Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

*GI System - Pathology > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

Where does the oesophagus begin and end?

A

Begins at lower level of cricoid cartilage (C6), terminates at T11-12 where it enters the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is its length in cm? How much of that is striated v smooth muscle?

A

approx 25cm

Upper 3-4cm = striated, rest is smooth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the epithelial lining of the oesophagus?

A

Stratified squmaous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe function of the oesophagus and how it acheives this

A

Transport food/liquid from mouth to stomach; oesophageal peristalsis produced by oesophageal circular muscles + propels swallowed materials distally into the stomach; co-ordinates with LOS relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Contraction in oesophageal body (peristalsis) and relaxation of the LOS is mediated via what nerve?

A

Vagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

2 key symptoms in oesophageal disease?

A
  • Heartburn*
  • Dysphagia*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is heartburn described as?

A

Retrosternal discomfort or burning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What can heartburn be associated with?

A

Waterbrash

Cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is heartburn a consequence of? Is it normal to experience it?

A

Heartburn is a consequence of reflux of acidic and/or bilious gastric contents into the oesophagus

Yes - almost everyone expeeriences it occasionally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What do certain drugs/foods do to LOS to cause increased reflux/heartburn? Give examples of what drugs

A

Reduce LOS pressure

e.g. alcohol, nicotine, dietary xanthines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does persistent reflux and heartburn lead to?

A

Gastro-oesophageal reflux disease (GORD) - can cause long-term complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is dysphagia described as?

A

Subjective sensation of difficulty in swallowing food and/or liquids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is odynophagia?

A

PAIN with swalling (may accompany dysphagia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What 3 things should be inquired about when asking about dysphagia?

A
  • Type of food (solid v liquid)
  • Pattern (progressive, intermittent)
  • Associated features (weight loss, regurgitation, cough)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 2 locations for dysphagia?

A

Oropharyngeal or oesophageal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Give 5 causes of oesophageal dysphagia

A
  • Benign stricture
  • Malignant stricture
  • Motility disorders (e.g. achalasia, presbyoesophagus)
  • Eosinophilic oesophagitis
  • Extrinsic compression (e.g. in lung cancer)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

3 investigations which can be done for oesophageal disease?

A 
Endoscopy (OGD or UGIE)
Contrast radiology (barium swallow)

Oesophageal pH; manometry (investigates refractory heartburn/reflux; assesses sphincter tonicity, relaxation of sphincters and oesophageal motility)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

2 ends of spectrum for motility disorders?

A

Hypermotility (e.g. diffuse oesophageal spasm)

Hypomotility (associated w connective tissue disease, diabetes, neuropathy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How would a hypermotility disorder appear on Ba swallow?

A

Corkscrew appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What symptoms are associated with hypermotility? What does this mean it can be confused with?

A

Severe, episodic chest pain +/- dysphagia

Can be confused with angina/MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What would the manometry for hypermotility show?

A

Exaggerated, uncoordinated, hypertonic contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Cause and Rx for hypermotility?

A

Cause unclear (idiopathic)

Rx smooth muscle relaxants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does hypomotility cause? Leading to what?

A

Causes failure of LOS mechanism leading to heartburn and reflux symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is achalasia? (functional loss of…)

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Incidence of achalasia?

A

1-2/100,000

Usually 3rd-5th decade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Cardinal feature of achalasia? Resulting in what?

A

Failure of LOS to relax resulting in functional distal obstruction of oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

4 symptoms of achalasia

A

Progressive dysphagia for solids and liquids

Weight loss

Chest pain (30%)

Regurgitation and chest infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

4 modalities of treatment for achalasia are pharmacological, endoscopic, radiological and surgical - give examples for each

A

Pharmacological - nitrates, CCBs

Endoscopic - botulinum toxin, pneumatic balloon dilatation

Radiological - pneumatic balloon dilatation

Surgical - myotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

2 possible complications of achalasia?

A

Aspiration pneumonia and lung disease

Increased risk of SC oesophageal carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Do patients with frequent, pathological episodes of acid/bile reflux always experience symptoms?

A

NO! Many do not

31
Q

4 symptoms of GORD

A

Heartburn

Cough

Water brash

Sleep disturbance

32
Q

Give risk factors for GORD

A

Pregnancy

Obesity

Drugs lowering LOS pressure

Smoking

Alcoholism

Hypomotility

33
Q

What can the typical reflux syndrome be diagnosed on the basis of?

A

The characteristic symptoms, without diagnostic testing

34
Q

Is endoscopy a good diagnostic test for GORD? When would it be used?

A

No, it is a poor diagnostic test - most patients with reflux symptoms have no visible evidence of oesophageal abnormality when endoscopy is performed

Endoscopy must be performed in presence of ‘alarm’ features suggestive of malignancy (e.g. dysphagia, weight loss, vomiting)

35
Q

What are the possible aetiologies of GORD without abnormal anatomy?

A

Increased transient relaxations of the LOS; hypotensive LOS; delayed gastric emptying; delayed oesophageal emptying; decreased oesophageal acid clearance; decreased tissue resistance to acid/bile

36
Q

What is the aetiology of GORD due to hiatus hernia?

A

Anatomical distortion of the OG junction

37
Q

What happens in a hiatus hernia?

A

Fundus of stomach moves proximally through the diaphragmatic hiatus

38
Q

2 main types of hiatus hernia?

A

Sliding - stomach and section of the esophagus that joins the stomach slide up into the chest through the hiatus (more common)

Para-oesophageal - OG junction remains where it belongs, but part of the stomach is squeezed up into the chest beside the esophagus (more concerning - needs surgery when causing symptoms)

39
Q

What 2 factors predispose hiatus hernia?

A

Obesity

Age

40
Q

What happens during GORD at the mucosal level and what does it lead to?

A

Mucosa exposed to acid-pepsin and bile

Increased cell loss and regenerative activity (i.e. inflammation)

Leads to erosive oesophagitis

41
Q

4 complications of GORD?

A

Ulceration (5%)

Stricture (8-15%)

Glandular metaplasia (Barrett’s oesophagus)

Carcinoma

42
Q

What is Barrett’s oesophagus?

A

Intestinal metaplasia related to prolonged acid exposure in distal oesophagus

43
Q

What do the squamous cells in the lower oesophagus change to in Barrett’s?

A

Mucin-secreting columnar (i.e. gastric type) epithelial cells

44
Q

What is Barrett’s a precursor to?

A

Dysplasia/adenocarcinoma

(cancer rate ~0.3% per year)

45
Q

Is Barrett’s more common in men or women?

A

Men

46
Q

Overall risk of progression from Barrett’s is 0.3%, but patients with high grade dysplasia the risk is 6%, so how is this treated? (3 ways)

A
  • Endoscopic Mucosal Resection (EMR)
  • Radio-Frequency Ablation (RFA)
  • Oesophagectomy (rarely as mortality ~10%)
47
Q
A
48
Q

GORD is usually treated empirically (w/o investigation) by lifestyle measures and pharmacological measures - what are 3 drugs used?

A
  • Alginates (Gaviscon)
  • H2RA (Ranitidine)
  • Proton Pump Inhibitor (e.g. Omeprazole, Lansoprazole)
49
Q

What is the treatment for GORD for refractory disease/symptoms following investigation?

A

Anti-reflux surgery (fundoplication - full/partial wrap)

50
Q

What are the 2 types of oesophageal cancer?

A
  • Squamous Cell Carcinoma*
  • Adenocarcinoma*

(benign tumours rare)

51
Q

Who is oesophageal cancer more common in men v women? Which type is most common in western europe/USA?

A

Men:Women 3:1

Adenocarcinoma more common europe and USA; rest of the world - squamous much more common

52
Q

Presentation of oesophageal cancer? (2 key features then others)

A

Progressive dysphagia (90%)

Anorexia and weight loss (75%)

Odynophagia

Chest pain

Cough

Pneumonia

Vocal cord paralysis

Haematemesis

53
Q

Which type of oesophageal cancer occurs in proximal and middle thirds of oesophagus?

A

Squamous cell carcinoma

54
Q

What is SCC oesophagus preceded by?

A

Dysplasia and carcinoma in situ

55
Q

2 significant risk factors for SCC oesophagus? (common ones)

A

Tobacco

Alcohol

56
Q

3 conditions SCC oesophagus is associated with?

A

Achalasia

Caustic strictures

Plummer-Vinson syndrome

57
Q

Which type of oesophageal cancer occurs in distal oesophagus?

A

Adenocarcinoma

58
Q

What condition is adenocarcinoma oesophagus associated with?

A

Barretts oesophagus

59
Q

4 predisposing factors for adencarcinoma oesophagus?

A

Obesity

Male sex

Middle age

Caucasian

60
Q

Does oesophageal cancer usually present early or late?

A

LATE - tumours have commonly spread to regional nodes and/or liver at presentation

61
Q

What often limits oesophageal cancer surgery?

A

Local invasion to heart, trachea, aorta (due to no peritoneal (serosal) lining in mediastinum meaning invasion is easier)

62
Q

Where does oesophageal cancermetastasise to?

A

Liver, brain, lungs, bone

63
Q

Prognosis for oesophageal cancer?

A

Poor; 5 yr survival <10%

64
Q

What investigations are used to diagnose oesophageal cancer?

A

Endoscopy and biopsy

65
Q

What 4 modalities are used to stage oesophageal cancer?

A

CT scan

Endoscopic ultrasound

PET scan

Bone scan

66
Q

How is oesophageal cancer treated?

A

Surgical oesophagectomy +/- adjuvant or neoadjuvant chemo = only potential cure

(limited to patients with localised disease, without co-morbid disease, usually <70yrs; long post-op recovery; significant mortality ~10%; requires nutritional support)

Chemo + radio now offers prospect of improved long-term survival in patients with locally advanced inpoerable disease

67
Q

Most patients with oesophageal cancer present with incurable disease, in this case what is the priority?

A

Symptom palliation (mainly dysphagia)

68
Q

4 methods for symptoms palliation in oesophageal cancer?

A

Endoscopic - stent, laser/APC, PEG

Chemo

Radiotherapy

Brachytherapy

69
Q

What type of condition is eosinphilic oesophagitis?

A

Chronic immune/allergen-mediated condition

70
Q

How is eosinophillic oesophagitis defined clinically v pathologically?

A

Clinically by symptoms of oesophageal dysfunction

Pathologically by an eosinophilic infiltration of the oesophageal epithelium (≥15 eosinophils per high-power microscopy field on oesophageal biopsy) in the absence of secondary causes of local or systemic eosinophilia

71
Q

Who is eosinophilic oesophagitis more commonly seen in?

A

Children and young adults

Males > females

72
Q

Presentation of eosinophilic oesophagitis?

A

Dysphagia and food bolues obstruction

73
Q

Endoscopic findings

A
74
Q

3 methods of treatment of eosinophillic oesophagitis?

A
  • Topical/swallow corticosteroids
  • Dietary elimination to reduce symptoms and inflammation
  • Endoscopic dilatation

*GI System - Pathology (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions