Oesophageal Disorders Flashcards
What is the length of oesophagus?
Approx 25cm in length
Where does the oesophagus start and end?
Begins at lower level of cricoid cartilage (C6), terminates at T11-12 where it enters the stomach
What is the type of epithelial lining in the oesophagus?
Stratified squamous epithelial lining
What type of muscle is in the oesophagus?
Upper 3-4 cm striated muscle, remainder is smooth muscle
What is the function of the oesophagus?
Transport of food/liquid from mouth to stomach – active process.
Explain oesophagus peristalsis
Oesophageal peristalsis produced by oesophageal circular muscles and propels swallowed materials distally into the stomach. Coordinates with lower oesophageal sphincter (LOS) relaxation
Peristalsis and the relaxation of the LOS id mediated by which nerve?
vagus nerve
What are the features of the LOS
- Physiological sphincter with a high resting pressure in distal smooth muscle
- Striated muscle of right crus of diaphragm
- “Mucosal Rosette” formed by acute angle (of His) at GOJ
What is heartburn a consequence of?
Heartburn is a consequence of reflux of acidic &/or bilious gastric contents into the oesophagus
What is heartburn associated with?
water brash and cough
What is heartburn?
Retrosternal discomfort or burning
What are the main symptoms of oesophageal disease?
heartburn, reflux, dysphagia
What are the methods of investigating oesophageal disease?
endoscopy, barium swallow, manometry, pH metry
What are the treatment options for achalasia?
Treatment options and complications of achalasia – treatment: pharmacological (CCB, nitrates), endoscopic (botulithum toxin and pneumatic balloon dilation), surgery (myotomy).
What are the complications of achalasia?
Complications include aspiration, lung disease, increased risk of squamous cell carcinoma, GORD
When do you investigate in cases of heartburn/GORD instead of empirical treatment
In the presence of alarm symptoms such as weight loss
What is the treatment for GORD?
lifestyle measures (dietary changes), pharmacological (alginates – gaviscon, H2RA – rantidine, PPI – omeprazole).
What is the long-term complications of untreated GORD?
Barrett’s oesophagus
What is the management of dysplasia in Barrett’s oesophagus
endoscopic mucosal resection, radio frequency ablation, oesophagectomy rarely
What is squamous cell carcinoma of the oesophagus?
Often large exophytic occluding tumours occurring proximal and middle third of the oesophagus preceded by dysplasia and carcinoma in situ.
What is adenocarcinoma of the oesophagus?
occurs in distal oesophagus, associated with Barret’ oesophagus progress through dysplasia to cancer.
What is the diagnostic investigation for oesophageal cancer
Diagnostic investigation includes endoscopy AND biopsy
What is the staging of the esophageal cancer?
Staging includes CT scan, EUS, PET, bone scan. TNM classification is used.
What is the curative treatment for esophageal cancer?
oesophagectomy +/- adjuvant or neoadjuvant chemotherapy
