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
