Brainscape's Knowledge GenomeTM

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


See full index

Gastrointestinal System > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

risk factors of GORD

A 
pregnancy
obesity 
excessive alcohol intake 
smoking 
male sex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

define GORD

A

irritation/damage of the simple squamous epithelium of the oesophagus due to acid reflux through the lower oesophageal sphincter (LOS) into the distal portion

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

clinical features of GORD

A

heartburn, water brash, restrosternal/epigastric pain, bloating, nocturnal cough and hoarse voice

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

red flag symptoms that require immediate admission and endoscopy referral

A 
weight loss
age >55 
dysphagia 
melena 
low Hb and high platelet count (anaemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

differentials of GORD

A 
eosinophillic or drug induced oesophagitis 
peptic ulcer disease 
achalasia 
oesophageal cancer
cardiac pathology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

conservative management of GORD

A

advise weight loss if obesity a contributing factor
advise reduced caffeine intake
advise smoking cessation
suggest smaller, lighter meals and avoidance of heavier meals before bed

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

medical management of GORD

A

4wks PPI trial (e.g. omezaprole)

OR H2 receptor antagonist (e.g. ranitidine)

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

common complications of GORD

A 
barrett's oesophagus
oesophageal cancer 
oesophageal stricture
peptic ulcer 
peptic ulcer perforation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

define distal oesophageal spasm (DOS)

A

a hyper-motility disorder of the oesophagus that causes uncoordinated contractions of several sections at once

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

risk factors of DOS

A

anxiety/stress and diabetes

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

clinical features of DOS

A

severe/crushing retrosternal chest pains
intermitting dysphagia
oesophageal pain
heartburn and other reflux-related issues

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

differentials of DOS

A

GORD
myocardial ischaemia/infarction
oesophageal stricture
achalasia

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

investigations of DOS

A

oesophageal manometry - shows exaggerated + uncoordinated hypertonic contractions
barium swallow - shows ‘corkscrew’ appearance
US of oesophagus
cardiac investigations to rule out cardiac issues

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

conservative management of DOS

A

provide reassurance that not cardiac disease
modify the diet - soft food + liquids only
suggest avoiding cold fluids

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

medical management of DOS

A

4 wks PPI trial (rule out GORD)

smooth muscle relaxants (e.g. nifedipine, Ca channel blocker OR nitrates)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

surgical management of DOS

A

botulinum toxin injection

oesophageal dilation

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

define achalasia

A

a hypo-motility disorder of the oesophagus that causes failure of the LOS to relax resulting in functional stenosis or stricture of the oesophagus

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

causes of achalasia

A

primary cause is unknown (either autoimmune or neurodegenerative) but causes functional degeneration and loss of myenteric plexus ganglion

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

risk factors of achalasia

A

> 50yrs old
autoimmune disease
neurodegenerative disorder

20
Q

clinical features of achalasia

A

progressive dysphagia for solid foods but eventually liquids and softs
food bolus impaction
regurgitation
chest pain (after eating)
heart burn
weight loss (minimal but may indicate malignancy)

21
Q

differentials of achalasia

A

oesophageal or gastric cancer
GORD
oesophageal stricture

22
Q

additional investigations of achalasia

A

CXR
barium swallow - will have characteristic ‘bird beak’ appearance
endoscopy (if rule out malignancy)

23
Q

gold standard investigation for achalasia

A

manometry

- shows high resting pressure in cardiac sphincter, incomplete relaxation on swallow and absent peristalsis

24
Q

management of achalasia

A

Heller’s myotomy - surgical division of musculature of LOS
pneumatic dilation
botulinum toxin A injection

25
Q

indications for pneumatic dilation and botulinum toxin injection

A

pneumatic dilation is preferred in older, unfit patients

injection is used for those who cannot tolerate either dilation or myotomy

26
Q

complications of achalasia

A

risk of oesophageal cancer
treatment may cause perforation or GORD
untreated may lead to aspiration pneumonia

27
Q

define Barrett’s Oesophagus

A

an oesophagus that has a portion of the normal epithelium replaced with metaplastic columnar epithelium ABOVE the gastro-oesophageal junction

28
Q

describe the change in epithelium during Barrett’s Oesophagus

A

simple squamous epithelium to columnar gastric epithelium

29
Q

risk factors of Barrett’s

A 
older age (50-70yrs)
smoking 
obesity 
male sex
MH of GORD or dysphagia
30
Q

clinical features of Barrett’s Oesophagus

A 
heartburn
waterbrash
bloating and belching 
nausea 
burning pain when swallowing hot drinks
31
Q

investigations for Barrett’s Oesophagus

A

gastroscopy (with biopsy)

32
Q

conservative management for Barrett’s Oesophagus

A 
recommend weight loss 
smoking cessation
reducing alcohol intake 
raising head during sleep 
suggest smaller, regular meals
avoid hot drinks and drugs that affect oesophageal motility
33
Q

medical management of Barrett’s Oesophagus

A

long term PPI therapy

ablative therapy

34
Q

surgical management of Barrett’s Oesophagus

A

oesophagectomy (for severe dysplasia)

laparoscopic fundoplication

35
Q

common complications of Barrett’s Oesophagus

A

development of adenocarcinoma

36
Q

define squamous cell carcinoma oesophageal cancer

A

affects upper 2/3rd of oesophagus and is proceeded by dysphasia and carcinoma in situ

37
Q

define adenocarcinoma oesophageal cancer

A

affects lower 1/3rd of oesophagus and is proceeded by Barrett’s

38
Q

risk factors of SCC

A

alcohol, obesity and poor diet

39
Q

risk factors of AC

A

obesity, male sex and smoking

40
Q

clinical features of oesophageal cancer

A 
unrelenting and progressive dysphagia 
weight loss and/or anorexia
lymphandenopathy 
melena 
hoarseness of voice
41
Q

differentials of oesophageal cancer

A

oesophageal stricture
achalasia
gastric cancer
metastatic tumours

42
Q

initial investigations for suspected oesophageal cancer

A 
bloods - FBC, U+E, LFT, glucose, CRP + CEA
urgent endoscopy (with biopsy if required)
43
Q

additional investigations for oesophageal cancer

A

CXR - check for metastases

double contrast barium swallow

44
Q

investigations for staging of cancer

A

CT/MRI of chest + upper abdomen

FDG-PET

45
Q

surgical management/treatment of oesophageal cancer

A

in AC: pre-operative chemoradiotherapy
oesophagectomy
endoscopic mucosal resection

46
Q

medical management/treatment of oesophageal cancer

A

rapid chemotherapy

palliative care

47
Q

when is surgical treatment considered for oesophageal cancer?

A

if disease is localised and no co-morbidities are present

Gastrointestinal System (9 decks)

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