Oesophageal Disorders Flashcards
Oesophagus begins and ends at what vertebral levels?
C6 - T11/12
Muscle distribution of the oesophagus
Upper 3-4cm skeletal
Rest is smooth
What type of cell lines the esophagus?
Non-keratinising stratified squamous epithelium
Vagus nerve stimulation mediates what in the oesophagus?
Peristalsis
LOS relaxation
What causes heartburn?
Acid Reflux
Bilious gastric contents into oesophagus
How do certain drugs/foods cause heartburn?
Reducing LOS pressure increasing reflux
Persistent reflux and heartburn leads to what?
GORD
What is dysphagia?
Subjective sensation of difficulty in swallowing boli
What to enquire about if a patient presents with dysphagia?
Type of food
Pattern of symptoms
Associated symptoms
Location of sensation
What is odynophagia?
Pain with swallowing
Causes of oesophageal dysphagia
Stricture (ben/mal)
Motility disorder
Esosinophilic oesophagitis
Extrinsic compression
Investigations in oesophageal disease
Endoscopy (UGIE) Contrast radiology (Ba) Oesophageal pH + manometry
Low oesophageal pH suggests what?
Acid presence
Manometry tests for what?
Dysphagia
Suspected motility issues
Hypermotility of the oesophagus appears as what?
Corkscrew Ba swallow
Severe episodic chest pain
Some dysphagia
Hypermotility of the oesophagus is often confused with what?
Angina/MI
Manometry of hypermotility shows what?
Uncoordinated, hypertonic contractions
Treatment for hypermotility
Smooth muscle relaxants
What is hypomotility associated with?
Connective tissue disease
Diabetes
Neuropathy
Hypomotility causes what?
Failure of LOS mechanism causing heartburn and reflux
What is achalasia?
Loss of myenteric plexus ganglion in distal oesophagus/LOS
Cardinal feature of Achalasia
Failure of the LOS to relax leading to distal obstruction
Symptoms of achalasia
Progressive Dysphagia
Chest pain
Weight loss
Regurgitation
Treatment for achalasia
Nitrates, CCBs
Botulinum toxin
Pneumatic balloon dilation
Myotomy
Complications of achalasia
Aspiration pneumonia
Increase risk of squamous cell carcinoma
Symptoms of GORD
Heartburn
Cough
Water brash
Sleep disturbance
Risk factors for GORD
Smoking Alcoholism Obesity LOS weakening Obesity
GORD is typically diagnosed how?
Symptomatically without diagnostic testing
Why is endoscopy not ideal in GORD?
> 50% of patients will have no visible oesophageal abnormality
When must an endoscopy be performed in a GORD patient?
Signs of malignancy:
Dysphagia
Weight loss
Vomiting
What are the two main types of hiatus hernia?
Sliding
Para-oesophageal
How does GORD cause damage to the epithelium?
Mucosa exposed to acid/pepsin/bile
Increased cell loss and inflammation
Erosive esophagitis
What are the main complications of GORD?
Ulceration
Stricture
Barretts Oesophagus
Carcinoma
What is barretts oesophagus?
Change from squamous to mucin-secreting epithelium in the distal oesophagus due to repeated acid exposure
Barretts oesophagus is a precursor to what?
Adenocarcinoma
What is the treatment for severe dysplasia in Barretts oesophagus?
Endoscopic Mucosal Resection
Radiofrequency ablation
Oesophagectomy (rare)
How is GORD treated?
Lifestyle changes Alginates H2RA PPIs ?Acid-reflux surgery
How does oesophageal cancer typically present?
PROGRESSIVE DYSPHAGIA ANOREXIA/WL Odynophagia Chest pain Cough Pneumonia Haematemesis Vocal cord paralysis
Squamous cell carcinoma of the oesophagus occurs where?
Proximal and middle 1/3 of oesophagus
Largest risk factors for oesophageal squamous cell carcinoma?
Tobacco and Alcohol
Adenocarcinoma of the oesophagus occurs where?
Distal 1/3 oesophagus
At what stage does oesophageal cancer typically present?
Late
Regional nodal spread
Invasive
Why does a tumour of the oesophagus have a greater likelihood of invading surrounding structures?
Lack of a serosal layer
Lamina propria has a rich lymphatic supply
Prognosis of oesophageal cancer?
5y survival<10%
How is oesophageal cancer investigated?
Endoscopy and biopsy
Staging (TNM)
How is oesophageal cancer staged?
CT Scan
Endoscopic Ultrasound
PET Scan
Bone scan
How is oesophageal cancer treated?
Oesophagectomy and chemotherapy
?Palliation
What is oesinophilic oesophagitis?
Chronic immune mediated oesophageal dysfunction
What is the aetiology of eosinophilic oesophagitis?
Eosinophilic infiltration of the oesophageal epithelium IN ABSENCE of secondary causes
How does eosinophilic oesophagitis usually present?
Dysphagia
Food bolus obstruction
Treatment for eosinophilic oesophagitis?
Topical/swallowed corticosteroids
Dietary elimination
Endoscopic dilation
