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Gastrointestinal (LECTURE NOTES) > Oesophagus > Flashcards

Oesophagus Flashcards

1
Q

What is GORD

A

Gastro-oesophageal reflux disorder

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2
Q

When does a patient with GORD typically have worsening symtpoms

A

After meals

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3
Q

What prevents reflux in health

A

Lower oesophageal sphincter pressure
Angle of Hiss: oblique angle between cardia and oesophagus - anatomical barrier
Oesophageal clearance: any material that gets back into the oesophagus will be rapidly cleared by peristaltic contractions

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4
Q

What is a hiatus hernia

A

herniation of the stomach in to the thorax

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5
Q

Are all hiatus hernias symptomatic

A

No

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6
Q

What are the 2 forms of hiatus hernia

A

Sliding and rolling

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7
Q

What is the most common form of hiatus hernia

A

Sliding

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8
Q

How does a hiatus hernia cause reflux

A

Reducing the LOS pressure
Increasing the TLSORs
Straightening out the angle of Hiss

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9
Q

What is a gastric volvulus

A

When the stomach twitsts on itself causing severe pain and dysphagia

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10
Q

Define gastroparesis

A

Any condition that delays gastric emptying

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11
Q

What can increase the gastric volume

A

Pregnancy, binge drinking, poorly controlled diabetes

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12
Q

What can cause an increase n the intra-abdominal pressure

A

Pregnancy
Obesity
Chronic cough

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13
Q

What increases the gastric acid production in the stomach

A

Smoking
eating fat and calorie rich foods
binge drinking
regular use of NSAIDs

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14
Q

What are some of the clinical features of GORD

A 
Heartburn
Fluid/ Food regurgitaiton
Waterbrash
Nocturnal cough 
Chest pain
Dysphagia or odynophagia
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15
Q

What is the first line investigation

A

Endoscopy

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16
Q

What is helpful if surgery is being considered

A

24 h pH measurement

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17
Q

What is helpful if surgery is being considered

A

24 h pH measurement

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18
Q

What is oesophagitis

A

Endoscopic change ranging from minor erythmea to frank ulceration and stricturing

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19
Q

What does an oesophageal stricture result in

A

Narrowing of the distal oeosphagus following repeated peptic ulceration and scarring

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20
Q

How does an oesophageal stricture present

A

Dysphagia

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21
Q

What is the treatment for an oesophageal stricture

A

Endoscopic dilatation and long term PPIs

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22
Q

What is Barrett’s oesophagus

A

A metaplasia of distal oesophageal mucosa from squamous to columnar epithelium caused by an adaptive response to chronic acid exposure

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23
Q

Barrett’s oeosphagus is usually symptomatic. True or False.

A

False. It is usually asymptomatic

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24
Q

What are 4 risk factors for Barrett’s oesophagus developing into carcinoma

A

White males
OVer 50 year olds
Obese
Smokers

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25
Q

How is a diagnosis of Barrett’s oesophagus made

A

BAsed on mucosal appearances and histology

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26
Q

What are the treatment options for Barrett’s oeosphagus

A

Endoscopic ablation through photodynamic therapy - has lots of side effects

27
Q

What might be considered when high-grade dysplasia is observed

A

Oesophagectomy

28
Q

What are the 2 main forms of conservative management for GORD

A

Lifestyle modification - weight loss, smoking cessation, elevation of bed head, avoiding fatty meals before bed
Antacids - provide symptoms relief

29
Q

What are the 2 main medical ways of managing GORD

A

H2 receptor antagonists- need to be taken less frequently than anatacids but are just as effective
PPI - achieve symptom relief - they also heal oesophagitic mucosa

30
Q

Who is laparoscopic or open fundoplication suitable for

A

Patients with large hiatus hernias

31
Q

What is corrosive ingestion

A

Deliberate self-harm through ingestion of bleach or battery acid

32
Q

What is the management for corrosive infestion

A

Analgesia
Antiemetics
NBM

33
Q

What is the major risk with corrosive ingestion

A

Oesophageal perforation

34
Q

What drugs cause drug induced oeopshageitis

A

NSAIDs
potassium supplements
bisphosphonates

35
Q

What should be considered for patients with known strictures

A

Liwuid or paarenteral preparations

36
Q

What is achalasia

A

Failure of propagation of peristalsis in the body of the oeosophagus
Progressive dilatation of the body of the oesophagus
Failure of relaxation of the LOS
High pressure LOS

37
Q

What is the cause of achalasia

A

THe degeneration of the ganglia in the distal oesophagus and LOS

38
Q

What are the clinical features of achalasia

A 
Dysphagia (for solids) 
Heartburn
Chest pain
Regurgitation (late disease)
Pulmonary aspiration (late disease)
39
Q

What is commonly seen in a CXR of achalasia

A

Bird beak appearance

40
Q

What is the endoscopic management for Achalasia

A

Forced pneumatic dilatation

LOS botulinium toxin injection

41
Q

What types of operation indicated for young patients or those requiring multiple dilatations

A

Heller’s myotomy

42
Q

What does diffuse oesophageal spasm typically present with

A

Angina like chest pain in middle age

43
Q

What is required for the diagnosis of difffuse oeosphageal spasm

A

Oesophageal manometry and 24hour pH

44
Q

Gastrointestinal stromal tumours (GISTs) are malignant tumours. True or false

A

False - they are benign lesions

45
Q

What is the treatment for GISTs

A

None - the do not cause symptoms

46
Q

What are the 2 different types of oesophageal carcinoma

A

Adenocarcinoma and Squamous carcinoma

47
Q

Where does adenocarcinoma typically appear in the oesophagus

A

Lower third (barrett’s oesophagus)

48
Q

is the incidence of adenocarcinoma increasing or decreasing

A

Increasing

49
Q

Where does squamous carcinoma typically appear in the oesophagus

A

Anywhere along the oesophagus

50
Q

What are the risk factors for squamous carcinoma

A 
Smoking 
alcohol
betel nut 
tobacco chewing 
achalasia 
post circoid web
coeliac and post corrosive ingestion
51
Q

What are the clinical features of oesophageal carcinoma

A 
Painless, rapidly pregressive dysphagia 
weight loss
chest pain
hoarse voice 
coughing after swallowing
52
Q

What should be looked for during examination

A

Cervical nodes

53
Q

What are the investigations for oesophageal carcinoma

A

Upper GI endoscopy
Barium swallow
CT of the thorax and abdomen
Endoscopic ultrasound

54
Q

What is the management for oesophageal carcinoma

A

30% have operable disease - oesophagectomy or preoperative chemo
70% have inoperable: palliation of dysphagia
palliation of pain
squamous cancers: radiotherapy
Provision of nutritional supplementation

55
Q

What is the prognosis for oesophageal carcinoma

A

Overall 5 year survival is

56
Q

What is a pharyngeal pouch also known as

A

Zenker’s diverticulum

57
Q

If Zenker’s diverticulum is suspected, what is the first line investigation

A

Barium swallow

58
Q

Males are affected by eosiniphilic oesophagitis twice as often as females. True or false

A

True

59
Q

What are the 2 age peaks for eosinophilic oesophagitis

A

children and early 30s

60
Q

What is a Schatzkis’s ring

A

A cricumferential narrowing in the mid or lower third of the oesophagus

61
Q

What is Plummer-Vinson syndrome

A

When iron-deficiency anaemia is associated with an oesophageal web

62
Q

What is a Mallory-Weiss Tear

A

A cause of haematemesis .
Is is caused by recurrent retching or forceful vomiting (typically after alcohol binges) resulting in mucosal tear of the oesophogastric junction

63
Q

What is the characteritic history of a Mallory-Weiss tear

A

That the initial vomit did not contain blood

64
Q

What is the treatment for a Mallory-Weiss tear

A

Most settle spontaneously

Acid suppression and endoscopic therapy are rarely necessary

Gastrointestinal (LECTURE NOTES) (29 decks)

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