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Yr2 GI Joe > Oesophageal disorders > Flashcards

Oesophageal disorders Flashcards

1
Q

At what veretbral levels does the oesophagus start and finish?

A

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

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2
Q

What are the varying muscle types of muscle in the oesophagus?

A

Upper 3/4cm is striated (skeletal) muscle

Remainder is smooth muscle

(although other lectures say its the top 1/3rd that is skeletal)

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3
Q

What type of lining is in the oesophagus?

A

Non-keritanised stratified squamous

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4
Q

What muscles produce peristaltic movement for food in the oesophagus?

A

Circular muscles in Muscularis externa

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5
Q

What mediates peristaltic contractions in the oesophagus and relaxation of the Lower oesophageal sphincter?

A

The vagus nerve

Peristalsis and LOS relaxation are coordinated

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6
Q

What ligament attaches the oesophagus to the diaphragm?

A

Phreno-oesophageal ligament

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7
Q

What is the name given to this area in the stomach?

(blocked out label)

A

Mucosal rosette

Formed by the ‘Angle of His’

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8
Q

What is heartburn?

A

Retrosternal discomfort or burning

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9
Q

How would heartburn present?

A
  • Retrosternal discomfort or burning feeling
  • Sometimes experienced with:
    • Waterbrash (sudden rush of saliva)
    • Cough
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10
Q

What causes heartburn?

A

Consequence of reflux of acidic &/or bilious gastric contents into the oesophagus

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11
Q

What causes reflux?

A

Certain drugs/foods:

  • Alcohol
  • nicotine
  • dietary xanthines (caffeine etc I think)

These lower the LOS pressure leading to increased reflux

However, there is a degree of reflux that takes place normally (after swallowing etc)

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12
Q

What is the problem with having persistant relfux/heartburn?

A

Gastro-oesophageal reflux disease (GORD) can develop

This can in turn cause long-term complications

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13
Q

What is dysphagia?

A

Subjective sensation of difficulty in swallowing foods and/or liquids

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14
Q

What is the difference between Dysphagia and Odynophagia?

A

Dysphagia - Difficulty swallowing

Odynophagia - Pain with swallowing

(often accompany eachother)

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15
Q

What aspects of a a patient’s dysphagia is it important to ask about in histories?

A
  • Type of food (solid vs liquid)
  • Pattern (progressive, intermittent)
  • Associated features (weight loss, regurgitation, cough
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16
Q

What are the possible locations of dysphagia?

A

Oropharyngeal

Oesophageal

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17
Q

What are the causes of oesophageal dysphagia?

A
  • Benign stricture
  • Malignant stricture (oesophageal cancer)
  • Motility disorders (eg achalasia, presbyoesophagus)
  • Eosinophilic oesophagitis
  • Extrinsic compression (eg in lung cancer)
18
Q

What are the investigations for oesophageal disease (Reflux etc)

A

Endoscopy:

  • Oesophago-Gastro-duodenoscopy (OGD)
  • Upper GI endoscopy (UGIE)

Imaging:

  • Barium swallow

Other:

  • pH monitoring
  • Manometry
19
Q

When is Endoscopy used for investigation in oesophageal disease?

A

used in investigation of dysphagia or reflux symptoms with alarm features

Endoscopy is pretty much always first line for this (preferred to Barium swallows)

20
Q

How does pH monitoring of the oesophagus work and when is it done?

A

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

used in investigation of refractory heartburn/reflux

21
Q

How does Manometry work and when is it used?

A

Nasal catheter containing multiple pressure sensors is placed in oesophagus to assess its motility

used in investigation of dysphagia / suspected motility disorder (usually after endoscopy)

22
Q

What are the different types of motility disorders?

A

Hypermotility (oesophageal spasm)

Hypomotility

Achalasia

23
Q

How does Hypermotility of the oesophagus present?

A

Severe episodic chest pain +/- dysphagia

(Easily confused with angina/MI)

24
Q

How is hypermotility of the oesophagus investigated?

A

Barium swallow - will show corkscrew appearance

Manometry - exaggerated, uncoordinated, hypertonic contractions

25
Q

How is hypermotility treated?

A

Smooth muscle relaxants

26
Q

What conditions is hypomotility associated with?

A

Associated with connective tissue disease, diabetes, neuropathy

27
Q

How does hypomotility present?

A

Retrosternal pain +/- dysphagia

Hypomotility causes the LOS to fail, meaning the symptoms are similar to reflux/heartburn

28
Q

What is achalasia?

A

Functional loss of myenteric plexus ganglion cells in distal oesophagus and LOS

This means the LOS can not relax resulting in functional distal oesophagus obstruction (stays shut)

29
Q

How does achalasia present?

A

Symptoms:

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

Epidem:

  • 30-50s is usual age
  • M = F
30
Q

What causes Achalasia?

A

Dont really know but in sites of nerve destruction, there is often Lymphocytic infiltration

An inflammatory aetiology is suspected…

31
Q

How is achalasia treated?

A

Drugs:

  • Nitrates, Calcium channel blockers

Endoscopic:

  • Botulinum Toxin/Pneumatic balloon dilation

Radiological:

  • Pneumatic balloon dilation

Surgical:

  • Myotomy
32
Q

What are the complications of achalasia?

A

Higher risk of:

  • Aspiration pneumonia & Lung disease
  • Squamous cell oesophageal carcinoma
33
Q

What is GORD?

A

Gastro-oesophageal reflux disease

Caused by weakening of LOS due to pathological acid (and bile) exposure in lower oesophagus

34
Q

What are the symptoms of GORD?

A
  • Heartburn
  • cough
  • waterbrash
  • sleep disturbance
35
Q

What are the risk factors for GORD?

A
  • Pregnancy
  • obesity
  • drugs lowering LOS pressure (smooth muscle relaxants?)
  • smoking
  • alcoholism
  • hypomotility
36
Q

Describe the epidemiology of GORD?

A
  • Men > Women
  • Caucasian > Black > Asian
37
Q

How is GORD investigated?

A

Diagnosis of GORD can be made based on symptoms alone

Endoscopy is a poor diagnostic tool for GORD, and should only be performed if there are ALARM features suggestive of malignancy etc

38
Q

Describe the aetiology of GORD without anatomical abnormalities

A
  1. Increased Transient relaxations of the LOS
  2. Hypotensive LOS
  3. Delayed gastric emptying
  4. Delayed oesophageal emptying
  5. Decreased Oesophageal acid clearance
  6. Decreased Tissue resistance to acid/bile
39
Q

What anatomical abnormality can cause GORD?

A

Hiatus Hernia

40
Q

What predisposes someone to developing a hiatus hernia?

A

Obesity

Older age

41
Q
A

Yr2 GI Joe (28 decks)

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