Brainscape's Knowledge GenomeTM

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


See full index

Surgery > Oesophagus > Flashcards

Oesophagus Flashcards

1
Q

Define oesophageal webs

A

Thin mucosal membrane that grows across lumen of upper! Oesophagus and may cause dysphasia.

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

Name 2 risk factors oesophageal webs

A

• Severe, chronic iron deficiency anemia (resolve with treatment)
• female

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

Symptoms oesophageal webs?

A

Dysphagia for solids.
Often signs of anaemia (underlying cause)

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

Diagnosis oesophageal webs

A

Barium swallow:webs upper oesophagus

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

Treatment oesophageal webs?

A

• Treat iron deficiency anaemia
• easily ruptured during œsophagoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name 5 causes proximal or mid esophageal strictures

A

• Caustic ingestion acid or alkali
• malignancy, radiation therapy, extrinsic compression, scc
• infections esophagitis: Candida, CMV, HSV, HIV
• medication induced esophagitis: NSAIDs, phenytoin, kCL, tetracycline, ascorbic acid, alendronate
• idiopathic eosinophilic esophagitis
• disease skin: pemphigus vulgaris, benign mucous membrane (cicatricial) pemphigoid
• AIDS and immunosuppression post transplant , graft vS host disease
• trauma, foreign body/ post-op structure, congenital esophageal stenosis

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

Name 5 causes distal esophageal strictures

A

• Peptic stricture: GORD, zollinger Ellison syndrome
• Adenocarcinoma
• collagen vascular disease: scleroderma, SLE, rheumatoid arthritis
• chrohn disease
• sclerotherapy, prolonged ngt
• extrinsic compression, alkaline reflux following gastric resection

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

Symptoms peptic stricture? (5)

A

• Heartburn, odynophagia, food impaction, weight loss, chest pain
• progressive dysphasia for solids = most commonly !
• atypical presentation = chronic cough, asthma secondary to aspiration
• obstruction perceived at a point either above or at level of lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Differential for dysphagia solids and liquids simultaneously?

A

Achalasia
Collagen Vascular disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Type of dysphagia due to schatzki ring?

A

Intermittent and nonprognessive

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

Treatment esophageal stricture? (4)

A

• Treat underlying cause eg Candida
• Long term PPI,
• endoscopic dilation or
• intralesional steroid injection or
• endoscopic stricturoplasty, stent etc

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

Name 6 types esophageal cancer

A

• squamous cell carcinoma
• Adenocarcinoma
Rare:
• neuroendocrine
• lymphoma
• gist
• melanoma

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

Name 9 risk factors esophageal squamous cell carcinoma

A

Non-modifiable
•male

Lifestyle
• smoking and alcohol
• caustic injury
• recurrent thermal injury due to ingestion of high temperature beverages
• diet: low fruits and veg, high in nitrogenous compounds eg beans, nuts, meat, poultry, fish
• lower socioeconomic status

Medical conditions
• longstanding achalasia
• tylosis (rare autosomal dominant disease with hyperkeratosis palm and sole)
• hpv

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

Name 4 risk factors esophageal Adenocarcinoma

A

Non-modifiable
• male

Comorbidities
• GERD and Barret’s esophagus

Lifestyle
• obesity
• smoking

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

Symptoms oesophageal cancer? (7)

A

Typical
• progressive dysphagia
• involuntary progressive weight loss and anorexia
• fatigue due to anaemia in presence of chronic, occult bleeding or chee to anaemia of chronic illness
• may vomit blood or pass melena

Symptoms of local invasion
• coughing, choking and recurrent pneumonias due to tracheo-esophageal fistula
• hoarseness due to vocal cord palsy from recurrent laryngeal nerve invasion
• aspiration pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Grading of dysphagia?

A

0: no dysphagia
1: can swallow some solids
2:can only swallow semi solids
3: liquids only
4: can’t swallow anything

17
Q

Clinical examination findings esophageal cancer? (6)

A

• severely wasted, dehydrated pale, lethargic
Signs metastasis:
• tinge of jaundice (liver)
• hepatomegaly
• supraclavicular cervical lymph nodes
• chest pneumonia or pleural effusion
Other signs mets to bones, adrenal glands, brain, peritoneum

18
Q

Common sites metastasis esophageal cancer? (7)

A

• Lymph
• lung
• liver
• bones
• brain
• adrenal glands
• peritoneal surfaces

19
Q

Diagnostic investigations for esophageal cancer?

A

• Barium swallow: can be done initially to evaluate anatomy before invasive procedures. Features= irregular apple core stricture, shouldering, prox dilatation esophagus, axis deviation or angulation, TOF if present
• endoscopy and biopsy mainstay. Nb to document: exact site relative to GE J, extension into stomach and distance from teeth, length lesion, circumferential involvement, obstruction, adjacent pre-malignant lesions ie squamous dysplasia or be. Need 6 biopsies.

20
Q

Name 4 signs of advanced esophageal cancer on imaging

A

• Endoscopic: long circumferential lesion > 8cm length
• ba swallow:tracheo-oesoph fistula, axis deviation and angulation
• cxr: pleural effusions or cannonball lesions
• Ultrasound abdomen: liver mets, Ascites

21
Q

Staging esophageal cancer?

A

Ajcc TNM
Tumour (CT chest abdomen pelvis, endoscopic ultrasound more sensitive, bronchoscope t4a )
• Tis: high grade dysplasia
• t1
- a: invade lamina propria or muscularis mucosae
-B: submucosa
• t2: muscularis propria
• t3: adventitia
• t4
- a: adjacent structures eg pleura, pericardium, azygous vein, diaphragm, peritoneum
-B: major adjacent structures eg aorta, vertebral body, trachea

Regional lymph nodes (CT chest abdomen pelvis, endoscopic ultrasound more sensitive)
• n1: 1-2 nodes
• n2: 3-6
• n3: ≥7

Metastasis (CT chest abdomen pelvis, endoscopic ultrasound, pet CT, staging laparoscopy with ≥ t3 or node involvement )
M1

22
Q

Management Tis and T1a esophageal cancer (confined to mucosa)? (2)

A

• Locally ablative techniques: radiofrequency ablation
• or endoscopic resection
Very low risk metastasis

23
Q

Management T 1 and T 2 NoMo esophageal cancer (confined to esophagus )?

A

Surgical resection esophagectomy with Adjacent lymph nodes (t1b submucosal involvement has 20% risk lymph metastasis )

24
Q

Management T1-3 N1-3 and T4a Mo esophageal cancer? (2)

A

• Still resectable. Surgery
• adjuvant chemo or chemoradiotherapy

25
Q

Management m1 and T4b Mo esophageal cancer? (3)

A

Aka disseminated and locally advanced irresectable
Palliation:
•oesophageal dilatation with self expanding metal stent for high grade dysphagia
• radiation (brachytherapy or external beam): early dysphagia
• Og junction tumours radiation is better. Stent will encourage GERD
• morphine syrup analgesia

26
Q

Management cervical esophageal cancer?

A

• can’t be safely resected with adequate clear margins.
• definitive chemoradiotherapy with curative intent

27
Q

Name 4 types esophagectomy for esophageal cancer

A

• Trans-hiatal: ideal for low tumour or early tumour with probable minimal lymph node involvement. Open abdo cavity only
• two stage ivor-lewis: distal third tumours. Open abdominal and thoracic cavity.
• three stage mckeon: open thorax abdomen and neck for the anastomosis
• also resent part or all of stomach in og junction tumours

28
Q

What type of injury do alkali ingestion cause?

A

Liquefactive necrosis

29
Q

What type of injury do acid ingestion cause?

A

Coagulative necrosis

30
Q

What kind of dysphagia will be present in diffuse oesophageal spasm?

A

Total, grade 4 dysphagia

31
Q

Name and describe the 2 types of esophageal spasms

A

• Diffuse: contractions of normal amplitude but uncoordinated, simultaneous or rapidly propagated
• hypertensive peristalsis: aka nutcracker esophagus. Contractions coordinated but excessive amplitude

32
Q

Diagnosis esophageal spasm?

A

High resolution manometer

33
Q

Treatment esophageal spasm? (8)

A

• CCB
• Botox
• nitrates
• tricyclic antidepressants
• sildenafil
• dilatation
• myotomy
• esophagectomy

34
Q

Define and describe pathopysiolgy esophageal achalasia (3)

A

• Absence esophageal peristalsis and Lower esophageal sphincter fails to relax in response to swallowing
• due to progressive destruction ganglion cells in myenteric plexus
• bolus can get stuck → further dysfunction due to continuous squeezing against fixed outflow

35
Q

Symptoms achalasia? (5)

A

• Progressive dysphagia to solids and liquids
• chest pain
• regurgitation
• weight loss
• aspiration (cough), vomiting, heartburn

36
Q

Diagnosis esophageal achalasia? (3)

A

• Barium swallow - bird’s beak appearance, esophageal dilatation, stasis of barium in esophagus
• esophageal manometer gold Standard: absent peristalsis, incomplete Les relaxation in response to swallowing, high resting Les tone.
• symptoms similar to cancer so do esophagogastroscopy to rule out

37
Q

Treatment esophageal achalasia? (4)

A

Medical
• ccb or nitrates for temporary relief
• endoscopic Botox injections relieve for a few months

Surgery
• laparoscopic heller myotomy preferably with partial funduplication
• peroral endoscopic myotomy (poem)
Endoscopic balloon dilatation
Esophagectomy last resort

Surgery (40 decks)

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