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Year 2 - Alimentary System > oesophageal disorders > Flashcards

oesophageal disorders Flashcards

1
Q

where does the oesophagus begin and terminate?

A

cricoid cartilage (C6)

T11-T12

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2
Q

upper 3-4cm of the oesophagus is ….. muscle

remainder is …… muscle

A

striated

smooth

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3
Q

oesophagus is lined with?

A

stratified squamous epithelium

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4
Q

oesophageal peristalsis is produced by oesophageal …

A

circular muscles and propels swelled materials distally into the stomach

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5
Q

contraction in the oesophageal body (peristalsis) and relaxation of the LOS is mediated via the….

A

vagus nerve

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6
Q

LOS - striated muscle of the

A

right crus of the diaphragm

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7
Q

heartburn is a consequence of….

A

reflux of acidic and/or billows gastric contents into the oesophagus

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8
Q

certain drugs (alcohol/nicotine) can reduce the LOS pressure resulting in increased ….

A

reflux/heartburn

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9
Q

persistant reflux and heartburn leads to

A

gastro-oesophageal reflux disease (GORD)

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10
Q

with dysphagia you should enquire about

A

type of food (solid, liquid)

pattern (progressive, intermittent)

associated features (weight loss, regurgitation)

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11
Q

causes of oesophageal dysphagia

A

benign stricture

malignant stricture (oesophageal cancer)

motility disorders

eosinophilic oesphagitis

extrinsic compression

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12
Q

oesophageal disease investigations

A

endoscopy (upper GI)

contrast radiology (barium swallow)

oesophageal pH and manometry

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13
Q

hyper motility

A

severe, episodic chest pain

often confused with angina

cause is unclear

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14
Q

hypo motility

A

associated with connective tissue disease

causes failure of LOS mechanism leading to heartburn and reflux symptoms

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15
Q

achalasia

A

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

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16
Q

main symptoms of achalasia

A

failure of LOS to relax

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17
Q

result of achalasia

A

functional distal obstruction of oesophagus

18
Q

symptoms of achalasia

A

progressive dysphagia for solids and liquids

weight loss

cheat pain (30%)

regurgitation and chest infection

19
Q

treatment of achalasia

A

nitrates

calcium channel blockers

botulinum toxin

balloon dilatation

myotomy

20
Q

complications of achalasia

A

aspiration pneumonia and lung disease

increased risk of squamous cell oesophageal carcinoma

21
Q

Gastro-oesophageal reflux disease

A

due to pathological acid (and bile) exposure in lower oesophagus

22
Q

symptoms of GORD

A

heartburn

cough

water brash

sleep disturbance

23
Q

risk factors of GORD

A

pregnancy

obesity

drugs lowering LOS pressure

smoking

alcoholism

hypomotility

24
Q

GORD aetiology

GORD without abnormal anatomy

A

increase in transient relaxations of the LOS

delayed gastric emptying

hypotensive LOS

delayed oesophageal emptying

reduced oesophageal acid clearance

25
Q

GORD aetiology

GORD due to hiatus hernia

A

anatomical distortion of the oesophageal junction

26
Q

hiatus hernia 2 main types

A

sliding and para-oesophageal

27
Q

hiatus hernia

A

fundus of the stomach moves proximally through the diaphragmatic hiatus

28
Q

what 2 factors predispose you to a hiatus hernia

A

obesity

ageing

29
Q

GORD pathophysiology

A

mucosa exposed to acid-pepsin and bile

increased cell loss and regenerative activity (ie inflammation)

erosive oesphagitis

30
Q

GORD complications

A

ulceration

stricture

glandular metaplasia (barretts oesophagus)

carcinoma

31
Q

Barrett’s oesophagus

A

intestinal metaplasia related to prolonged acid exposure on distal oesophagus

change from squamous to mucin secreting columnar cells

32
Q

barretts oesophagus is a precursor to

A

dysplasia / adenocarcinoma

33
Q

Treatment of barretts oesophagus

A

endoscopic mucosal resection

radio-frequency ablation

oesophagectomy (rarely)

34
Q

GORD treatment

A

lifestyle measures

alginates –> Gaviscon

H2RA –> Ranitidine

Proton Pump Inhibitor –> Omeprazole

anti-reflux surgery

35
Q

oesophageal cancers are usually

A

squamous cell carcinomas

adenocarcinoma

36
Q

oesophageal cancer presentation

A

progressive dysphagia

anorexia and weight loss

chest pain

cough

pneumonia

vocal cord paralysis

haematemesis

37
Q

squamous cell carcinoma

A

often large exophytic occluding tumours

occur in proximal and middle third of oesophagus

38
Q

where do adenocarcinomas usually occur?

A

distal oesophagus

39
Q

adenocarcinoma is associated with what condition?

A

Barretts oesophagus

40
Q

common metastasis from oesophageal cancer

A

hepatic

brain

pulmonary

bones

41
Q

oesophageal investigation

A

endoscopy

biopsy

CT scan

endoscopic ultrasound

PET scan

bone scan

42
Q

oesophageal cancer treatment

A

palliation

endoscopic

chemotherapy

radiotherapy

brachytherapy

Year 2 - Alimentary System (31 decks)

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