oesophageal disorders Flashcards
where does the oesophagus begin and terminate?
cricoid cartilage (C6)
T11-T12
upper 3-4cm of the oesophagus is ….. muscle
remainder is …… muscle
striated
smooth
oesophagus is lined with?
stratified squamous epithelium
oesophageal peristalsis is produced by oesophageal …
circular muscles and propels swelled materials distally into the stomach
contraction in the oesophageal body (peristalsis) and relaxation of the LOS is mediated via the….
vagus nerve
LOS - striated muscle of the
right crus of the diaphragm
heartburn is a consequence of….
reflux of acidic and/or billows gastric contents into the oesophagus
certain drugs (alcohol/nicotine) can reduce the LOS pressure resulting in increased ….
reflux/heartburn
persistant reflux and heartburn leads to
gastro-oesophageal reflux disease (GORD)
with dysphagia you should enquire about
type of food (solid, liquid)
pattern (progressive, intermittent)
associated features (weight loss, regurgitation)
causes of oesophageal dysphagia
benign stricture
malignant stricture (oesophageal cancer)
motility disorders
eosinophilic oesphagitis
extrinsic compression
oesophageal disease investigations
endoscopy (upper GI)
contrast radiology (barium swallow)
oesophageal pH and manometry
hyper motility
severe, episodic chest pain
often confused with angina
cause is unclear
hypo motility
associated with connective tissue disease
causes failure of LOS mechanism leading to heartburn and reflux symptoms
achalasia
functional loss of myenteric plexus ganglion cells in distal oesophagus and LOS
main symptoms of achalasia
failure of LOS to relax
result of achalasia
functional distal obstruction of oesophagus
symptoms of achalasia
progressive dysphagia for solids and liquids
weight loss
cheat pain (30%)
regurgitation and chest infection
treatment of achalasia
nitrates
calcium channel blockers
botulinum toxin
balloon dilatation
myotomy
complications of achalasia
aspiration pneumonia and lung disease
increased risk of squamous cell oesophageal carcinoma
Gastro-oesophageal reflux disease
due to pathological acid (and bile) exposure in lower oesophagus
symptoms of GORD
heartburn
cough
water brash
sleep disturbance
risk factors of GORD
pregnancy
obesity
drugs lowering LOS pressure
smoking
alcoholism
hypomotility
GORD aetiology
GORD without abnormal anatomy
increase in transient relaxations of the LOS
delayed gastric emptying
hypotensive LOS
delayed oesophageal emptying
reduced oesophageal acid clearance
GORD aetiology
GORD due to hiatus hernia
anatomical distortion of the oesophageal junction
hiatus hernia 2 main types
sliding and para-oesophageal
hiatus hernia
fundus of the stomach moves proximally through the diaphragmatic hiatus
what 2 factors predispose you to a hiatus hernia
obesity
ageing
GORD pathophysiology
mucosa exposed to acid-pepsin and bile
increased cell loss and regenerative activity (ie inflammation)
erosive oesphagitis
GORD complications
ulceration
stricture
glandular metaplasia (barretts oesophagus)
carcinoma
Barrett’s oesophagus
intestinal metaplasia related to prolonged acid exposure on distal oesophagus
change from squamous to mucin secreting columnar cells
barretts oesophagus is a precursor to
dysplasia / adenocarcinoma
Treatment of barretts oesophagus
endoscopic mucosal resection
radio-frequency ablation
oesophagectomy (rarely)
GORD treatment
lifestyle measures
alginates –> Gaviscon
H2RA –> Ranitidine
Proton Pump Inhibitor –> Omeprazole
anti-reflux surgery
oesophageal cancers are usually
squamous cell carcinomas
adenocarcinoma
oesophageal cancer presentation
progressive dysphagia
anorexia and weight loss
chest pain
cough
pneumonia
vocal cord paralysis
haematemesis
squamous cell carcinoma
often large exophytic occluding tumours
occur in proximal and middle third of oesophagus
where do adenocarcinomas usually occur?
distal oesophagus
adenocarcinoma is associated with what condition?
Barretts oesophagus
common metastasis from oesophageal cancer
hepatic
brain
pulmonary
bones
oesophageal investigation
endoscopy
biopsy
CT scan
endoscopic ultrasound
PET scan
bone scan
oesophageal cancer treatment
palliation
endoscopic
chemotherapy
radiotherapy
brachytherapy
