Oesophageal disorders Flashcards
what is the muscle make up of the oesophagus ?
upper 3-4cm is striated
rest is smooth
what sort of epithelium makes up the oesophagus ?
stratified squamous epithelium
what are symptoms of oesophageal disease ?
heartburn
dysphagia
what is heartburn, what can cause it and what are its complications ?
retrosternal discomfort or burning, associated with waterbrash or cough
certain drugs/foods can lower LOS pressure causing reflux
persistent reflux can result in GORD
what can cause dysphagia ?
benign stricture malignant stricture motility disorders eosinophilic oesophagitis extrinsic compression
what investigations should be done for oesophageal disease ?
endoscopy
contrast radiology
oesophageal pH and manometry
what is an example of a hyper motility disorder ?
diffuse oesophageal spasm
what is the appearance of diffuse oesophageal spasm on a barium swallow ?
corkscrew appearance
what are clinical features of diffuse oesophageal spasm ?
chest pain
sometimes dysphagia
often confused with angina
what causes diffuse oesophageal spasm ?
idiopathic
what would a manometry show with diffuse oesophageal spasm ?
uncoordinated hypertonic contractions
how is diffuse oesophageal spasm treated ?
smooth muscle relaxants
what conditions are associated with hypomotility disorders ?
connective tissue diseases
diabetes
neuropathy
what is the pathology of hypomotility and what can it lead to ?
failure of LOS
leads to heartburn and reflux
what is achalasia and what is its pathology ?
failure of the LOS to relax leading to obstruction
functional loss of the myenteric plexus ganglion in distal oesophagus and LOS
what are symptoms of achalasia ?
progressive dysphagia
weight loss
chest pain
regurgitation and chest infection
what is the treatment for achalasia ?
pharmacological - nitrates, calcium channel blockers
endoscopic - botox, ballon dilatation
surgical - myotomy
what are complications of achalasia ?
aspiration pneumonia
risk of squamous cell oesophageal carcinoma
what are risk factors for GORD ?
pregnancy obesity drugs lowering LOS pressure smoking alcoholism hypomotility
what are symptoms of GORD ?
heartburn
cough
water brash
sleep disturbance
what is GORD often associated with ?
hiatus hernia
what complication is associated with GORD ?
Barrett’s oesophagus
what are the treatment options for Barrett’s oesophagus ?
endoscopic mucosal resection
radio frequency ablation
oesophagectomy
what is the treatment for GORD ?
lifestyle changes
drugs - alginates(gaviscon), H2RA (ranitidine), PPI (omeprazole)
anti-reflux surgery - fundoplication
how does oesophageal cancer present ?
progressive dysphagia anorexia/weight loss odynophagia chest pain cough pneumonia vocal cord paralysis haematemesis
where do squamous carcinomas commonly occur in the oesophagus ?
the upper 2/3rds
where do adenocarcinomas commonly occur in the oesophagus ?
the bottom 1/3rd
where does oesophageal cancer commonly metastasise ?
liver
brain
bone
lungs
how do you investigate an oesophageal cancer ?
endoscopy and biopsy
staging - CT, USS, PET, bone scan
how do you treat oesophageal cancer
surgical oesophagectomy
prognosis is poor
what is eosinophilic oesophagitis ?
chronic immune/allergen mediated condition causing oesophageal dysfunction
how does eosinophilic oesophagitis present ?
dysphagia
bolus obstruction
how do you treat eosinophilic oesophagitis ?
topical corticosteroids
dietary elimination
endoscopic dilatation
what are the ALARMS symptoms ?
Anorexia Loss of weight Anaemia Recent onset, >55 years old, persistent Melaena/heamatemesis Swallowing problems
