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gastrointestinal > Oesophagul Disorders > Flashcards

Oesophagul Disorders Flashcards

1
Q

What is achalasia?

A

Disorders of motility or peristalsis of oesophagus (assess the motor function of the UOS, LOS and oesophageal body)

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2
Q

What can cause GORD?

A

Assess cause of regurgitation (e.g. reflux of stomach acids into oesophagus); weak LOS

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3
Q

What is aphagia?

A

inability or refusal to swallow

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4
Q

What is meant by an oesophagul spasm?

A

Abnormal oesophageal contractions and food is not effectively reaching the stomach

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5
Q

What is diffuse oesophagul spasm?

A

condition characterised by chest pain coming from oesophagus (~angina)

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6
Q

What is the pathophysiology of Achalasia?

A

Findings may vary:
- Impaired LOS relaxation (spasms) -
- May be accompanied by impaired peristalsis (sphincter
spasms);
- Food + liquids don’t reach stomach; delayed LOS
opening

=> dilation of oesophageal body with distal narrowing (bird’s beak appearance) of the barium-filled oesophagus on oesophagram;

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7
Q

What is the effect of Achalasia?

A

Long period of sporadic dysphagia (difficulty swallowing);

Regurgitation of food

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8
Q

What is the aetiology of achalasia?

A

Disorders of motility or peristalsis of oesophagus (assess the motor function of the UOS, LOS and oesophageal body)

Damage to the innervation of oesophagus

Degenerative lesions to the vagus nerve and loss of myenteric plexus ganglionic cells in the oesophagus

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9
Q

What is the cause of achalasia?

A

Initiating factor unknown, but thought to be autoimmune or triggered by infection

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10
Q

What are the symptoms of achalasia?

A

Dysphagia
Vomiting
Heartburn
Retrosternal burning sensation due to oesophageal dysmotility
Retention of ingested (acidic) food;
Generation of lactic acid in the process of decomposition of retained food;

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11
Q

Why does heartburn occur in patients with achalasia?

A

Retrosternal burning sensation due to oesophageal dysmotility
Retention of ingested (acidic) food;
Generation of lactic acid in the process of decomposition of retained food;

could be due to retention of acid refluxed in oesophagus due to poor emptying and incomplete relaxation of LOS

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12
Q

What tests do we use to diagnose Achalasia?

A 
Barium radiography (barium swallow): dilatation of oesophagus with beak deformity at lower end
Evaluates the entire swallowing channel (mouth, pharynx, and oesophagus)

Oesophageal manometry: absent peristalsis

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13
Q

What considerations should you take when diagnosing Achalasia?

A

Patient’s self-report may suggest type of disorder responsible for complaints
=> may trigger tests required to determine/verify specific cause of complaint

Note some abnormalities of swallowing may be frequent in elderly

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14
Q

When is an oesophagul manometry carried out?

A
  1. To determine the cause of non-cardiac chest pain
  2. To evaluate the cause of reflux (regurgitation) of stomach acid and other contents back up into the oesophagus (GORD?)
  3. To determine the cause of difficulty with swallowing food (does UOS/LOS contract and relax properly?)
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15
Q

What would normal manometry results show?

A

Pressure of muscle contractions moving food to oesophagus = normal (15 mmHg) (when food oesophagus →stomach P = <10 mmHg)

Muscle contractions follow normal pattern down oesophagus

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16
Q

What would an abnormal manometry show

A

Muscle spasms in the oesophageal body

Weak contractions along oesophagus
*The LOS pressure is less than 10 mmHg (GORD / swallowing) – do not confuse these 2

Characterised by high LOS pressure which fails to relax after swallowing

Lack of a coordinated LOS relaxation in response to swallowing

17
Q

What is reflux?

A

Reflux is the retrograde movement of gastric content into oesophagus, due to relaxation of the LOS;

18
Q

How often does reflux normally occur?

A

Often brief, relatively infrequent;
Often occurs after meals in normal individuals (- transient spontaneous LOS relaxation, tsr);
Reflux usually stimulates salivation

19
Q

What is the benefit of saliva?

A

Saliva is an effective natural antacid - dilutes and neutralises refluxed gastric contents

20
Q

How does low salivation lead to GORD?

A

Low rate of salivation; lack of ability to swallow own saliva →prolongation of contact of refluxed material with oesophagus →GORD

21
Q

What is GORD?

A

Gastro-oesophagul reflux disorder
retro-grade movement of gastric content into oesophagus due to relaxation of LOS;
Causes burning sensation in chest after meals – angina-like pain?

22
Q

What is the difference between GORD and normal reflux?

A

GORD - when reflux is more frequent and troublesome

23
Q

What are the causes of GORD?

A

Transient spontaneous LOS relaxation (tsr)
98% of normal reflux associated with (tsr) of LOS

Resting LOS pressure is too weak to resist the pressure within the stomach

Sudden relaxation of LOS not induced by swallowing

24
Q

How does weak/uncoordinated oesophagul contractions contribute to GORD?

A

oesophageal irritation from reflux disease itself?)

prolonged duration of contact of refluxed digestive contents with oesophagus

25
Q

What factors increase the severity of GORD?

A
  • Length of time oesophagus exposed to gastric acid
  • ↑ Gastric acid secretion + bile in gastric contents →
    severe oesophageal damage
  • Amount of pressure placed on the anti-reflux barrier
26
Q

What can induce reflux?

A

Reflux occurs after eating, lying down (supine), and when there is delayed gastric emptying

27
Q

What factors induce GORD?

A
  • pregnancy or obesity
  • Fat, chocolate, coffee or alcohol ingestion
  • Large meals, tomatoes, orange juice, onions, etc.
  • Cigarettes
  • Drugs (e.g. Anticholinergic agents, calcium channel
    blockers and nitrate drugs)
28
Q

What are the clinical features of GORD?

A

Resting LOS tone = low / absent
LOS tone fails to increase when lying flat / during pregnancy
Poor oesophageal peristalsis →↓ acid clearance
A hiatus hernia (impairs the functioning of LOS + diaphragm closing mechanisms)
Delayed gastric emptying

29
Q

What are the symptoms of GORD?

A

Heartburn and acid regurgitation
Wake up at night – reflux irritates the larynx
Dysphagia

30
Q

How do we investigate GORD?

A

Low dose proton pump inhibitor (PPI) challenge is 1st line
Upper GI endoscopy
Manometry
24-hr ambulatory pH monitoring

31
Q

Explain how pregnancy may cause GORD?

A

Foetus increases pressure on abdominal contents
Pushes terminal segments of oesophagus into thoracic cavity
Last trimester of pregnancy is associated with increased abdominal pressure forcing gastric contents into oesophagus
Heartburn subsides in last months of pregnancy as uterus descends into pelvis

32
Q

Outline features of Heartburn

A

May occur in some individuals upon eating large meals
Less efficient LOS
Gastric contents episodically refluxed into oesophagus
Heartburn
Ulcer, scarring, obstruction or perforation of lower oesophagus

33
Q

What are the long term effects of GORD?

A

Oesophagitis, oesophageal strictures
Squamous cell carcinoma
Barrett’s syndrome - this may predispose someone to oesophageal adenocarcinoma
Oesophageal ulcer

34
Q

When would a manometry be ordered?

A

if you have symptoms of:
Heartburn or nausea after eating (GORD)
Problems swallowing [feeling of food stuck behind breast bone (achalasia)]

35
Q

What lifestyle changes are made to try and manage GORD?

A

Life-style changes:
raise head of bed at night
weight loss
modify food
↓ Intake of foods and drink which cause symptoms
Anti-reflux surgery (fundoplication – wrap fundus around LOS)

36
Q

What is the role of antacids?

A

Neutralise gastric acid, increase pH of gastric lumen

Inhibit peptic activity and stop acid secretion

37
Q

What medication may be used to manage GORD?

A

H2 receptor antagonists + proton pump inhibitors
Metoclopramide / domperidone – may enhance peristalsis and help gastric acid clearance
Fundoplication can cause dysphagia as it reduces the distensibility of LOS

gastrointestinal (18 decks)

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