Oesophageal Disorders Flashcards by oli crawford

where does the oesophagus start and end?

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

How well did you know this?

Not at all

Perfectly

is the oesophagus striated or smooth muscle?

Upper 3-4 cm striated muscle, remainder is smooth muscle

How well did you know this?

Not at all

Perfectly

what type of epithelium is the oesophagus?

stratified squamous epithelium

How well did you know this?

Not at all

Perfectly

what is the function of the oesophagus?

Transport of food/liquid from mouth to stomach – active process

How well did you know this?

Not at all

Perfectly

how are oesophageal peristalsis produced?

by oesophageal circular muscles and propels swallowed materials distally into the stomach

How well did you know this?

Not at all

Perfectly

true or false?

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

true

How well did you know this?

Not at all

Perfectly

what are the symptoms of heartburn?

Retrosternal discomfort or burning

May be associated with: Waterbrash, Cough

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

How well did you know this?

Not at all

Perfectly

how can the LOS be reduced?

certain drugs/food can reduce it, resulting in increased reflux/ heartburn

How well did you know this?

Not at all

Perfectly

what does Persistent reflux and heartburn lead to?

gastro-oesophageal reflux disease (GORD) which can in turn cause long-term complications

How well did you know this?

Not at all

Perfectly

what is dysphagia?

Subjective sensation of difficulty in swallowing foods and/or liquids

How well did you know this?

Not at all

Perfectly

what do you enquire about for someone who has dysphagia?

Type of food (solid vs liquid) - Pattern (progressive, intermittent)
- Associated features (weight loss, regurgitation, cough

How well did you know this?

Not at all

Perfectly

where would the possible locations be for dysphagia?

Oropharyngeal -Oesophageal

How well did you know this?

Not at all

Perfectly

causes of dysphagia?

benign stricture

- malignant stricture (oesophageal cancer)
- motility disorders (eg achalasia, presbyoesophagus)
- eosinophilic oesophagitis 
- extrinsic compression (eg in lung cancer

How well did you know this?

Not at all

Perfectly

investigations of dysphagia

ENDOSCOPY
Oesophago-Gastro-Duodenoscopy (OGD)
Upper GI Endoscopy (UGIE)

How well did you know this?

Not at all

Perfectly

what is hypermotility

Corkscrew appearance” on Ba swallow
-Severe, episodic chest pain +/- dysphagia
-Often confused with angina/MI
-Cause unclear (idiopathic)
-Manometry shows exaggerated,
uncoordinated, hypertonic contractions
-Rx smooth muscle relaxants

How well did you know this?

Not at all

Perfectly

what is hypomotility

Associated with connective tissue disease,
diabetes, neuropathy
-Causes failure of LOS mechanism leading to
heartburn and reflux symptoms

How well did you know this?

Not at all

Perfectly

what is achalasia?

Degeneration of inhibitory neurons (ganglion cells) in the myenteric plexus in the oesophagus
Often surrounded by lymphocytes- so an inflammatory aetiology is suspected

How well did you know this?

Not at all

Perfectly

what are symptoms of achalasia?

progressive dysphagia for solids and liquids
weight loss
Chest pain (30%)
Regurgitation and chest infection

How well did you know this?

Not at all

Perfectly

what is the treatment for achalasia?

Pharmacological - Nitrates,
Calcium Channel blockers

Endoscopic - Botulinum Toxin
Pneumatic balloon dilation

Radiological - Pneumatic balloon
dilation

Surgical - Myotomy

How well did you know this?

Not at all

Perfectly

what are complications of achalasia?

Aspiration pneumonia and lung disease

Increased risk of squamous cell oesophageal carcinoma

what are the symptoms of gastro-oesophageal reflux disease?

heartburn, cough, water brash, sleep disturbance

may not experience any symptoms

what are the risk factors for gastro-oesophageal refluc disease?

Pregnancy, obesity, drugs lowering LOS pressure, smoking, alcoholism, hypomotility

who is more likely to get gastro-oesophageal reflux disease?

men, caucasian

true or false:

The typical reflux syndrome can be diagnosed on the basis of the characteristic symptoms, without diagnostic testing.

true

why is endoscopy a poor diagnostic test but still performed?

. Most patients (>50%) with reflux symptoms have no visible evidence of oesophageal abnormality when endoscopy is performed. However endoscopy must be performed in the presence of ‘alarm’ features suggestive of malignancy (eg dysphagia, weight loss, vomiting)

what is GORD without abnormal anatomy?

increased Transient relaxations of the LOS Hypotensive LOS Delayed gastric emptying Delayed oesophageal emptying decreased Oesophageal acid clearance decreased Tissue resistance to acid/bile

what is GOD due to hiatus hernia?

Anatomical distortion of the OG junction

what are the two main types of hiatus hernia?

Sliding and Para-oesophageal

GORD pathophysiology

Mucosa exposed to acid-pepsin and bile Increased cell loss and regenerative activity (ie inflammation) Erosive oesophagitis

GORD complications

Ulceration (5%) Stricture (8-15%) Glandular metaplasia (Barrett’s oesophagus) Carcinoma

whos more likely to get barretts oesophagus?

men

what is barretts oesophagus a precurser to?

dysplasia | adenocarcinoma

what is barretts oesophagus?

Intestinal metaplasia related to prolonged acid exposure in distal oesophagus

what type of epithelium is in the lower oesophagus?

Change from squamous to mucin-secreting columnar (ie gastric type)

what is the risk of developing oesophageal cancer ?

6% year

what is the treatment of barrettsoesophagus?

``` Endoscopic Mucosal Resection (EMR) Radio-Frequency Ablation (RFA) Oesophagectomy rarely (mortality ~10%) ```

GORD treatment?

Lifestyle measures Pharmacological Alginates (Gaviscon) H2RA (Ranitidine) Proton Pump Inhibitor (e.g. Omeprazole, Lansoprazole) For refractory disease/symptoms following investigation Anti-reflux surgery (Fundoplication – full / partial wrap)

oesophageal cancer presentation

Progressive dysphagia (90%) Anorexia and Weight loss (75%) Odynophagia Chest pain Cough Pneumonia (tracheo- oesophageal fistula) Vocal cord paralysis Haematemesis

where does squamous cell carcinoma happen in the oesophagus?

Occur in proximal and middle third of oesophagus

risk factors for squamous cell carcinoma

tobacco and alcohol

where does adenocarcinoma happen in the oesophagus?

distal oesophagus

what are the predisposing factors for adenocrcinoma?

obesity, male sex, middle age, caucasian

metastases of oesophageal cancer

Hepatic, brain, pulmonary, bone

oesophageal cancer investigations

Diagnosis by Endoscopy & Biopsy ``` Staging: CT Scan Endoscopic ultrasound PET Scan Bone Scan ``` Disease staging by TNM classification

oesophageal cancer treatment

Only potential cure is surgical oesophagectomy +/- adjuvant (after) or neoadjuvant (before) chemotherapy ``` Endoscopic (stent, laser/APC, PEG) Chemotherapy Radiotherapy Brachytherapy ```

what is Eosinophilic Oesophagitis

Chronic immune-/allergen-mediated condition defined clinically by symptoms of oesophageal dysfunction, and 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.

who is more likely to have Eosinophilic Oesophagitis

children and young adults of males

presentation of Eosinophilic Oesophagitis

Dysphagia & Food bolus obstruction

treatment of Eosinophilic Oesophagitis

topical/swallowed corticosteroids - dietary elimination - endoscopic dilatation