Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

At what vertebral level does the oesophagus begin? End?

A

Begins at lower level of cricoid cartilage - C6

Terminates at T11-12 where it enters stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the epithelium and muscle of the oesophagus

A

Stratified squamous epithelium

Upper oesophagus skeletal muscle - becomes smooth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which layer of the muscularis externa powers peristalsis in the oesophagus?

A

Circular muscle layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Peristalsis and the lower oesophageal sphincter are controlled by which nerve?

A

Vagus nerve (the two are coordinated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Two major symptoms of oesophageal disorders?

A

Dysphagia and heartburn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the localization of heartburn. What is it caused by?

A

Heartburn is retrosternal discomfort/burning

Caused by reflux of acidic/bilious contents into oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the opening to the stomach at the distal end of the oesophagus

A

LOS above angle of His, at level of diaphragm

Angle of His between oesophageal opening and fundus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is heartburn a major warning sign?

A

If consistent, but it is normal if occurring every now and then

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Examples of drugs/foods that can cause reflux/heartburn?

A

Alcohol
Nicotine
Dietary xanthines (caffeine/theophylline)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is Gastro-oesophageal reflux disease?

Symptoms?

A

Weakening of LOS - frequent reflux into oesophagus. Causes cell loss and inflammation (erosive oesophagitis)

Symptoms - many asymptomatic, or - heartburn, cough, water brash (saliva and acid mix in throat), sleep disturbance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is dysphagia?

A

Subjective sensation of difficulty swallowing foods/liquids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is odynophagia?

A

Pain with swallowing - may accompany dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What enquiries should be made when a patient is experiencing dysphagia?

A

**Associated features (weight loss/regurgitation/cough)

Type of food (solid/liquid)
Pattern (progressive/intermittent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Anatomical locations of the dysphagia sensation?

A

Oropharyngeal

Oesophageal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes of dysphagia?

A 
Benign stricture
Malignant stricture (oesophageal cancer)
Motility disorders (achalasia, presbyoesophagus)
Eosinophilic oesophagitis (immune)
Extrinsic compression (eg. lung cancer)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Primary investigation for oesophageal disease? Why is it the primary choice?

A

Endoscopy
OGD - oesophago-gastro-duodenoscopy
UGIE - upper GI endoscopy

Simple, effective, safe and quick

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Other investigations for oesophageal disease? When are they likely to be used?

A

Contrast radiology (barium swallow) - investigation of dysphagia (usually proximally caused dysphagia)

pH probing - nasal catheter with pH sensors at LOS and UOS - measures reflux

Manometry - assesses motility, tonicity and coordination of oesophageal tube by measuring pressure changes due to contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Motility disorders of the oesophagus?

A

Hypermotility
Hypomotility
Achalasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is hypermotility of the oesophagus? Symptoms? Appearance on Ba swallow?

A

Corkscrew appearance on Ba swallow
It is characterized by exaggerated, uncoordinated, hypertonic contractions of the oesophagus

symptoms
- Severe episodic chest pain (+/- dysphagia)
Often confused with angina/MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cause of hypermotility of the oesophagus? Treatment? Examples?

A

Cause is idiopathic
Treat with smooth muscle relaxants (eg. CCB)

Ex. - diffuse oesophageal spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Causes of oesophageal hypomotility? What is the effect on oesophagus function?

A

Associated with CT disease, diabetes, neuropathy

Causes failure of LOS contraction - leads to heartburn and reflux

22
Q

What is Achalasia?

A

It is the functional loss of the myenteric plexus in the distal oesophagus and LOS

Failure of LOS to RELAX

23
Q

Symptoms of achalasia?

A 
Progressive dysphagia for solids and liquids 
Weight loss 
Chest pain (30%)
Regurgitation
Chest infection (?)
24
Q

Treatment of achalasia?

A

Smooth muscle relaxants - Nitrates, CCB’s

Endoscopic - botulinum toxin pneumatic balloon dilation (dilation of tube via balloon, inject botox to stop perforation)

Surgical - myotomy (cut the LOS muscles)

25
Q

Complications of achalasia treatment?

A

Aspiration pneumonia/lung disease

Increased risk of squamous cell oesophageal carcinoma

26
Q

Risk factors for gastro-oesophageal reflux disease? (GORD)

A 
Pregnancy 
Obesity 
Drugs lowering LOS pressure 
Smoking 
Alcohol
Hypomotility
27
Q

What investigations are needed for GORD?

A

Typical GORD can be diagnosed on symptoms alone

Endoscopy is a poor test

  • pH monitoring
  • Barium swallow
28
Q

Aetiology of GORD with normal anatomy?

A

Can be due to:

  • Increased transient relaxations of LOS
  • Hypotensive LOS
  • Delayed gastric emptying
  • Delayed oesophageal emptying
  • Reduced oesophageal acid clearance
  • Low tissue resistance to acid/bile
29
Q

Cause of GORD due to anatomical abnormality?

A

Hiatus Hernia

30
Q

What is a hiatus hernia?

A

Where part of your stomach (+/- gastro-oesophageal junction) penetrates the diaphragm into the chest

31
Q

Types of hiatus hernia? Description? Prevalence?

A

Sliding - oesophagus + GOJ + part of fundus penetrates the oesophageal hiatus (80%)

Para-oesophageal - fundus penetrates the hiatus, GOJ remains below (15-20%)

32
Q

Complications of GORD?

A

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

33
Q

What is Barrett’s oesophagus?

A

It is a change in the epithelium of the lower oesophagus from stratified squamous to mucin secreting columnar cells due to prolonged acid exposure

(eg. from oesophageal to gastric cells in oesophagus)

34
Q

What gender is more at risk of Barrett’s oesophagus? What is it a risk factor for?

A

Men&raquo_space; Women

It is a precursor to dysplasia/adenocarcinoma (6% per year risk of developing cancer if high grade dysplasia)

35
Q

Treatment for Barrett’s Oesophagus?

A

Endoscopic mucosal resection (EMR)

Radio-Frequency Ablation (RFA - uses heat from medium frequency alternating current)

Oesophagectomy (rarely)

36
Q

GORD treatment?

A

In absence of alarm features:
Lifestyle measures
Pharmacological: Alginates (gaviscon) H2RA, proton pump inhibitor (omeprazole, lansoprazole)

Following investigation of alarming symptoms:
Anti-reflux surgery - funcoplication (full/partial wrap)

37
Q

Types of oesophageal cancer? Which is more common?

A

Adenocarcinoma and Squamous cell carcinoma

Western Europe/USA - Adenocarcinoma > Squamous
Rest of world - Squamous&raquo_space; Adenocarcinoma

38
Q

Presentation of oesophageal cancer?

A 
Progressive dysphagia (90%)
Anorexia and Weight Loss (75%) 
Odynophagia 
Chest pain
Cough
Pneumonia (tracheo-oesophageal fistula)
Vocal cord paralysis
Haematemesis (vomiting blood)
39
Q

Where does squamous cell carcinoma occur in the oesophagus? Adenocarcinoma?

A

SCC - proximal and middle 1/3 of oesophagus

Adenocarcinoma - distal oesophagus

40
Q

Which gender is more at risk of oesophageal cancer?

A

Males 3:1 Females

41
Q

Risk factors for squamous cell carcinoma of the oesophagus?

A

Tobacco
Alcohol
Vitamin deficiency (?)

Associated with - achalasia, caustic strictures, Plummer-Vinson Syndrome

42
Q

Risk factors for oesophageal adenocarcinoma?

A 
Barrett's oesophagus 
Obesity
Being male
Middle age 
Caucasian 
Smoking
43
Q

Why does oesophageal cancer metastasize easily?

A
  • Usually presents late, more time to spread
  • Lamina propria of oesophagus is lymph vessel rich (lymph mainly submucosal in rest of GI) so lymphatic invasion readily occurs
44
Q

Investigations for diagnosis of oesophageal cancer?

A

Biopsy

Endoscopy

45
Q

Investigations for staging of oesophageal cancer?

A
  • CT scan
  • Endoscopic ultrasound
  • PET scan
  • Bone scan
46
Q

Treatment of oesophageal cancer?

A

Only cure is:
Oesophagectomy +/- adjuvant/neoadjuvant chemo

In patients with non-operable disease combined chemo + radiotherapy can improve long-term survival

47
Q

Who is eligible for oesophagectomy? Is it a safe surgery? What is post-operative recovery like?

A

Only patients with localized tumours, without co-morbid disease are eligible. Usually <70 years old too
It is a risky surgery, 10% mortality

Got a long post operative recovery period, where the patient requires nutritional support

48
Q

What are the options for palliative treatment for those with oesophageal tumours?

A

Endoscopic surgery (stenting, lazer/APC, Percutaneous endoscopic gastrostomy)
Chemotherapy
Radiotherapy
Brachytherapy

49
Q

What is eosinophilic oesophagitis?

A

An eosinophilic infiltration of the oesophageal epithelium in the absence of secondary causes of inflammation

Allergen/immune mediated
Causes oesophageal dysfunction

50
Q

How does eosinophilic oesophagitis present? What investigations are useful?

A

Presents with dysphagia and food bolus obstruction

Endoscopy

51
Q

Treatment of eosinophilic oesophagitis?

A

Topical/oral corticosteroids
Elimination of dietary allergens
Endoscopic dilatation

GI (46 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions