Oesophageal Disorders Flashcards
vertebral extent of the oesophagus
C6 to T11/12
true/false the LOS is a true sphincter
false - while there is some muscle thickening it is largely functional from the muscle of the diaphragm around it
how do certain drugs cause heartburn
by reducing LOS pressuring and increasing reflux
what does GORD stand for
gastro-oesophageal reflux disease
what problem with eating do people with oesophageal disease encounter
dysphagia
causes of oesophageal dysphagia
stricture
motility disorder
eosinophilic oesophagitis
external compression (such as from lung cancer)
investigations that can be used to view the oesophagus
endoscopy
contrast radiology with barium swallow
what would be the preferred test to investigate dysphagia or reflux symptoms
endoscopy
what is a manometry
investigation to measure pressure through the oesophagus and sphincters
when would you use manometry
when investigating dysphagia or a motility disorder
what are the motility disorders
hypermotility, hypomotility and achalasia
what does hypermotility look like on barium swallow
corkscrew appearance
presentation of hypermotility
severe episodic chest pain with/out dysphagia
how do you treat hypermotility
smooth muscle relaxants
how does hypomotility present
heartburn and reflux symptoms
what is achalasia
loss of inhibitory neurons in myenteric plexus of oesophagus. Function is lost in distal and LOS
essentially the LOS won’t relax and the oesophagus is obstructed
presentation of achalasia
dysphagia
weight loss
chest pain
regurgitation
medical treatment for achalasia
nitrates and CCBs
endoscopic treatment for achalasia
endoscopic balloon dilatation
what is motility disorder is aspiration a common complication of
achalasia
how is reflux diagnosed
on the basis of symptoms
when would you do an endoscopy in someone with reflux
if there are accompanying alarm symptoms
what are the alarms symptoms
Anorexia Loss of weight Anaemia Recent Onset Malaena/Mass Swallowing Problems
what causes barrett’s oesophagus
prolonged exposure to acid
what is the epithelium change in barrett’s
stratified squamous –> mucus secreting simple columnar
Treatment of barrett’s oesophagus to prevent cancer
endoscopy mucosal resection
radio-frequency ablation
treatment for GORD
alginates (gaviscon)
PPI (reduce stomach acid)
H2 receptor antagonists
how do H2 receptor antagonists work
they block histamine from binding and stimulating acid production
what is a surgery than can be done in GORD
fundoplication - wrapping the fundus around the LOS region
two types of oesophageal cancer
squamous and adeno
which type of oesophageal cancer is most common in the western world
adenocarcinoma
presentation of oesophageal cancer
dysphagia anorexia weight loss odynophagia chest pain cough haematemesis pneumonia from a fistula hoarseness
given the different causes of the two oesophageal cancers where do they occur in the oesophagus
adenocarcinoma in the distal part because it is caused by metaplasia from acid reflux
which oesophageal cancer has smoking and drinking as risk factors
squamous
what feature of the oesophagus makes tumour invasion easier
it’s lack of a serosal later
invasions of oesophageal cancer
heart, trachea, aorta
lymph node spread in oesophageal cancer is common/uncommon
common - richly lymphatic in lamina propria of oesophagus
staging scans of oesophageal cancer
CT, PET, endoscopic US, bone scan
treatment for oesophageal cancer
oesophagectomy with/out neo/adjuvant chemo
how can you surgically eleviate symptoms in the cancer
by putting in a stent to help with the dysphagia
what is eosinophilic oesophagitis
an autoimmune condition of eosinophil infiltration of oesophagus epithelium
treatment of eosinophilic oesophagitis
topical or swallowed corticosteroids
dietary changes
endoscopic dilatation
presentation of eosinophilic oesophagitis
dysphagia
treatment in non resectable oesophageal cancer
stenting and palliative radio/chemo
treatment in resectable oesophageal cancer
oesophagectomy and chemo, or just chemo/radio if unfit for surgery
morbidity rate of an oesophagectomy
20%
mortality rate of an oesophagectomy
5%
