Oesophageal disorders Flashcards
What is dysphagia?
Difficulty swallowing
What is important to ask about when assessing dysphagia?
What foods are causing the dysphagia?
If solid foods are affected this mostly suggests an obstruction e.g. malignant
If solid and liquids are affected it suggest a functional disorder with the oesophagus e.g. achalasia
If someone has retrosternal chest pain what emergency investigations should be done?
ECG
Cardiac troponins
What is the best investigation for esophageal issues?
OGD
What is used to diagnose functional esophageal disorders?
Esophageal manometry
Measures pressures in the esophagus to show if there are abnormal contractions
What is achalasia? What are its features?
Impairment of esophageal peristalsis and impaired relaxation of the LOS
Causes issues with solids and liquids, regurgitation of undigested food, chest pain and heartburn
For any esophageal disorders what are red flag symptoms that indicated an OGD is needed?
Weight loss Haematemesis Progressive dysphagia Aged older than 55 Previous cancer Barrett's Oesophagus
What might be done for achalasia?
Balloon dilatation to stretch out the LOS
Surgical correction- Heller Laparoscopic Myotomy and Fundoplication
BOTOX injections into LOS for people unsuitable for surgery
Medical- Calcium channel blocker- nifedipine
What is the unique feature of achalasia on a barium swallow X-ray?
Birds beak appearance- due to stricture at LOS and dilation proximal to it
What is the gold standard investigation for achalasia?
Esophageal manometry- for any functional disorders this should be done
What are some functional esophageal disorders?
Achalasia
Diffuse esophageal spasm
GORD
What investigations might be done for someone presenting with probably esophageal disorders?
Barium swallow X-Ray Esophageal manometry Oesophageal pH monitoring OGD Endoscopy H.Pylori testing may also be considered
What is the investigation for diffuse esophageal spasm?
Esophageal manometry
What is the treatment for diffuse esophageal spasm?
Prevent the spasm
Calcium channel blockers- nifedipine
Nitrates
Botox injection
What rheumatological condition causes esophageal issues?
CREST Syndrome- Now limited scleroderma
Associated with anti-centromere Abs
What is a serious associated factor of limited scleroderma/CREST?
Pulmonary HTN- treated with Sildenafil and Bosetin
What are the features of CREST?
Calcinosis Raynaud's Esophageal dysmotility Systemic sclerosis Telangiectasia
Only affecting the hands, feet and face
How can you investigate for esophageal dysmotility in scleroderma?
Manometry
What is the treatment for scleroderma?
Immunosuppression-
Steroids, IV Cyclophosphamide, Methotrexate, Rituximab, Azathioprine
What is an esophageal web?
Areas of obstruction that cause intermittent dysphagia. They occur in the upper 1/3 of the oesophagus.
Schatzki’s ring is similar, a tight mucosal band, that occurs in the lower 2/3
What is Zenker’s diverticulum?
A pouch that forms outside of the oesophagus and food can collect there leading to bad breath, may also aspirate and regurge
What is a benign esophageal stricture and what commonly causes it?
Narrowing of the lumen often due to GORD
What is the treatment for benign esophageal stricture?
Stenting or ballooning
What are the symptoms of esophageal cancer?
Odynophagia Progressive dysphagia- initially for solids Weight loss Haematemesis Heartburn IDA due to bleeding Malaena is blood digested
What investigations need to be done for oesophageal malignancy?
Upper GI endoscopy
CT Scan to assess extent of spread
Biopsy for histological analysis
Lymph node biopsy to check for metastatic spread
What is the most common type of oesophageal cancer?
Adenocarcinoma due to barrett’s and prevalence of GORD
How are esophageal cancers staged?
TNM
Like every other cancer
Management depends upon staging
