oesophageal pathologies Flashcards
what is gastro-oesophageal reflux disease
when the lower oesophageal sphincter allows the contents of the stomach to go back up the oesophagus
the HCl is damaging to the stratified squamous non-keratinised epithelium of the oesophagus
what are risk factors/causes for GORD
alcohol
smoking
male
caffeine
anything that increases intrathoracic pressure - obesity, pregnancy
tricyclics, nitrates, anti-cholinergic drugs, antimuscarinics as they lower LOS pressure
MAIN CAUSE - sliding hiatus hernia
genetic inheritance of lower angle of LOS
hypomotility
how may GORD present
epigastric pain retro-sternal pain 'heartburn' water brash - excess saliva acid brash - acid in mouth bad breath cough (usually nocturnal) worse lying down/after meals sore throat - laryngitis sinusitis vomiting
what investigations could you do for GORD
what are alarm symptoms
if under 55 do an endoscopy, biopsy, 24/hr pH monitoring
if over 55 treat as normal unless there are red flags
test for H. pylori (urea breath test, faecal antigens, rapid urease)
alarm symptoms - anorexia, weight loss, iron deficiency anaemia, melaena, haematemesis, swallowing issues, masses
how could you manage GORD
proton pump inhibitors to decrease HCl production
antacids
H2 receptor agonists
alginates - Gaviscon
give lifetyle advice - weight loss, smaller meals, don’t eat before bed, lie more upright, don’t lie down after meals, smoking cessation, reduce alcohol, tea and coffee
surgery - nissan fundoplication
what are complications of GORD
stricture due to oesophageal scarring and fibrotic healing barrets oesophagus oesophageal cancer dysphagia flatulence diarrhoea vomiting ulceration
what is Barret’s oesophagus
condition where the non-keratinised stratified squamous epithelium of the oesophagus undergoes metaplasia and becomes simple columnar epithelium
what can cause Barret’s oesophagus
long term GORD - acid damages the cells
how does the oesophagus undergo malignant change in Barret’s oesophagus
the cells are damaged and undergo metaplasia - this is premalignant stage
it can then progress to low then high grade dysplasia and then to adenocarcinoma
how can you treat Barret’s oesophagus
PPIs
radiofrequency ablation treatment during endoscopy
endoscopic mucosal resection
monitor for adenocarcinoma by regular endoscopy
regular biopsy
What are the two types of oesophageal cancer
squamous - proximal 2/3rds
adenocarcinoma - distal 1/3rd
what are risk factors for oesophageal cancer
squamous - smoking, alcohol, dietary carcinogens, genetics
adenocarcinoma - Barret’s oesophagus, obesity
how may oesophageal cancer present
progressive dysphagia odynophagia pneumonia tiredness weight loss anorexia chest pain coughing and belching vocal chord paralysis hoarse voice hiccups haematemesis pain between shoulder blades reflux achalasia
what investigations could you do for oesophageal cancer
endoscopy CT - look at liver for metastasis PET X-ray with barium MRI biopsy TNM staging US bone scan
how could you manage oesophageal cancer
oesophagostomy - remove part of the oesophagus and bring stomach further up - need full CVS assessment before surgery, below 70, no co-morbidities
endoscopic radiofrequency ablation
chemoradiotherapy
brachytherapy
palliative care - radiotherapy, oesophageal stent
nutritional support after surgery
what are complications of oesophageal cancer
can be malignant - spreads to heart and lungs, this makes it difficult to operate on
ulcers
obstruction
perforation
stricture
achalasia
do not operate on people who are frail, can take months to recover from a leak from the surgery
oesophageal-tracheal fistula - can cause pneumonia
poor prognosis
what are oesophageal varices
dilated/tortuous veins in the submucosa of the oesophagus that can rupture
what can cause oesophageal varices
portal hypertension - the pressure increases and backs up as blood can’t get through the liver as easily
the increased pressure dilated the veins
what are risk factors for oesophageal varices
alcoholic liver disease - causes cirrhosis
how may oesophageal varices present
dizziness haemoptysis haematemesis pallor jaundice
what investigations could you do for oesophageal varices
endoscopy
how could you treat oesophageal varices
band ligation - necrose the vessel to seal it
glue injections to close vessels
IV Terlipressin (to constrict vessels that supply venous blood to the portal system)
correct coagulopathy
what is achalasia
LOS doesn’t relax properly due to myenteric plexus ganglia becoming damaged in sphincter and distal oesophagus
what are risk factors for achalasia
genetics
how may achalasia present
regurgitation dysphagia recurrent chest infections weight loss chest pain
how could you treat achalasia
nitrates CCBs botox balloon dilation myotomy
what are complications of achalasia
aspiration pneumonia
lung disease
carcinoma
what is eosinophilic oesophagus
autoimmune attack and infiltration by eosinophils on the oesophageal epithelium
what causes eosinophilic oesophagus
autoimmune disease
genetics
what are risk factors for eosinophilic oesophagus
male
child
how may eosinophilic oesophagus present
dysphagia odynophagia obstruction of food bolus when swallowing impaction - food stuck in oesophagus regurgitation upper abdominal pain heart burn
what tests could you do for eosinophilic oesophagus
endoscopy
biopsy
bloods
microscopy - more than 15 eosinophils per high power field
how could you treat eosinophilic oesophagus
corticosteroids
avoid food triggers
endoscopic dilatation for any strictures
