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Gastrointestinal > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

What is heartburn?

A

Retrosternal discomfort or burning associated with waterbrash/cough as a consequence of acid reflux

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2
Q

What are the causes of oesophageal dysphagia?

A

Benign stricture, malignant stricture, motility disorders (e.g. achalasia), eosinophilic oesophagitis and extrinsic compression (e.g. lung cancer)

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3
Q

What investigations can be done for dysphagia?

A

Upper GI endoscopy, contrast barium swallow, oesophageal pH and manometry

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4
Q

What are the signs of hypermotility?

A

Severe, episodic chest pain with or without dysphagia

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5
Q

How does hypermotility appear on manometry?

A

Exaggerated, uncoordinated, hypertonic contractions

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6
Q

How is hypermotility treated?

A

With smooth muscle relaxants

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7
Q

What are the causes of hypomotility?

A

Connective tissue disease, diabetes and neuropathy

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8
Q

What is the cause of achalasia?

A

Functional loss of myenteric plexus ganglion cells in distal oesophagus and LOS

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9
Q

What is the pathology of achalasia?

A

Failure of LOS to relax and functional distal obstruction of oesophagus

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10
Q

What are the symptoms of achalasia?

A

Progressive dysphagia, weight loss, chest pain, regurgitation and chest infection

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11
Q

What is the treatment of achalasia?

A

Pharmacological: nitrates and CCBs
Endoscopic: botulinum toxin and pneumatic balloon dilation
Radiological: pneumatic balloon dilation
Surgical: myotomy

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12
Q

What are the symptoms of GORD?

A

Heartburn, cough, water brash and sleep disturbance

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13
Q

What are the risk factors of GORD?

A

Pregnancy, obesity, drugs lowering LOS pressure, smoking, alcoholism and hypomotility

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14
Q

When is endoscopy indicated in GORD?

A

In the presence of alarm features

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15
Q

What are the complications of GORD?

A

Ulcerations, stricture, glandular metaplasia (Barrett’s oesophagus) and carcinoma

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16
Q

What is barrett’s oesophagus?

A

Intestinal metaplasia related to prolonged acid exposure in distal oesophagus - change from squamous to mucin secreting columnar cells

17
Q

What is the treatment of Barrett’s oesophagus?

A

Endoscopic mucosal resection, radio-frequency ablation and oesophagectomy (rarely)

18
Q

What is the treatment of GORD?

A

Lifestyle measures, alginates (gaviscon), ranitidine and PPIs (omeprazole) and anti-reflux surgery (fundoplication)

19
Q

What histological types of oesophageal cancer are there?

A

Squamous cell or adenocarcinoma

20
Q

What are the presentations of oesophageal cancer?

A

Progressive dysphagia, anorexia/weight loss, odynophagia, chest pain, cough, pneumonia, vocal cord paralysis and haematemesis

21
Q

What are the risk factors for squamous cell carcinomas?

A

Tobacco, alcohol, diet, achalasia, caustic strictures and Plummer-Vinson syndrome

22
Q

What are the risk factors for adenocarcinoma?

A

Obesity, male sex, middle age and caucasian

23
Q

Where are the common sites from metastases from the oesophagus?

A

Hepatic, brain, pulmonary and bone

24
Q

What is the prognosis for oesophageal cancer?

A

5yr survival less than 10%

25
Q

What investigations are used in diagnosing oesophageal cancer?

A

Endoscopy and biopsy

26
Q

What investigations are used to stage oesophageal cancer?

A

CT scan, endoscopic ultrasound, PET scan and bone scan

27
Q

What is the treatment for oesophageal cancer?

A

Curative - surgical oesophaectomy +/- chemotherapy

Palliative: endoscopic, chemotherapy, radiotherapy and brachytherapy

28
Q

What is eosinophilic oesophagitis?

A

Chronic immune condition defined clinically by symptoms of oesophageal dysfunction and pathologically by eosinophilic infiltration of the oesophageal epithelium in the absence of secondary causes

29
Q

What is the presentation of eosinophilic oesophagitis?

A

Dysphagia and food bolus obstruction

30
Q

What is the treatment of eosinophilic oesophagitis?

A

Topical/swallowed corticosteroids, dietary elimination and endoscopic dilatation

Gastrointestinal (23 decks)

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