Brainscape's Knowledge GenomeTM

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


See full index

Year 4: General Surgery + GI > Oesophageal Problems > Flashcards

Oesophageal Problems Flashcards

1
Q

what vertebral level does the oesophagus originate

A

C6

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

What are the symptoms of oesophageal disease?

A

Dysphagia

Dyspepsia (Heartburn)

Regurgitation

Painful swallow

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

What is dysphagia?

A

DIFFICULTY swallowing

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

What does a short history of progressive dysphagia first to solids and then liquids suggest? What is the most appropriate investigation?

A

Mechanical stricture

Urgent ODG (endoscopy)

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

What does a long history of slow onset dysphagia to both solids and liquids suggest? What is the most appropriate investigation?

A

Motility disorder

  • OGD to exclude cancer
  • Barium swallow rarely performed now
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is heartburn?

A

Retrosternal/Epigastric burning sensation due to acid reflux. Pain is made worse by lying down

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

What is regurgitation? What conditions does it occur in?

A

Reflux of oesophageal contents into the mouth/pharynx Occurs in reflux disease + oesophageal strictures

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

What is odynophagia? What condition does it indicate?

A

Painful swallow

Oesphagitis caused by GORD/infection

  • candida in HIV patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is GORD?

A

Gastro-oesophageal reflux disease

  • gastric acid from stomach leaks back up into the oesophagus
  • lower oesophageal spincter relaxes more frequently than it should
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the major symptom of GORD?

A

Heartburn- burning retrosternal pain

  • worse after meals
  • worse lying down / bending over

May also present with regurgitation + odynophagia.

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

How is the diagnosis of GORD made?

A

The history

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

risk factors for GORD

A

male

age

obesity

smoking

alcohol

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

When is an endoscopy (OGD) indicated?

A

New onset GORD > 55 years old or worsening despite PPI

patients with ALARM Symptoms

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

What are the ALARM Symptoms?

A

Anaemia

Loss of weight

Anorexia

Recent onset of progressive symptoms

Malena or haematemesis

Swallowing difficulty

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

what is the gold standard investigation for GORD?

when is it required?

A

24 hour pH monitoring

  • patients where medical treatment fails and are being considered for surgery
  • should be combined with oesophageal manometry to exclude motility disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What non-pharmacological management is indicated in GORD?

A

Weight loss

Smoking cessation

Avoidance of aggravating foods (e.g. coffee, fatty foods) + excess alcohol

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

What is the first line treatment for mild GORD?

A

Antacids, e.g. gavascon

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

What is the first line treatment for severe GORD or patients with complications?

A

PPIs e.g. omeprazole

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

surgical options for GORD

A

Fundoplication

  • fundus is wrapped around gastro-oesophageal junction to create lower sphincter
  • indicated for patients who dont respond to treatment / patient preference to avoid life long medication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What do H2 receptor antagonists do?

A

Relieve the symptoms of GORD. e.g. ranitidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some of the complications of GORD?

A

Stricture formation

Barret oesophagus

Aspiration pneumonia

Oesophageal cancer

Schatski ring

22
Q

How is an oesophageal stricture treated?

A

PPIs + endoscopic dilatation

23
Q

What is Barrets oesophagus?

A

Metaplastic change from squamous epithelium to columnar epithelium.

It is an irreversible premalignant change

majority of cases caused by chronic GORD

24
Q

investigation of Barrets oesophagus

A

OGD + biopsy

  • it is a histological diagnosis
25
Q

appearance of the oesophagus in a patient with Barrets oesophagus on OGD

A

red + velvety appearance

26
Q

How is Barrets oesophagus treated?

A

PPIs + endoscopic surveillance due to risk of progression to adenocarcinoma

27
Q

What is a schatski ring?

A

Localised mucosal stricture at the gastro-oesophageal junction

28
Q

what is the difference between the upper and lower oesophageal sphincter?

what are their functions?

A

upper = skeletal muscle

  • prevents air from entering GI tract

lower = smooth muscle

  • prevents reflux from the stomach
29
Q

What is achalasia?

A

Failure of the lower oesophageal sphincter to relax, preventing food from passing into the stomach

30
Q

What is the pathology behind achalasia?

A

Degeneration of the vagus nerve

  • progressive destruction of the ganglion cells in the myenteric plexus
31
Q

symptoms of achalasia

A

progressive dysphagia to both solids + liquids

vomiting

regurgitation of food

chest discomfort

weight loss

32
Q

What is the buzz word seen on a barium swallow for achalasia?

A

Birds beak oesophagus

33
Q

What else does a barium swallow show that indicates achalasia?

A

Dilatation of the oesophagus + no peristalsis

34
Q

What investigation confirms achalasia?

A

Oesophageal manometry

3 key features:

  • absence of peristalsis
  • failure of relaxation of LOS
  • high LOS resting tone
35
Q

How do you treat achalasia?

A

surgical:

  • endoscopic dilation
  • heller myotomy

Nitrates/Ca channel blockers (nifedipine) can be given to relax LOS but effects are short lived

36
Q

What is an oesophageal spasm? What is seen on a barium swallow?

A

Simultaneous contractions in the distal oesophagus

  • dysfunction in oesophageal inhibitory nerves

CORKSREW OESOPHAGUS

37
Q

presentation of oesophageal spasm

A

Dysphagia + chest pain

38
Q

what does the pain in oesophageal spasm respond to

A

nitrates / calcium channel blockers

  • relax the smooth muscle
39
Q

manometry finding in oesophageal spasm

A

repetitive, simultaneous, ineffective contractions

40
Q

what autoimmune conditions can cause oesophageal dysmotility

A

systemic sclerosis

polymyositis / dermatomyositis

41
Q

What is allergic eosinophilic oesophagits?

A

Inflammation of the oesophagus caused by reaction to food. Immune complex mediated + eosinophilic infiltrates present

42
Q

How does oesophageal perforation present? How is it diagnosed?

A

Severe chest pain, Fever, Hypotension, Emphysema

Diagnosis: erect CXR for peritoneal air + CT gold standard for any perforation (shows presence + location)

43
Q

What are the most common malignant oesophageal tumours and where do they occur?

A

Squamous cell - usually middle 3rd of oesophagus Adenocarcinoma- usually lower 3rd of oesophagus

44
Q

What are the risk factors for Squamous cell carcinoma?

A

Smoking, Alcohol, Achalasia, Coeliac disease

45
Q

What causes adenocarcinoma?

A

Barrets oesophagus

GORD, smoking + obesity are also risk factors

46
Q

How does oesophageal cancer present?

A

Progressive dysphagia to solids then liquids.

Weight loss

Hoarseness / odynophagia may also occur

47
Q

How is oesophageal cancer diagnosed?

A

OGD + biopsy

48
Q

What is the treatment for oesophageal cancer?

A

70% require palliative therapy and are unfit for treatment

  • oesophageal stent for dysphagia

Chemo-radiotherapy +/- oesophagectomy

49
Q

Are benign oesophageal tumours common or rare?

A

Rare

50
Q

What is the most common benign oesophageal tumour?

A

Squamous papilloma

Year 4: General Surgery + GI (13 decks)

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