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Alimentary System > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

Oesophageal peristalsis produced by

A

Oesophageal circular muscles

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2
Q

Oesophageal peristalsis coordinates with

A

Lower oesophageal sphincter (LOS) relaxation

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3
Q

Contraction in the oesophageal body

A

Peristalsis

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4
Q

Peristalsis and LOS relaxation mediated by

A

Vagus nerve

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5
Q

Symptoms of oesophageal disease

A

Heartburn

Dysphagia

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6
Q

Heartburn

A

Retrosternal discomfort or burning sensation
consequence of reflux of acidic and/or bilious gastric contents into the oesophagus
A degree of reflux occurs physiologically (eg after swallowing)
Certain drugs/foods, (e.g. alcohol, nicotine, dietary xanthines) can reduce the LOS pressure resulting in increased reflux / heartburn
Persistent reflux and heartburn leads to GORD

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7
Q

GORD

A

Gastro-oesophageal reflux disease

Due to pathological acid (and bile) exposure in lower oesophagus or abnormal anatomy (eg hiatus hernia)

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8
Q

Dysphagia

A

Difficulty swallowing foods and/or liquids

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9
Q

Pain swallowing foods

A

Odynophagia

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10
Q

Causes of oesophageal dysphagia

A

Benign stricture
Malignant stricture (oesophageal cancer)
Motility disorders (eg achalasia, presbyoesophagus)
Eosinophilic oesophagitis
Extrinsic compression (eg in lung cancer)

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11
Q

Oesophageal disease investigations

A 
Endoscopy
Contrast radiography (barium swallow)
Oesophageal pH and manometry
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12
Q

Motility disorders

A

Hypermotility
Hypermobility
Achalasia

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13
Q

Hypermotility

A

Corkscrew appearance on barium swallow
Severe, episodic chest pain +/- dysphagia
Cause unclear (idiopathic)
Manometry shows exaggerated, uncoordinated, hypertonic contractions

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14
Q

Hypomotility

A

Associated with connective tissue disease, diabetes, neuropathy
Causes failure of LOS mechanism leading to heartburn and reflux symptoms

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15
Q

Achalasia pathology

A

Degeneration of inhibitory neurons (ganglion cells) in the myenteric plexus in the oesophagus
Often surrounded by lymphocytes- so an inflammatory aetiology is suspected

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16
Q

Main feature and result of achalasia

A

Failure of LOS to relax - causes functional distal obstruction of oesophagus

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17
Q

Symptoms of achalasia

A

Progressive dysphagia for solids and liquids
Weight loss
Chest pain
Regurgitation and chest infection

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18
Q

Pharmacological treatment of achalasia

A

Nitrates

Calcium channel blockers

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19
Q

Endoscopic treatment of achalasia

A

Botulinum Toxin

Pneumatic balloon dilation

20
Q

Radiological treatment of achalasia

A

Pneumatic balloon dilation

21
Q

Surgical treatment of achalasia

A

Myotomy

22
Q

Complications of achalasia

A

Aspiration pneumonia and lung disease

Increased risk of squamous cell oesophageal carcinoma

23
Q

Types of hiatus hernia

A

Fundus of stomach moves proximally through the diaphragmatic hiatus
Sliding - still one tube
Para-oesophageal - with a wee sac sticking out to the side

24
Q

GORD complications

A

Ulceration
Stricture
Carcinoma
Glandular metaplasia (Barrett’s oesophagus)

25
Q

Barrett’s oesophagus

A

Intestinal metaplasia related to prolonged acid exposure in distal oesophagus
Change from squamous to mucin-secreting columnar (ie gastric type) epithelial cells in lower oesophagus
Precursor to dysplasia/ adenocarcinoma

26
Q

Barrett’s oesophagus treatment

A

Endoscopic Mucosal Resection (EMR)
Radio-Frequency Ablation (RFA)
Oesophagectomy rarely

27
Q

GORD treatment

A

Mainly empirical in absence of alarm features

28
Q

Empirical treatment of GORD

A

Without investigation
Lifestyle measures
Pharmacological

29
Q

GORD treatment for refractory disease/symptoms following investigation

A

Anti-reflux surgery

30
Q

Oesophageal cancer types

A

Benign tumours rare
Squamous cell carcinoma
Adenocarcinoma

31
Q

Pesentation of oesophageal cancer

A 
Progressive dysphagia 
Anorexia and Weight loss 
Odynophagia			
Chest pain
Cough
Pneumonia (tracheo-oesophageal fistula)
Vocal cord paralysis	
Haematemesis
32
Q

Adenocarcinoma located

A

Distal oesophagus

33
Q

Squamous cell carcinoma located

A

Proximal and middle third of oesophagus

34
Q

Adenocarcinoma associated with

A

Barrett’s oesophagus

35
Q

Squamous cell carcinoma associated with

A

Achalasia
Caustic strictures
Plummer-Vinson syndrome

36
Q

Risk factors for adenocarcinoma

A

Obesity
Male
Middle aged
Caucasian

37
Q

Risk factors for squamous cell

A

Tobacco

Alcohol

38
Q

Squamous cell carcinoma preceded by

A

Dysplasia

Forms large, exophytic occluding tumours

39
Q

Oesophagus lacks a _____ allowing tumour invasion to adjacent structures to occur more easily

A

Serosal layer

40
Q

Tumours at presentation

A

Late

Normally regional node/liver metastases

41
Q

Oesophageal metastases

A

Hepatic
Brain
Pulmonary
Bone

42
Q

Oesophageal cancer investigation

A 
Diagnosis by endoscopy & biopsy
Staging:
    CT Scan
    Endoscopic ultrasound
    PET Scan
    Bone Scan
43
Q

Oesophageal cancer treatment

A

Only potential cure is surgical oesophagectomy +/- adjuvant (after) or neoadjuvant (before) chemotherapy
Palliative care

44
Q

Eosinophilic oesophagitis

A

Chronic immune-/allergen-mediated condition Eosinophilic infiltration of the oesophageal epithelium
in the absence of secondary causes of local or systemic eosinophilia

45
Q

Presentation of eosinophilic oesophagitis

A

Dysphagia and food bolus obstruction

46
Q

Treatment of eosinophilic oesophagitis

A

Topical/swallowed corticosteroids
Dietary elimination
Endoscopic dilatation

Alimentary System (26 decks)

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