oesophagus Flashcards
what is achalasia
failure of oesophageal peristalsis and relaxation of LOS
what ganglia degenerates in achalasia
Auerbach’s plexus
what dysphagia is present in achalasia
of both liquids and solids
what are the 3 main investigations for achalasia and what is most important
oesophageal manometry (first line) // Ba swallow (birds beak) // CXR (wide mediastinum)
what surgical treatment options are available for achalasia (3), what is first line
pneumatic balloon dilation (first line) // heller cardiomytomy // botulinum toxin injection
where does a pharyngeal pouch form
between thyropharyngeus and cricophargygeus muscles
what are features of pharyngeal pouch
elderly men // dysphagia// regurgitation // neck swelling that gurgles on palpation // bad breath
investigation for pharyngeal pouch
ba swallow and video fluoroscopy
how do you manage pharyngeal pouch
surgically
what does corkscrew appearance on CXR/ ba swallow indicate
diffuse oesophageal spasm
what is oesophagitis
heartburn, odnophagia but systemically well
what must be done with new onset dysphagia
urgent endoscopy regardless of age/ other symptoms
what are risk factors for gord
pregnancy, obese, smoking, TCA, anticholinergics, nitrates
what are the common features of GORD
heartburn worse lying down // water/ acid brash, (regurg) / odnophagia
what features/ symptoms of GORD would warrant an OGD
> 55 weeks // symptoms last >4 weeks despite symptoms // dysphagia // unresponsive // weight loss
if an endoscopy is negative for GORD what invx can be considered
24 hour oesophageal pH monitoring (gold standard)
what treatment is offered for GORD w/o endoscopy
- review meds and lifestyle 2. full dose PPI one month OR H.pylori treatment
what treatment is offered for GORD positive endoscopy
full dose PPI 1-2 months –> double if not working, half if it is
what treatment is offered for GORD negative endoscopy
full dose PPI 1 month –> H2 receptor blocker eg cimetidine, raniditine
what is a haitus hernia
herniation of stomach above the point of diaphragm
what is a sliding hiatus hernia
gastroesophageal junction moves above diaphragm// (stomach slides up the oesophagus) // 95%
what is a rolling hiatus hernia
gastroesophageal junction remains below diaphragm but part of stomach herniates through to sit next to oesophagus
what are risk factors for hiatus hernia
obese, raised intra pressure eg ascites, multiparity
what investigations are done for hiatus hernia and what is most sensitive
Ba most sensitive // usually OGD –> for dyspepsia
what lifestyle, pharmacological, and surgical options are available for hiatus hernias
weight loss // PPI // surgical only in paraesophageal
what is barrett’s oesophagus
squamous –> columnar cells from repeated GORD
what cells can be found on biopsy of barrett’s
epithelium with goblet cells and brush border
how + when can you manage barrett’s surgically
if signs of DYSplasia –> ablation if low grade // mucosal resection
how often should barrett’s patients get endoscopy
3-5 years if metaplasia but not dysplasia
what are the 2 common cancers and which is gord a risk factor for
adenocarcinoma, lower 1/3 (GORD) // SSC, upper 2/3 (smoking)
how is oesophageal cancer diagnosed
(FBC) OGD + biopsy
how is oesophageal cancer staged
CT usually first line –> USS for local
how is oesophageal cancer managed surgically + what adjuvant
oesophagectomy + chemo
what is a mallory weiss tear
haemetemesis from repeated vomitting
what is Boerhaave’s syndrome
rupture of oesophagus from repeat vomiting (left distal side) + chest pain
what is seen on the chest wall of Boerhaave’s syndrome
seubcut empysema
invx for Boerhaave’s syndrome
CT contrast swallow
mx Boerhaave’s syndrome
thoracotomy + lavage if <12 hours // if 12+ create fistula
how does sepsis occur from Boerhaave’s syndrome
mediastinitis (severe sepsis)
what is plummer vinson syndrome a triad of
dysphagia from oesophageal webs// glossitis// iron deficiency anaemia
what is the biggest risk factor for variceal bleeds
portal hypertension from liver disease
what is the first management in variceal bleeds
ABCDE // consider platelets, FFP and vit K
what is the order of treatment in variceal bleeds
1 terlipressin (vasoactive) 2. IV abx usually quinolones 3. endoscopy
OGD treatment of variceal bleeds best –> worst (4)
band ligation > sclerotherapy > SB tube (balloon) (IF UNCONTROLLED HAEMORRHAGE) > TIPSS
what is the most common side effect of TIPPS
hepatic encephalopathy
what prophylaxis is given for variceal heamorrhage (2)
propranolol or variceal band ligation (give 2 week PPI cover)
what assessment can be done pre or post endoscopy to manage patients
blatchford before –> rockall after
what usually causes gastroparesis
autonomic (diabetes!) or illness
what are features of gastroparesis
early satiety, abdo pain, vomitting undigested foods, (erratic glucose in diabetics)
invx gastroparesis
gastric emptying studies / T99
what prokinetics are given for gastroparesis and when are they to be avoided
domperidone, metoclopramide // small bowel obstruction
what is a side effect of metoclopramide
extrapyramidal (D2 antagonist)
