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Alimentary Clinical medicine > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

What conditions are hypo motility of the oesophagus associated with?

A

connective tissue diorders
diabetes
neuropathy

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2
Q

what is hypo motility of the oesophagus?

A

failure of the LOS mechanism which results in reflux and heart burn.
the LOS doesn’t contract efficiently

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3
Q

what is achalasia and what causes it?

A

Achalasia is failure of the LOS to relax

Achalasia is caused by a functional loss of myenteric plexus ganglion inhibitory cells

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4
Q

what symptom is found in patients with hyper motility?

A

chest pain similar to angina

dysphagia

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5
Q

what are the symptoms of achalasia?

A

progressive dysphagia with solids and liquid
chest pain
weight loss
regurgitation and chest infection

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6
Q

what are the treatments for achalasia?

A

nitrates and CCB
endoscopic botulin toxin & a pneumatic balloon dilatation
radiological pneumatic balloon dilatation
surgical myotomy

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7
Q

what are the complications of achalasia?

A

aspiration pneumonia and lung disease

increased risk of squamous cell oesophageal carcinoma

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8
Q

what are the 3 main investigations used to investigate oesophageal disorders?

A 
endoscopy 
contrast radiology (barium swallow)
oesophageal PH and Manometry
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9
Q

intermittent progression of dysphagia with history of heart burn is likely to be caused by what?

A

benign peptic stricture

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10
Q

relentless progression of dysphagia over weeks is likely due to what?

A

malignant structure

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11
Q

slow onset dysphagia for solids and liquids at the same time is likely to be due to what?

A

motility disorder

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12
Q

describe what the pathophysiology of gastro-oesophageal reflux disease is.

A

the mucosa is exposed to acid-pepsin and bile
this increases cell loss and regenerative activity (inflammation)
this results in an erosive oesophagus

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13
Q

what are the risk factors for gastro-oesophageal reflux?

A 
pregnancy
obesity
drugs
smoking
alcohol
hypomotility
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14
Q

what are the causes of gastro-oesophageal reflux disease?

A

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)

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15
Q

what are the symptoms of gastro-oesophageal reflux disease?

A 
asymptomatic
heart burn
cough
watersplash
sleep disturbance
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16
Q

what are the treatments for GORD?

A 
lifestyle changes
drugs: 
- alginates (gaviscon)
- H2 receptor antagonist (Ranitidine)
PPI (omeprazole) 
reflux surgery: fundoplication
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17
Q

in what sex and ethnicity is GORD more common in?

A

male > female

caucasian > black > asian

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18
Q

what are the complications of GORD?

A

ulceration
stricture
metaplasia (Barrett’s oesophagus)
carcinoma

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19
Q

where in the oesophagus is squamous cell and adenocarcinoma found?

A

squamous cell - proximal and middle third

adenocarcinoma- distal

20
Q

what are the main risk factors for squamous cell and adenocarcinoma of the oesophagus?

A

squamous cell = tobacco and alcohol

adenocarcinoma = obesity, male, middle aged, caucasian

21
Q

what condition is adenocarcinoma of the oesophagus associated with and what is this?

A

barrett’s oesophagus

metaplasia of the oesophageal epithelium from squamous to columnar cells

22
Q

what conditions are squamous cell carcinoma associated with?

A

achalasia
caustic strictures
pulmmer-vinson syndrome

23
Q

what is the presentation of oesophageal cancer?

A 
progressive dysphagia 
weight loss
odynophagia 
chest pain
cough
vocal cord paralysis
haematemesis
pneumonia (trachea-oesophageal fistula)
24
Q

what investigations are used in the diagnosis of oesophageal cancer?

A

endoscopy and biopsy

25
Q

what is the treatment for oesophageal cancer?

A

surgical oesophagectomy + neoadjuvant/adjuvant chemo in selected patients
chemo + radiotherapy improves survival in inoperative patients

26
Q

where are metastasis most commonly found in oesophageal cancer?

A

liver
lungs
brain
bone

27
Q

what is oesinophillic oesophagitis?

A

chronic immune/allergen mediated condition
eosinophilic infiltration
symptoms of oesophageal dysfunction

28
Q

what is the presentation of eosinophilic oesophagitis?

A

dysphagia and food bolus obstruction

29
Q

what is the treatment for eosinophilic oesophagitis?

A

topical (throat spray) or oral steroids
dietary elimination
endoscopic dilatation

30
Q

in what sex is eosinophilic oeosphagitis most common in and what age group?

A

males > females

most commonly found in young children

31
Q

what are the 3 different approaches to a oesophagectomy?

A

ivor lewis
left thoracic abdominal
trans hiatal

32
Q

what is the prognosis for a patient with metastasic oesophageal cancer?

A

<1 year

33
Q

what is the prognosis for a patient with resectable oesophageal cancer and has an oesophagectomy?

A

5yr survival 45%

34
Q

what is the prognosis for a patient with non metastatic oesophageal cancer and is treated with chemo+radiotherapy?

A

5 yr survival 30%

35
Q

what are the conduits for an oesophagectomy?

A

stomach

colon

36
Q

what staging classification is used for oesophageal cancer?

A

TNM

37
Q

what investigation is used for M staging oesophageal cancer?

A

PET CT

38
Q

what investigation is used for T/N staging oesophageal cancer?

A

endoscopy USS

39
Q

what are the treatment options for a patient with metastatic oesophageal cancer?

A

stenting

palliative chemotherapy and radiotherapy

40
Q

what is the morbidity and mortality statistics for an oesophagectomy and how long does it normally take a patient to recover?

A

morbidity = 20-30%
mortality = 5%
10 months to get to their pre-op quality of life

41
Q

what is the treatment for hiatus hernia GORD ?

A

fundoplication surgery

42
Q

what type of hiatus hernia resulting in reflux causes chest pain?

A

paraoesophagheal

43
Q

what are the side effects of fundoplication?

A 
dysphagia
difficulty to burp and vomit
gas bloating
excess flatulence 
diarrhoea
44
Q

what are the 2 different hiatus hernias?

A

sliding

paraoesophagheal

45
Q

what are the complications of GORD?

A

ulceration
stricture
glandular metaplasia (barretts oesophagus)
carcinoma

46
Q

what is barretts oesophagus?

A

chronic reflux causes the oesophageal metaplasia from simple squamous to columnar epithelium
can progress to neoplasia = adenocarcinoma

Alimentary Clinical medicine (23 decks)

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