Oesophagus Flashcards
what is GORD and what is the pathophysiology
condition whereby gastric acid leaks up into the oesophagus
dysfunction of the lower oesophageal sphincter - it relaxes too much and allows the reflux of gastric contents into the oesophagus
this results in pain and mucosal damage in the oesophagus
risk factors for GORD
age, obesity, male gender, alcohol, smoking, caffeine intake and spicy foods
clinical features of GORD
chest pain - burning retrosternal, worse after meals and when laying down or straining
belching, chronic cough, nocturnal cough
red flags for suspected upper GI malignancy
patients with dysphagia
any patient >55yrs with weight loss, upper abdo pain, dyspepsia or reflux
management of GORD
conservative; avoid caffeine, alcohol, spicy foods, weight loss, smoking cessation, PPIs - lifelong
surgical; fundoplication - wrap fundus around oesophagus to recreate LOS lower down - side effects include dysphagia, bloating and inability to vomit
what are the 2 main subtypes of oesophageal cancer
squamous cell carcinoma and adenocarcinoma
what are the differences in aetiology between adenocarcinoma and squamous cell carcinomas of the oesophagus
squamous cell = developing countries, upper/middle third of the oesophagus, associated with smoking and excessive alcohol consumption
adenocarcinoma = developed world, lower third of oesophagus, arises as a consequence of Barrett’s oesophagus, associated with GORD, obesity and high fat intake
if a patient presents with dysphagia, what is it important to think about/rule out
oesophageal cancer
what are the common clinical features of oesophageal cancer
most common is progressive dysphagia (difficulty swallowing - starting with solids them transitioning to liquids aswell)
weight loss, odynophagia (painful swallowing), hoarseness
what are the red flag signs for oesophageal malignancy that require urgent upper GI endoscopy
any patient with dysphagia
any patient >55yrs with weight loss and upper abdo pain, dyspepsia, or reflux
initial investigations into suspected oesophageal malignancy
first line is an upper GI endoscopy (OGD - oesophagogastroduodenoscopy)
any malignancy then biopsied and sent for histology
what staging investigations is it important to do in a patient with oesophageal malignancy
CT chest-abdo-pelvis and PET-CT scan ; both used to assess for distant metastases
endoscopic ultrasound ; measures penetration into the oesophageal wall
staging laparoscopy ; look for intra-peritoneal mets
management of oesophageal cancer
only a small proportion of oesophageal cancers are suitable for surgical intervention
the survival rate is poor due to presentation with already advanced disease - therefore approx 70% are treated palliatively
chemo and radiotherapy are the main options with surgical resection possible in very few patients with early disease
what subtype of oesophageal cancer is most common in developing countries
squamous cell carcinomas; smoking and alcohol association
what are the 2 main sub-categories of oesophageal tears
mallory-weiss tears; superficial mucosal tears
full thickness ruptures