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Alimentary System > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

Define ‘dysphagia’ and state the appropriate history taking enquiries.

A

Subjective sensation of difficulty in swallowing foods and/or liquids.

History;

  • Type of food
  • Pattern
  • Associated features
  • Location
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2
Q

Explain the presentation of GORD.

A

Many are asymptomatic!

Symptoms;

  • Heartburn
  • Cough
  • Waterbrash
  • Sleep disturbance
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3
Q

List the causes of dysphagia.

A
  • Benign stricture
  • Malignant stricture e.g. oesophageal cancer
  • Motility disorders e.g. achalasia, presbyoesophagus
  • Eosinophilic oesophagitis
  • Extrinsic compression e.g. lung cancer
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4
Q

Describe the treatment of GORD without ALARMS symptoms.

A
  • Lifestyle measures

Pharmacological;

  • Alginates (Gaviscon)
  • H2 receptor antagonists (Ranitidine)
  • PPIs (Omeprazole)
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5
Q

Describe the treatment of oesophageal cancer.

A

Surgical oesophagectomy +/- adjuvant or neoadjuvant chemotherapy.

Many present late stage so palliation is the priority.

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6
Q

Describe the use of endoscopy in the investigation of oesophageal disease.

A

Used in the investigation of dysphagia or reflux symptoms with ALARMS features.

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7
Q

Describe the use of barium swallow in the investigation of oesophageal disease.

A

Primarily used for investigating dysphagia (however endoscopy is preferred).

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8
Q

Describe the use and procedure of pH-metry swallow in the investigation of oesophageal disease.

A

Used in investigation of refractory heartburn/reflux.

Nasal catheter containing pH sensors is placed at both sphincters (UOS and LOS).

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9
Q

Describe the use of manometry swallow in the investigation of oesophageal disease.

A

Used investigation of dysphagia/suspected motility disorder (usually after endoscopy) by assessing sphincter and oesophageal motility and tonicity.

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10
Q

Describe the aetiology and symptoms of hypomotility disorders, and list associated conditions.

A

Aetiology: failure of LOS mechanism

Symptoms: heartburn and reflux.

Associated conditions;

  • Connective tissue disease
  • Diabetes
  • Neuropathy
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11
Q

Describe the aetiology of achalasia.

A
  • Degeneration of inhibitory neurones (ganglion cells) in myenteric plexus in distal oesophagus and LOS
  • Often surrounded by lymphocytes (inflammatory aetiology suspected)
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12
Q

Explain the epidemiology of achalasia.

A

Incidence: 1-2/100,00
M=F
Onset: 3rd-5th decade

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13
Q

Describe the treatment of achalasia.

A

Pharmacological: nitrates, CCBs

Endosopic: botulinum toxin, pneumatic balloon dilation (can be X-ray guided)

Surgical: myotomy

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14
Q

State the complications of achalasia.

A
  • Aspiration pneumonia and lung disease

- Increased risk of squamous oesophageal carcinoma

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15
Q

State the risk factors of GORD.

A
  • Pregnancy
  • Obesity
  • Drugs lowering LOS pressure
  • Smoking
  • Alcoholism
  • Hypomotility
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16
Q

Describe the diagnosis of GORD.

A

Diagnosed based on symptoms rather than testing.

> 50% with reflux have no visible abnormality seen through endoscopy (but must perform if ALARMS present).

17
Q

Describe the aetiology of GORD without abnormal anatomy.

A
  • Increase in LOS relaxation
  • Delayed gastric/oesophageal emptying
  • Decrease in oesophageal acid clearance
  • Decrease in tissue resistance to acid/bile
18
Q

Describe the methods of investigation and staging in oesophageal cancer.

A

Investigation;

  • Endoscopy
  • Biopsy
  • Laparoscopy (only if suspicion of transcoloemic spread)

Staging;

  • CT
  • Endoscopic USS
  • PET
  • Bone scan
19
Q

What is the description of eosinophilic oesophagitis?

A

Chronic immune/allergen-mediated condition defined clinically by;

  • Oesophageal dysfunction
  • Eosinophilic infiltration of oesophageal epithelium with no secondary causes of local/systemic eosinophilia
20
Q

Describe the epidemiology of eosinophilic oesophagitis.

A
  • Increasing incidence and prevalence
  • More common in children and young adults
  • M>F
21
Q

Describe the treatment of eosinophilic oesophagitis.

A
  • Topical/oral corticosteroids
  • Dietary elimination
  • Endoscopic dilation
22
Q

Describe heartburn and name its associated features.

A
  • Retrosternal pain or discomfort
  • Associated with waterbrash, cough
  • Consequence of gastric reflux
23
Q

How long is the oesophagus?

A

25cm.

24
Q

Where does the oesophagus begin?

A

At the lower level of the cricoid cartilage (C6).

25
Q

Where does the oesophagus end?

A

At T11-12, where it enters the stomach.

26
Q

Describe the muscle found in the oesophagus.

A

Upper 3-4cm is striated, the rest is smooth.

27
Q

Describe the epithelium of the oesophagus.

A

Stratified squamous.

28
Q

Describe the symptoms of hypermotility disorders and give an example of one.

A
  • Severe, episodic chest pain +/- dysphagia
  • Often confused with angina/MI

e.g. diffuse oesophageal spasm.

29
Q

Describe the aetiology of hypermotility disorders.

A

Usually idiopathic.

30
Q

Describe the investigation of hypermotility disorders and the positive findings.

A
  • Ba swallow: corkscrew appearance

- Manometry: exaggerated, uncoordinated, hypertonic contractions

31
Q

Describe the treatment of hypermotility disorders.

A

Smooth muscle relaxants.

32
Q

Describe the presentation of achalasia.

A

Cardinal feature: failure of LOS to relax.
Result: functional obstruction of oesophagus.

Symptoms;

  • Progressive dysphagia
  • Weight loss
  • Chest pain
  • Regurgitation
  • Chest infection
33
Q

Describe the aetiology of GORD due to hiatus hernia.

A

Anatomical distortion of oesophagogastric junction.

34
Q

Describe the treatment of GORD for refractory disease or symptoms following initial treatment.

A

Anti-reflux surgery (fundoplication).

35
Q

Describe the presentation of oesophageal cancer.

A
  • Progressive dysphagia
  • Anorexia and weight loss
  • Odynophagia
  • Chest pain
  • Cough
  • Pneumonia (tracheo-oesophageal fistula)
  • Vocal cord paralysis
  • Haematemesis

Alimentary System (43 decks)

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