Oesophageal Disorders Flashcards
What conditions are hypo motility of the oesophagus associated with?
connective tissue diorders
diabetes
neuropathy
what is hypo motility of the oesophagus?
failure of the LOS mechanism which results in reflux and heart burn.
the LOS doesn’t contract efficiently
what is achalasia and what causes it?
Achalasia is failure of the LOS to relax
Achalasia is caused by a functional loss of myenteric plexus ganglion inhibitory cells
what symptom is found in patients with hyper motility?
chest pain similar to angina
dysphagia
what are the symptoms of achalasia?
progressive dysphagia with solids and liquid
chest pain
weight loss
regurgitation and chest infection
what are the treatments for achalasia?
nitrates and CCB
endoscopic botulin toxin & a pneumatic balloon dilatation
radiological pneumatic balloon dilatation
surgical myotomy
what are the complications of achalasia?
aspiration pneumonia and lung disease
increased risk of squamous cell oesophageal carcinoma
what are the 3 main investigations used to investigate oesophageal disorders?
endoscopy contrast radiology (barium swallow) oesophageal PH and Manometry
intermittent progression of dysphagia with history of heart burn is likely to be caused by what?
benign peptic stricture
relentless progression of dysphagia over weeks is likely due to what?
malignant structure
slow onset dysphagia for solids and liquids at the same time is likely to be due to what?
motility disorder
describe what the pathophysiology of gastro-oesophageal reflux disease is.
the mucosa is exposed to acid-pepsin and bile
this increases cell loss and regenerative activity (inflammation)
this results in an erosive oesophagus
what are the risk factors for gastro-oesophageal reflux?
pregnancy obesity drugs smoking alcohol hypomotility
what are the causes of gastro-oesophageal reflux disease?
increase transient relaxations of the LOS
hypotensive LOS
delayed gastric emptying
delayed esophageal emptying
decreased oesophageal acid clearance
decreased tissue resistance to bile/acid
Hiatus hernia (distortion of the OG junction)
what are the symptoms of gastro-oesophageal reflux disease?
asymptomatic heart burn cough watersplash sleep disturbance
what are the treatments for GORD?
lifestyle changes drugs: - alginates (gaviscon) - H2 receptor antagonist (Ranitidine) PPI (omeprazole) reflux surgery: fundoplication
in what sex and ethnicity is GORD more common in?
male > female
caucasian > black > asian
what are the complications of GORD?
ulceration
stricture
metaplasia (Barrett’s oesophagus)
carcinoma
where in the oesophagus is squamous cell and adenocarcinoma found?
squamous cell - proximal and middle third
adenocarcinoma- distal
what are the main risk factors for squamous cell and adenocarcinoma of the oesophagus?
squamous cell = tobacco and alcohol
adenocarcinoma = obesity, male, middle aged, caucasian
what condition is adenocarcinoma of the oesophagus associated with and what is this?
barrett’s oesophagus
metaplasia of the oesophageal epithelium from squamous to columnar cells
what conditions are squamous cell carcinoma associated with?
achalasia
caustic strictures
pulmmer-vinson syndrome
what is the presentation of oesophageal cancer?
progressive dysphagia weight loss odynophagia chest pain cough vocal cord paralysis haematemesis pneumonia (trachea-oesophageal fistula)
what investigations are used in the diagnosis of oesophageal cancer?
endoscopy and biopsy
what is the treatment for oesophageal cancer?
surgical oesophagectomy + neoadjuvant/adjuvant chemo in selected patients
chemo + radiotherapy improves survival in inoperative patients
where are metastasis most commonly found in oesophageal cancer?
liver
lungs
brain
bone
what is oesinophillic oesophagitis?
chronic immune/allergen mediated condition
eosinophilic infiltration
symptoms of oesophageal dysfunction
what is the presentation of eosinophilic oesophagitis?
dysphagia and food bolus obstruction
what is the treatment for eosinophilic oesophagitis?
topical (throat spray) or oral steroids
dietary elimination
endoscopic dilatation
in what sex is eosinophilic oeosphagitis most common in and what age group?
males > females
most commonly found in young children
what are the 3 different approaches to a oesophagectomy?
ivor lewis
left thoracic abdominal
trans hiatal
what is the prognosis for a patient with metastasic oesophageal cancer?
<1 year
what is the prognosis for a patient with resectable oesophageal cancer and has an oesophagectomy?
5yr survival 45%
what is the prognosis for a patient with non metastatic oesophageal cancer and is treated with chemo+radiotherapy?
5 yr survival 30%
what are the conduits for an oesophagectomy?
stomach
colon
what staging classification is used for oesophageal cancer?
TNM
what investigation is used for M staging oesophageal cancer?
PET CT
what investigation is used for T/N staging oesophageal cancer?
endoscopy USS
what are the treatment options for a patient with metastatic oesophageal cancer?
stenting
palliative chemotherapy and radiotherapy
what is the morbidity and mortality statistics for an oesophagectomy and how long does it normally take a patient to recover?
morbidity = 20-30%
mortality = 5%
10 months to get to their pre-op quality of life
what is the treatment for hiatus hernia GORD ?
fundoplication surgery
what type of hiatus hernia resulting in reflux causes chest pain?
paraoesophagheal
what are the side effects of fundoplication?
dysphagia difficulty to burp and vomit gas bloating excess flatulence diarrhoea
what are the 2 different hiatus hernias?
sliding
paraoesophagheal
what are the complications of GORD?
ulceration
stricture
glandular metaplasia (barretts oesophagus)
carcinoma
what is barretts oesophagus?
chronic reflux causes the oesophageal metaplasia from simple squamous to columnar epithelium
can progress to neoplasia = adenocarcinoma
