oesophageal diseases

A

Endoscopy

Contrats radiology (barium swallow)

Oesophageal pH anf manometry (pressure)

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22
Q

What are the two endoscopic procedures for investigating oesophageal disease

A

Oesophago-Gastro-Duodenoscopy (OGD)

Upper GI Endoscopy (UGIE)

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23
Q

When is an endoscopy used in the investigation of oesophageal disease

A

In the investigation of dysphagia or reflux symptoms with alarm features

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24
Q

Although endoscopy is preferred as an overall investigation what is best for primary investigation of dysphagia

A

CT contract - Barium swallow

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25
Why is Barium swallow used in a high dysphagia
Exclude pharyngeal pouch or post cricoid web prior to endoscopy
26
What occurs in an Oesophageal pH and manometry investigation
Naso-gastric catheter containing multiple pressure and pH sensors is placed in oesophagus at both sphincters (UOS + LOS)
27
What does manometry specially investigate | and asses
``` Investigates dysphagia and suspected motility disorder assesses - sphincter muscle tone, - relaxation sphincters - oesophageal motility ```
28
What symptoms does the pH studies specifically investigate
Refractory heartburn and reflux
29
What is examples of motility disorder resulting in oesophageal disease
Hyper-motility Hypo-motility Presbyoesophagus Achalasia
30
Define Presbyoesophagus
Degenerative motor function in ageing oesophagus
31
What happens in hyper- motility
Idiopathic Oesophageal spasm
32
What is the presentation of hyper motility
Severe episodic chest pain with or without dysphagia | confused with angina/MI
33
What is seen in the imaging Ba swallows of Hyper-motility
Ba swallow - corkscrew appearances
34
What does the investigation of monastery shows in hyper-motility
Exaggerated uncoordinated, hypertonic contractions
35
What is the treatment of hyper-motility
Smooth muscle relaxants
36
What is the aetiology of hypo-motility
Connective tissue disease Diabetes Neuropathy
37
What is the result of hypo-motility
Failure of Lower oesophageal spinchter
38
What is the symptoms of hypo-motility
Heart burn | reflux symptoms
39
What is the aeitology of achalasia
Degeneration and functional loss of inhibitory neurons (ganglion cells) in the myenteric plexus in the distal oesophagus and LOS
40
Why is achalasia suspected to have an inflammatory aetiology
Often surrounded by lymphocytes
41
What is the result of Achalasia
Failure of LOS to relax Causing functional distal obstruction of oesophagus preventing food from entering the stomach
42
What is the symptoms of achalasia
Progressive dysphagia for solids and liquids Weight loss Chest pain (30%) Regurgitation Chest infection
43
What investigation is used to diagnose achalasia
Manometry
44
What are the diagnostic findings in a manometry of achalasia
High pressure in the LOS at rest ( usually above 45mm Hg normal being 10mm) MOST IMPORTANT 2: Failure of the LOS to relax after swallowing An absence of useful (peristaltic) contractions in the lower oesophagus
45
What is the treatment options of achalasia
Pharmacological - Nitrates, - Calcium Channel blockers Endoscopic - Botulinum Toxin Surgical - Myotomy (muscle cut) Pneumatic balloon dilation (either radiological or endoscopically)
46
What is the complications of achalasia
Aspiration pneumonia and lung disease Increased risk of squamous cell oesophageal carcinoma
47
What is the pathology of gastro-oesophageal reflux disease GORD
Pathological acid and bile exposure in the lower oesophageal
48
What is the symptoms of GORD
Heart burn Cough Water Brash Sleep disturbance {Many patients with frequent, pathological episodes of acid/bile reflux do not experience any symptoms!}
49
What is the risk factors of GORD
``` Pregnancy Obesity Drugs lowering the LOS pressure Smoking alcohol Hypo-mobility ```
50
Why is endoscopy a poor diagnostic test for GORD
Most patients (>50%) with reflux symptoms have no visible evidence of oesophageal abnormality when endoscopy is performed
51
Diagnosis of GORD is due to characteristic symptoms but | When must endoscopy be performed
When there is presence of alarm features: Dysphagia, weight loss, Vomiting that may suggest malignancy
52
What is the two main aetiologies of GORD
abnormal oesophageal anatomy Hiatus hernia (many patients have both)
53
What abnormal oesophgeal anatomy can result in GORD occurring
Increased transient relaxations of the LOS Hypotensive LOS Delayed gastric/oesophageal emptying Decreased Oesophageal acid clearance Decreased Tissue resistance to acid/bile
54
Define Hiatus hernia and the two types
Sliding - Fundus of stomach moves through the oesophageal hiatus Para-oespphgaeal - funds of stomach moves proximal through diaphragmatic hiatus
55
What is the pathophysiology of GORD
The mucosa is exposed to acid pepsin and bile This increases cell loss and regenerative activity = inflammation eventually causing erosive oesophagi's
56
What is the complications of GORD
Ulceration Stricture Barrets oesophagus (glandular metaplasia) Carcinoma
57
What is the aetiology of Barretts oesophagus
Intestinal metaplasia related to prolonged acid exposure in distal oesophagus
58
What is the pathology of Barretts oesophagus
Change from squamous to mucin-secreting columnar epithelial cells in lower oesophagus
59
What do the epithelial cells become a precursor of in Barrett's oesophagus What risk does this increase
Dysplasia/adenocarcinoma Therefore have an increased risk of developing oesophageal cancer in high grade dyslplasia
60
What is the treatment of Barretts Oesophagus with high grade dysplasia
Endoscopic Mucosal Resection (EMR) Radio-Frequency Ablation (RFA) Oesophagectomy (rarely due to high mortality)
61
What is the treatment options for GORD
Lifestyle measures Pharmacological - Aliginates (gaviscon) - H2RA (ranitidine) - PPI (omeprazole, lansoprazole) Anti-reflux surgery -Fundoplication
62
What is fundoplication
Full or partial wrapping of the fundus of the stomach around the oesophagus in order to strengthen spinchter
63
What is the two cell types of oesophageal cancer
Squamous cell carcinoma adenocarcinoma
64
How common are benign tumours in oesophageal cancer
rare
65
What is the symptoms of oesophageal cancer
Anorexia and Weight loss Odynophagia -pain when swallowing Chest pain Cough Pneumonia (tracheo-oesophageal fistula) Vocal cord paralysis Haematemesis
66
Where is squamous cell carcinoma likely to occur in oesophageal cancer
Proximal and middle third of the oesophagus
67
What is the morphology and pathology of squamous cell carcinoma in oesophageal cancer
Large exophlitic occluding tumours | Preceded by dysplasia and carcinoma in situ
68
What is the risk factors of squamous cell carcinoma
Smoking alcohol vitamin deficiency/diet
69
What is squamous cell carcinoma Oesophageal cancer associated with
Achalaisa Caustic strictures Plummer vinson syndrome
70
Where is adenocarcinoma oesophageal cancer occur in the oesophagus
In the distal oesophagus
71
What is adenocarcinoma oesophageal cancer associated with
Barrets oesophagus Obesity
72
What is the predisposing factors of adenocarcinoma oesophageal cancer
obesity, male sex, middle age, caucasian
73
What is the presentation of oesophageal cancer
Usually presents late and tumours have commonly spread to Regional lymph nodes or/and Liver
74
Why is tumour invasion easy in oesophageal cancer
Oesophagus lacks a serosal layer, so tumours can easily invade into adjacent structures
75
Where does local invasion occur in oesophageal cancer
Heart Trachea Aorta
76
What does local invasion of oesophgeal cancer limit
Limits surgery intervention - more difficult to treat in late stage presentation
77
What does lymph node envelopment occur early in oesophageal tumours
The Lamina propria | has a rich lymphatic supply compared to the rest of the GI tract
78
Where does metastases of oesophageal cancer occur
Hepatic, Brain, Pulmonary, Bone
79
How is oesophageal cancer diagnoses
Endoscopy and >8 biopsy
80
What investigations are used for Staging of oesophageal cancer and what do they investigation
CT scan - distant metastases Endoscopic ultrasound - T,N staging PET Scan Bone scan Laparoscopy -peritoneal spread (ascites on EUS/CT)
81
What is oesophageal cancer staged by
TNM staging ``` T1- Tumor invades lamina propria or submucosa (a-lamina propria, b-submucosa) T2- Tumor invades muscularis propria T3- Tumor invades adventitia T4- Tumor invades adjacent structures N1- Regional lymph node metastasis M1- Distant metastasis ```
82
What is the Curative treatment for Oesophageal cancer
oesophagectomy +/- adjuvant/ neoadjuvant chemotherapy Potential long term survival - combined chemo and radio
83
Who is oesophagectomy limited to in the treatment of oesophageal cancer
patients with localised disease, without co-morbid disease, usually <70 years of age
84
What is the disadvantages to oesophagectomy
Significant morbidity and mortality - 10% Long post-operative recovery require nutritional support
85
Most oesophageal cancer is incurable at presentation so what is the palliative options of treatment
Endoscopic (stent, laser/APC, PEG) Chemotherapy Radiotherapy Brachytherapy (radioactive plants in tissue)

Alimentary System: Pathology SA (27 decks)

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