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SPM- Gastroenterology > Oesophageal disorders > Flashcards

Oesophageal disorders Flashcards

1
Q

What is dysphagia?

A

Difficulty swallowing

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2
Q

What is important to ask about when assessing dysphagia?

A

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

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3
Q

If someone has retrosternal chest pain what emergency investigations should be done?

A

ECG

Cardiac troponins

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4
Q

What is the best investigation for esophageal issues?

A

OGD

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5
Q

What is used to diagnose functional esophageal disorders?

A

Esophageal manometry

Measures pressures in the esophagus to show if there are abnormal contractions

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6
Q

What is achalasia? What are its features?

A

Impairment of esophageal peristalsis and impaired relaxation of the LOS

Causes issues with solids and liquids, regurgitation of undigested food, chest pain and heartburn

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7
Q

For any esophageal disorders what are red flag symptoms that indicated an OGD is needed?

A 
Weight loss
Haematemesis
Progressive dysphagia
Aged older than 55
Previous cancer
Barrett's Oesophagus
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8
Q

What might be done for achalasia?

A

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

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9
Q

What is the unique feature of achalasia on a barium swallow X-ray?

A

Birds beak appearance- due to stricture at LOS and dilation proximal to it

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10
Q

What is the gold standard investigation for achalasia?

A

Esophageal manometry- for any functional disorders this should be done

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11
Q

What are some functional esophageal disorders?

A

Achalasia
Diffuse esophageal spasm
GORD

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12
Q

What investigations might be done for someone presenting with probably esophageal disorders?

A 
Barium swallow X-Ray
Esophageal manometry
Oesophageal pH monitoring
OGD Endoscopy
H.Pylori testing may also be considered
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13
Q

What is the investigation for diffuse esophageal spasm?

A

Esophageal manometry

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14
Q

What is the treatment for diffuse esophageal spasm?

A

Prevent the spasm

Calcium channel blockers- nifedipine
Nitrates
Botox injection

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15
Q

What rheumatological condition causes esophageal issues?

A

CREST Syndrome- Now limited scleroderma

Associated with anti-centromere Abs

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16
Q

What is a serious associated factor of limited scleroderma/CREST?

A

Pulmonary HTN- treated with Sildenafil and Bosetin

17
Q

What are the features of CREST?

A 
Calcinosis
Raynaud's
Esophageal dysmotility
Systemic sclerosis
Telangiectasia

Only affecting the hands, feet and face

18
Q

How can you investigate for esophageal dysmotility in scleroderma?

A

Manometry

19
Q

What is the treatment for scleroderma?

A

Immunosuppression-

Steroids, IV Cyclophosphamide, Methotrexate, Rituximab, Azathioprine

20
Q

What is an esophageal web?

A

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

21
Q

What is Zenker’s diverticulum?

A

A pouch that forms outside of the oesophagus and food can collect there leading to bad breath, may also aspirate and regurge

22
Q

What is a benign esophageal stricture and what commonly causes it?

A

Narrowing of the lumen often due to GORD

23
Q

What is the treatment for benign esophageal stricture?

A

Stenting or ballooning

24
Q

What are the symptoms of esophageal cancer?

A 
Odynophagia
Progressive dysphagia- initially for solids
Weight loss
Haematemesis
Heartburn
IDA due to bleeding
Malaena is blood digested
25
Q

What investigations need to be done for oesophageal malignancy?

A

Upper GI endoscopy
CT Scan to assess extent of spread
Biopsy for histological analysis
Lymph node biopsy to check for metastatic spread

26
Q

What is the most common type of oesophageal cancer?

A

Adenocarcinoma due to barrett’s and prevalence of GORD

27
Q

How are esophageal cancers staged?

A

TNM

Like every other cancer

Management depends upon staging

SPM- Gastroenterology (13 decks)

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