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Oesophageal pathologies Flashcards

1
Q

What is oesophagitis?

A

Inflammation of the oesophagus.

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2
Q

How is oesophagitis presented?

A
  • epigastric pain or chest pain, burning
  • acidic or sour taste
  • dysphagia (difficulty swallowing)
  • odynophagia (painful swallowing)
  • hoarseness
  • persistent cough
  • +/- epigastric tenderness to palpation
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3
Q

Risk factors and complications of oesophagitis?

A

RFs:
- eating just before bed
- excessive alcohol, caffeine, chocolate
- greasy or spicy food
- smoking
- obesity
- hiatus hernia
- medications

Complications:
- strictures (scarring can lead to narrowing called strictures)
- Barrett’s oesophagus (cellular changes of oesophagus)
- Oesophageal cancer

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4
Q

Causes of oesopahgitis?

A
  • GORD
  • Medication (NSAIDs, bisphosphonates, tetracycline abx)
  • Immune-mediated (eosinophilic oesophagitis)
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5
Q

How is oesophagitis diagnosed? What are you looking for?

A

OGD endoscopy and biopsies

Endoscopy checks for mucosal erosions, inflamed oesophageal tissue.

Biopsies check for increased eosinophils, cellular changes.

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6
Q

How is oesophagitis treated?

A

Tx depends on the cause.

Reflux oesophagitis
- stop smoking
- wt loss
- avoid alcohol, greasy/spicy food, citrus, chocolate, peppermint, caffeine.
- PPI

Eosinophilic oesophagitis
- refer to allergist
- avoid food allergies
- daily PPI
- topical steroids
- fluticasone metered-dose inhaler (MDI) without spacer →spray into pt’s mouth, then swallow. Helps reduce inflammation in the oesophagus.

During-induced oesophagitis
- discontinue offending medication and offer alternative
- remain upright 30 mins after consuming medication or prescribe liquid version of that medication

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7
Q

What is Mallory Weiss tear?

A

Tear or laceration of the oesophagus near where the stomach and the oesophagus meets.

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8
Q

Causes of Mallory Weiss tear?

A

If there is sudden increased pressure in the oesophagus and the lower oesophagus is unable to adjust to that, it will not be able to expand enough, hence the little tears in the lining.

  • excessive alcohol
  • vomiting
    • pts who have gastroenteritis, hyperemesis gravidarum (excessive vomiting during pregnancy), bulimia, migraine.
  • coughing
  • blunt abdominal trauma
  • iatrogenic (refers to something a healthcare worker has caused)
    • NG tube placement
    • OGD
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9
Q

Diagnosis of Mallory Weiss tear?

A
  • OGD endoscopy -diagnostic
  • CXR -should not see pneumomediastinum (air present in the mediastinum)
  • FBC e.g. anaemia
  • LFTs
  • PT/INR -bleeding or clotting disorders
  • PTT (partial thromboplastin time)
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10
Q

Presentation of Mallory Weiss tear?

A
  • epigastric pain or back pain
  • hx of vomiting
  • hx of a procedure
  • haematemsis (signs of upper GI bleed)
  • dysphagia (difficulty swallowing)
  • odynophagia (painful swallowing)
  • melaena (signs of upper GI bleed)
  • lightheadedness (bleeding causing anaemia)
  • signs of hypovolaemia
    • tachycardia
    • low BP
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11
Q

Treatment of Mallory Weiss tear?

A

OGD endoscopy + haemoclip (clipping) or epinephrine injection (constricts blood vessel and stops bleeding)

IV access -blood transfusion, fluid replacement

IV PPI, then oral for 4-8 wks

Antiemetic (e.g. metaclopramide, prochlorperazine)

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12
Q

What is oesophageal malignancy?

A

Abnormal cancer cells in the oesophagus, typically squamous cell carcinoma (SCC) and adenocarcinoma.

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13
Q

Pathological cause for SCC and adenocarcinoma in oesophageal malignancy?

A

SCC:
- carcinogenic effects of alcohol and tobacco, which damage the lining of the oesophagus and promote cancer cell development.

Adenocarcinoma
- longstanding GORD →Barrett’s oesophagus → malignancy

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14
Q

Risk factors for oesophageal malignancy?

A
  • longstanding GORD
  • Barrett’s oesophagus
  • excessive alcohol
  • smoking
  • male
  • FHx of oesophageal, gastric, oral, pharyngeal cancer
  • diet low in fresh fruits and vegetables
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15
Q

How do you diagnosis oesophageal malignancy?

A

OGD endoscopy

2ww referral for OGD endoscopy if:
- age 55 or over with unexplained wt loss and any of the following:
- dyspepsia
- reflux
- upper abdominal pain

  • dysphagia (regardless of age and other symptoms)
  • unexplained appetite loss
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16
Q

How does oesophageal malignancy present?

A
  • dysphagia (difficulty swallowing)
  • odynophagia (painful swallowing)
  • unexplained wt loss
  • apeptite loss
  • dyspepsia
  • haematemsis (signs of upper GI bleed)
  • hoarseness
  • hiccups
  • postprandial cough
  • n+v
  • reflux
  • upper abdominal pain
  • +/- epigastric abdominal tenderness to palpation
17
Q

Treatment for oesophageal malignancy?

A
  • Oesophagectomy
  • Chemotherapy
  • Radiotherapy
18
Q

What is oesophageal stricture?

A

Oesophageal narrowing secondary to oesophageal wall injury and scarring.

19
Q

Causes of oesophageal stricture?

A
  • reflux oesophagitis
  • eosinophilic oesophagitis
  • drug-induced oesophagitis
  • exposure to external beam radiation (neck/breast cancer hx)
  • post-endoscopic therapy
  • oesophageal malignancy
  • infections -HIV, CMV, HSV, Candida
20
Q

Presentations of oesophageal stricture?

A
  • dysphagia with food (difficulty swallowing; rapid progression if malignant)
  • odynophagia (painful swallowing)
  • unexplained wt loss
  • heartburn
  • regurgitation
  • chest pain
  • +/- epigastric abdominal tenderness to palpation
21
Q

How is oesophageal stricture diagnosed?

A

OGD endoscopy to rule out malignancy (1st)
- 2ww referral for OGD endoscopy if:
- age 55 or over with unexplained wt loss and any of the following:
- dyspepsia
- reflux
- upper abdominal pain
-dysphagia (regardless of age and other symptoms)
- unexplained appetite loss

If endoscopy comes negative, then perform barium swallow.

22
Q

How is oesophageal stricture treated?

A

Endoscopic dilation

Acid suppression via PPI

23
Q

What is achalasia?

A

A motility disorder of the oesophagus where there is loss of oesophageal peristalsis and failure of lower oesophageal sphincter (LOS) relaxation when swallowing. The LOS remains closed, making it difficult for food and fluid to move through.

24
Q

What causes achalasia?

A
  • genetic factors
  • autoimmune disorders
  • infections -HIV, measles, Chagas disease
25
Q

How is achalasia diagnosed?

A

2ww referral OGD endoscopy:
- age 55 or over with unexplained wt loss and any of the following:
- dyspepsia
- reflux
- upper abdominal pain
- dysphagia (regardless of age and other symptoms)
- unexplained appetite loss

Barium swallow (oesophagus dilate, bird’s beak sign)

Oesophageal manometry (measure muscle pressure)

26
Q

How does achalasia present?

A
  • dysphagia with food and liquids
  • substernal chest pain
  • difficulty burping (belching)
  • heartburn
  • regurgitation
27
Q

How is achalasia treated?

A

No known cure.

Pneumatic dilation
- insert a fibre and blow a balloon

Laparoscopic cardiomyotomy (Heller’s myotomy)
- surgical procedure where they divide some of the muscle fibres of the lower oesophageal sphincter so that it can open and allow fluid and food to move through.

CCB (nifedipine, verapamil)
- to help relax the muscles

Nitrates (isosorbide dinitrate -keeps the muscle relaxed)

Botulinum toxin (injected via endoscopy -botox; helps keep the LOS open)

28
Q

What is oesophageal varices?

A

Dilated oesophageal veins due to portal hypertension

29
Q

Causes and pathophysiology of oesophageal varices?

A

liver cirrhosis
- primary biliary cirrhosis
- alcoholic hepatitis
- fatty liver disease
- HBV, HCV

chronic thrombosis
- portal or splenic vein occlusion

  • In a normal liver, blood flows through the liver to the inferior vena cava and enters the right atrium of the heart.
  • In liver cirrhosis, there are lots of scarring. This blocks the blood getting through the liver and up into the inferior vena cava. Therefore, blood backs up and enters the veins that go to the oesophagus and stomach. This causes the veins to become distended and dilated due to the backup of the blood.
  • If there is a thrombus in the portal or splenic vein, the blood won’t go up to the inferior vena cava. Instead, the blood backs up and reaches the oesophagus veins, causing distention and dilation.
30
Q

How is oesophageal varices diagnosed?

A
  • OGD endoscopy
  • FBC
  • PT/INR
  • LFTs
  • U&Es
  • HBV/HCV serology
  • liver USS
31
Q

RFs of bleeding oesophageal varices?

A
  • previous variceal bleed
  • ongoing alcohol use
  • severe liver cirrhosis or liver failure
32
Q

How does bleeding oesophageal varices present?

A
  • haematemesis
  • melaena
  • lightheadedness, syncope
  • iron deficiency anaemia
33
Q

What is the most significant complication of oesophageal varices?

A

Bleeding oesophageal varices -fatal

34
Q

How to treat varices without bleeding?

A
  • prescribe non-cardioselective BB (e.g. propranolol, carvedilol →decreases pressure within the varices to prevent bleeding)
  • endoscopic variceal band ligation (putting rubber bands around varices to stop bleeding)
35
Q

How to treat active bleeding varices?

A

MEDICAL EMERGENCY

  • control bleeding
    • endoscopic variceal band ligation
    • vasoconstrictor pharmacotherapy (terlipressin, somatostatin)

-IV fluid -volume resuscitation, blood transfusion

36
Q

How to manage cirrhosis with no varices?

A

Endoscopy every 2-3 years

GI (12 decks)

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