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Year 2 GI (JK) > Oesophageal disorders > Flashcards

Oesophageal disorders Flashcards

1
Q

Where does the oesophagus start and end?, state its length

A

starts at the cricoid cartilage (C6) and ends at the stomach (T11/12)

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2
Q

What muscles in the oesophagus produce peristalsis?

A

circular muscle layer

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3
Q

What nerve mediates co-ordinated LOS relaxation and peristalsis?

A

vagus

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4
Q

What maintains the closure of the LOS?

A

right crus striated muscle of the diaphragm

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5
Q

What is heartburn?

A

retrosternal discomfort or burning associated with waterbrash and cough

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6
Q

What is waterbrash?

A

acid taste in the back of the mouth

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7
Q

What is reflux due to?

A

acid/bile reflux into oesophagus

drugs/food can reduce LOS pressure resulting in increased reflux

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8
Q

Does the LOS have a high or low resting pressure?

A

high

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9
Q

What can persistent reflux lead to?

A

Gastroesophageal reflux disease

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10
Q

What is dysphagia?

A

subjective sensation of difficulty swallowing foods and /or liquids

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11
Q

Odynophagia definition

A

pain with swallowing

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12
Q

What 3 things should you ask someone complaining of dysphagia?

A

type of food - severity
pattern - progressive, intermittent
associated features eg weight loss, cough

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13
Q

What are the 2 locations of dysphagia?

A

oropharyngeal

oesophageal

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14
Q

List some causes of dysphagia

A

benign/malignant stricture
motility disorder
oesophagitis
extrinsic pressure eg lung cancer

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15
Q

What investigations are used for dysphagia?

A

endoscopy, barium swallow, oesophageal pH and manometry

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16
Q

What do oesophageal pH and manometry detect?

A

pH - acid

manometry - peristalsis movements

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17
Q

What is hypermotility seen as and how is manometry useful?

A

diffuse oesophageal spasms with corkscrew appearance on barium swallow
unco-ordinated, exaggerated contractions

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18
Q

What is hypomotility caused by and what can it cause?

A

connective tissue disease, diabetes, neuropathy

reflux due to LOS failure

19
Q

What is achalasia?

A

functional loss of myenteric plexus in the LOS and oesophagus
failure of LOS to relax leading to functional obstruction

20
Q

Who does achalasia commonly effect?

A

30-50 yrs, M=F, 1-2 per 100000

21
Q

What are the symptoms of achalasia?

A

progressive dysphagia, weight loss, chest pain, chest infection

22
Q

How is achalasia treated?

A

nitrates, CCBs
endoscopic - botulinum toxin and balloon dilation
myotomy

23
Q

What are the complications of achalasia?

A

aspiration pneumonia, lung disease and cancer

24
Q

What are the symptoms of GORD?

A

waterbrash, cough, heartburn, sleep disturbance

25
Q

What are the risk factors for GORD?

A

pregnancy, obesity, smoking, alcohol, hypermotility

male, white, caucasian

26
Q

When must a patient have an endoscopy?

A

ALARM features

27
Q

What is the aetiology behind GORD without abnormal anatomy?

A

increase in transient LOS relaxations
decrease in gastric and oesophageal emptying
decrease in acid clearance and sensitivity to acid

28
Q

What are the 2 types of hiatus hernia that can cause GORD?

A

sliding

para-oesophageal

29
Q

What are the pathological changes in GORD?

A

oesophagitis

mucosa exposed to acid leading to cell loss

30
Q

Complications of GORD

A

ulceration, stricture, glandular metaplasia and carcinoma

31
Q

What is barrett’s oesophagus and who is effected more men or women?

A

metaplasia related to long acid exposure from squamous to mucus secreting columnar
men

32
Q

is barretts oesophagus a precursor to SCC or adenoC?

A

adenocarcinoma

33
Q

What is the treatment for high grade barretts oesophagus dysplasia?

A

endoscopic mucosal resection
radiofrequency ablation
rarely an oesophagectomy

34
Q

How do we treat GORD?

A

lifestyle, gaviscon, PPI

refactory disease may require fundoplication

35
Q

How does oesophageal carcinoma present?

A

progressive dysphagia, weight loss, haematemesis, odynophagia, cough, chest pain

36
Q

What parts of the oesophagus to SCC and AC effect?

A

SSC proximal and middle 1/3

AC - distal oesophagus

37
Q

What are the main causes of SCC and AC?

A

SSC - smoking and alcohol

AC - barretts oesophagus

38
Q

Explain the reasons why the oesophagus tumours invade easily and have early node involvement

A

lacks serosa

lamina propria has rich lymphatic supply

39
Q

Oesophageal cancer investigations

A

endoscopy and biopsy

CT, MRI, EUS, PT, bone scan

40
Q

Only surgical treatment for oesophageal cancer/.

A

oesophagectomy with adjuvant or neoadjuvant chemotherapy

41
Q

What is adjuvant and neoadjuvant chemotherapy?

A

adjuvant - after chemo

neoadjuvant - before

42
Q

criteria for oesophagectomy

A

under 70, no co-morbidities and localised disease

43
Q

Incurable disease treatment?

A

palliation for dysphagia

44
Q

What is brachytherapy?

A

radiation seed placed close to the tumour

Year 2 GI (JK) (39 decks)

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