Oesophageal disorders Flashcards
Where does the oesophagus start and end?, state its length
starts at the cricoid cartilage (C6) and ends at the stomach (T11/12)
What muscles in the oesophagus produce peristalsis?
circular muscle layer
What nerve mediates co-ordinated LOS relaxation and peristalsis?
vagus
What maintains the closure of the LOS?
right crus striated muscle of the diaphragm
What is heartburn?
retrosternal discomfort or burning associated with waterbrash and cough
What is waterbrash?
acid taste in the back of the mouth
What is reflux due to?
acid/bile reflux into oesophagus
drugs/food can reduce LOS pressure resulting in increased reflux
Does the LOS have a high or low resting pressure?
high
What can persistent reflux lead to?
Gastroesophageal reflux disease
What is dysphagia?
subjective sensation of difficulty swallowing foods and /or liquids
Odynophagia definition
pain with swallowing
What 3 things should you ask someone complaining of dysphagia?
type of food - severity
pattern - progressive, intermittent
associated features eg weight loss, cough
What are the 2 locations of dysphagia?
oropharyngeal
oesophageal
List some causes of dysphagia
benign/malignant stricture
motility disorder
oesophagitis
extrinsic pressure eg lung cancer
What investigations are used for dysphagia?
endoscopy, barium swallow, oesophageal pH and manometry
What do oesophageal pH and manometry detect?
pH - acid
manometry - peristalsis movements
What is hypermotility seen as and how is manometry useful?
diffuse oesophageal spasms with corkscrew appearance on barium swallow
unco-ordinated, exaggerated contractions
What is hypomotility caused by and what can it cause?
connective tissue disease, diabetes, neuropathy
reflux due to LOS failure
What is achalasia?
functional loss of myenteric plexus in the LOS and oesophagus
failure of LOS to relax leading to functional obstruction
Who does achalasia commonly effect?
30-50 yrs, M=F, 1-2 per 100000
What are the symptoms of achalasia?
progressive dysphagia, weight loss, chest pain, chest infection
How is achalasia treated?
nitrates, CCBs
endoscopic - botulinum toxin and balloon dilation
myotomy
What are the complications of achalasia?
aspiration pneumonia, lung disease and cancer
What are the symptoms of GORD?
waterbrash, cough, heartburn, sleep disturbance
What are the risk factors for GORD?
pregnancy, obesity, smoking, alcohol, hypermotility
male, white, caucasian
When must a patient have an endoscopy?
ALARM features
What is the aetiology behind GORD without abnormal anatomy?
increase in transient LOS relaxations
decrease in gastric and oesophageal emptying
decrease in acid clearance and sensitivity to acid
What are the 2 types of hiatus hernia that can cause GORD?
sliding
para-oesophageal
What are the pathological changes in GORD?
oesophagitis
mucosa exposed to acid leading to cell loss
Complications of GORD
ulceration, stricture, glandular metaplasia and carcinoma
What is barrett’s oesophagus and who is effected more men or women?
metaplasia related to long acid exposure from squamous to mucus secreting columnar
men
is barretts oesophagus a precursor to SCC or adenoC?
adenocarcinoma
What is the treatment for high grade barretts oesophagus dysplasia?
endoscopic mucosal resection
radiofrequency ablation
rarely an oesophagectomy
How do we treat GORD?
lifestyle, gaviscon, PPI
refactory disease may require fundoplication
How does oesophageal carcinoma present?
progressive dysphagia, weight loss, haematemesis, odynophagia, cough, chest pain
What parts of the oesophagus to SCC and AC effect?
SSC proximal and middle 1/3
AC - distal oesophagus
What are the main causes of SCC and AC?
SSC - smoking and alcohol
AC - barretts oesophagus
Explain the reasons why the oesophagus tumours invade easily and have early node involvement
lacks serosa
lamina propria has rich lymphatic supply
Oesophageal cancer investigations
endoscopy and biopsy
CT, MRI, EUS, PT, bone scan
Only surgical treatment for oesophageal cancer/.
oesophagectomy with adjuvant or neoadjuvant chemotherapy
What is adjuvant and neoadjuvant chemotherapy?
adjuvant - after chemo
neoadjuvant - before
criteria for oesophagectomy
under 70, no co-morbidities and localised disease
Incurable disease treatment?
palliation for dysphagia
What is brachytherapy?
radiation seed placed close to the tumour
