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Pathologies of the GI > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

What is heartburn?

A

Retrosternal discomfort or burning sensation

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2
Q

What other symptoms are often associated with heartbun?

A

Waterbrash (a sudden flow of saliva)

Cough

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3
Q

What causes heartburn?

A

USually a consequence of reflux of gastric contents into oesophagus.
Can be induced by certain drugs and foods which reduce pressure in the LOS such as alcohol, nicotine and dietary xanthines.

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4
Q

Define dysphagia and odynophagia?

A

Dys - Diffculty swallowing

Odyno - Pain on swallowing

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5
Q

What questions should be asked about dysphagia?

A
  • Solids or liquids
  • Progressive or intermittent
  • Location? (oropharyngeal or oesophageal
  • Associated features such as weight loss, regurgitation of cough
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6
Q

What can cause dysphagia?

A 
A benign stricture
Malignant stricture
Motility disorder (E.g. Achalasia)
Eosinophilic Oesophagitis
Extrinsic compression (e.g. lung cancer)
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7
Q

What type of endoscopy is there for oesophageal disorders?

A

OGD - Oesophago-Gastro-Duodenoscopy

Also called Upper GI Endoscopy (UGIE)

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8
Q

What investigative tests can be done for oesophageal disorders?

A 
Endoscopy (UGIE)
Contrast Radiology (barium swallow)
Oesophageal pH & Manometry
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9
Q

When is a barium swallow used?

A

When an UGIE isnt possible, particularly when investigation dysphagia

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10
Q

How is OEsophageal pH and manometry performed?

A

A probe with pressure and pH sensors is inserted through a naso-gastric catheter,
It measures muscle contraction and pH as you swallow

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11
Q

What is the use of a oesophageal pH and manometry?

A
  • Tells us about dysphagia and motility disorders
  • Assesses sphincter tonicity
  • pH helps investigate refractory (stubborn) heart burn
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12
Q

Give an example of a hypermotility disorder?

A

Diffuse Oesophageal spasm

  • Severe episodic chest pain (easily confused with angina)
  • +/- dysphagia
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13
Q

How would oesophageal spasm appear on tests?

A

Corkscrew barium swallow

Manometry shows exaggerated, uncoordinated, hypertonic contractions

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14
Q

How do we treat oesophageal spasms?

A

Smooth muscle relaxants and wait for it end

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15
Q

What conditions are related to hypomobility of the oesophagus?

A
  • connective tissue disorders
  • Diabetes
  • Neuropathies

They cause the LOS to fail leading gastro-oesophageal reflux disease

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16
Q

What is achalasia?

A

Unable to properly open the LOS due to functional loss of the myenteric plexus ganglion cells in the distal oesophagus.
Essentially causing a functional obstruction of the distal oesophagus

17
Q

What are the symptoms/complications of achalasia?

A 
Progressive dysphagia
Weight loss
30% get chest pain
Regurgitation
Chest infection

Can also be complicated by aspiration pneumonia

Also raises risk of squamous cell carcinoma

18
Q

How do we treat achalasia?

A

Drugs - Nitrates, CCBs
Endoscopic - Botulinum toxin/Pneumatic balloon dilatation - Tend to relapse
Surgical - Myotomy - Definitive treatment

19
Q

What is Gastro-oesophageal Relfux Disease? (GORD)

A

Pathological acid and bile exposure to the lower oesophagus

20
Q

What are the symptoms of GORD?

A

Heartburn
Cough
Water Brash
Sleep Disturbance

Can often have no symptoms

21
Q

What are the risk factors for GORD?

A 
Pregnancy
Obesity
Smoking & alcholism
Hypomotility
Drugs lowering LOS pressure

Men and caucasians are most affected

22
Q

How do we investigate/diagnose GORD?

A

Can diagnose on symptoms alone.
If there are any alarm features of malignancy an endoscopy is required (but will only show abnormalities 50% of the time)

23
Q

What are the alarm features of malignancy in GORD?

A

Dysphagia, Weight loss, Vomiting

24
Q

How does GORD occur?

A

One of two ways:

  • Transient relaxation of the LOS
  • > Delayed gastric emptying/oeosphageal emptying
  • > Lower oesophageal acid clearance & acid regurg

Or

Hiatus hernia distorts the GO junction leading to reduced acid clearance and regurg

Either way the mucosa is exposed to acid, pepsin and bile leading to inflammation i.e. erosive oesophagitis

25
Q

What are the types of hiatus hernia and predisposing factors?

A

Sliding and para-oesophageal

Being old or fat

26
Q

Complications of GORD

A

Ulcers
Fibrotic strictures
Glandular metaplasia (Barret’s Oesophagus)
Carcinoma

27
Q

What is eosonophilic oesophagitis?

A

Immune mediated inflammation of the oesophagus due to infiltration of eosinophils into the epithelium of the oesophagus.

28
Q

What are the symptoms of eosinophilic oesophagtis?

A
  • Dysphagia

- usually presents In children

29
Q

What is the treatment for eosonophilic oeophagitis

A
  • Oral/topical corticosteroids
  • Dietary changes
  • Endoscopic dilatation
30
Q

Different types of oesophageal cancers

A

Adenoma

  • Presents in bottom 1/3rd of oesophagus
  • Risk factors: Barrett’s oesophagus, male, obesity

Squamous cell

  • In top 2/3rds of oesophagus
  • Risk factors: tobacco, alcohol, obesity
31
Q

Symptoms of oesophageal cancers

A
  • Loss of voice- if vocal cords affected
  • Pain between shoulder blades
  • Weight loss
  • Persistant cough/hiccups
  • Dysphagia/odynophagia
32
Q

Spreading in oesophageal cancers

A

More common than in other cancers

  • No serosa in the oesophagus
  • Blood vessels tend to present in the lamina propria rather than in the submucosa
33
Q

Investigations for oesophageal cancers?

A

For diagnosis: biopsy, endoscopy

For staging: PET scan, CT…

34
Q

Treatment for oesophageal cancers

A

Usually palliative: endoscopy, radiation, chemo..
Oesophagectomy
Best result: chemo + oesophagectomy

35
Q

What is Barrett’s oesophagus

A

Glandular metaplasia which leads to a change from squamous cells to mucin secreting

Pathologies of the GI (32 decks)

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