Oesophagus Flashcards
What is GORD
Gastro-oesophageal reflux disorder
When does a patient with GORD typically have worsening symtpoms
After meals
What prevents reflux in health
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
What is a hiatus hernia
herniation of the stomach in to the thorax
Are all hiatus hernias symptomatic
No
What are the 2 forms of hiatus hernia
Sliding and rolling
What is the most common form of hiatus hernia
Sliding
How does a hiatus hernia cause reflux
Reducing the LOS pressure
Increasing the TLSORs
Straightening out the angle of Hiss
What is a gastric volvulus
When the stomach twitsts on itself causing severe pain and dysphagia
Define gastroparesis
Any condition that delays gastric emptying
What can increase the gastric volume
Pregnancy, binge drinking, poorly controlled diabetes
What can cause an increase n the intra-abdominal pressure
Pregnancy
Obesity
Chronic cough
What increases the gastric acid production in the stomach
Smoking
eating fat and calorie rich foods
binge drinking
regular use of NSAIDs
What are some of the clinical features of GORD
Heartburn Fluid/ Food regurgitaiton Waterbrash Nocturnal cough Chest pain Dysphagia or odynophagia
What is the first line investigation
Endoscopy
What is helpful if surgery is being considered
24 h pH measurement
What is helpful if surgery is being considered
24 h pH measurement
What is oesophagitis
Endoscopic change ranging from minor erythmea to frank ulceration and stricturing
What does an oesophageal stricture result in
Narrowing of the distal oeosphagus following repeated peptic ulceration and scarring
How does an oesophageal stricture present
Dysphagia
What is the treatment for an oesophageal stricture
Endoscopic dilatation and long term PPIs
What is Barrett’s oesophagus
A metaplasia of distal oesophageal mucosa from squamous to columnar epithelium caused by an adaptive response to chronic acid exposure
Barrett’s oeosphagus is usually symptomatic. True or False.
False. It is usually asymptomatic
What are 4 risk factors for Barrett’s oesophagus developing into carcinoma
White males
OVer 50 year olds
Obese
Smokers
How is a diagnosis of Barrett’s oesophagus made
BAsed on mucosal appearances and histology
What are the treatment options for Barrett’s oeosphagus
Endoscopic ablation through photodynamic therapy - has lots of side effects
What might be considered when high-grade dysplasia is observed
Oesophagectomy
What are the 2 main forms of conservative management for GORD
Lifestyle modification - weight loss, smoking cessation, elevation of bed head, avoiding fatty meals before bed
Antacids - provide symptoms relief
What are the 2 main medical ways of managing GORD
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
Who is laparoscopic or open fundoplication suitable for
Patients with large hiatus hernias
What is corrosive ingestion
Deliberate self-harm through ingestion of bleach or battery acid
What is the management for corrosive infestion
Analgesia
Antiemetics
NBM
What is the major risk with corrosive ingestion
Oesophageal perforation
What drugs cause drug induced oeopshageitis
NSAIDs
potassium supplements
bisphosphonates
What should be considered for patients with known strictures
Liwuid or paarenteral preparations
What is achalasia
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
What is the cause of achalasia
THe degeneration of the ganglia in the distal oesophagus and LOS
What are the clinical features of achalasia
Dysphagia (for solids) Heartburn Chest pain Regurgitation (late disease) Pulmonary aspiration (late disease)
What is commonly seen in a CXR of achalasia
Bird beak appearance
What is the endoscopic management for Achalasia
Forced pneumatic dilatation
LOS botulinium toxin injection
What types of operation indicated for young patients or those requiring multiple dilatations
Heller’s myotomy
What does diffuse oesophageal spasm typically present with
Angina like chest pain in middle age
What is required for the diagnosis of difffuse oeosphageal spasm
Oesophageal manometry and 24hour pH
Gastrointestinal stromal tumours (GISTs) are malignant tumours. True or false
False - they are benign lesions
What is the treatment for GISTs
None - the do not cause symptoms
What are the 2 different types of oesophageal carcinoma
Adenocarcinoma and Squamous carcinoma
Where does adenocarcinoma typically appear in the oesophagus
Lower third (barrett’s oesophagus)
is the incidence of adenocarcinoma increasing or decreasing
Increasing
Where does squamous carcinoma typically appear in the oesophagus
Anywhere along the oesophagus
What are the risk factors for squamous carcinoma
Smoking alcohol betel nut tobacco chewing achalasia post circoid web coeliac and post corrosive ingestion
What are the clinical features of oesophageal carcinoma
Painless, rapidly pregressive dysphagia weight loss chest pain hoarse voice coughing after swallowing
What should be looked for during examination
Cervical nodes
What are the investigations for oesophageal carcinoma
Upper GI endoscopy
Barium swallow
CT of the thorax and abdomen
Endoscopic ultrasound
What is the management for oesophageal carcinoma
30% have operable disease - oesophagectomy or preoperative chemo
70% have inoperable: palliation of dysphagia
palliation of pain
squamous cancers: radiotherapy
Provision of nutritional supplementation
What is the prognosis for oesophageal carcinoma
Overall 5 year survival is
What is a pharyngeal pouch also known as
Zenker’s diverticulum
If Zenker’s diverticulum is suspected, what is the first line investigation
Barium swallow
Males are affected by eosiniphilic oesophagitis twice as often as females. True or false
True
What are the 2 age peaks for eosinophilic oesophagitis
children and early 30s
What is a Schatzkis’s ring
A cricumferential narrowing in the mid or lower third of the oesophagus
What is Plummer-Vinson syndrome
When iron-deficiency anaemia is associated with an oesophageal web
What is a Mallory-Weiss Tear
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
What is the characteritic history of a Mallory-Weiss tear
That the initial vomit did not contain blood
What is the treatment for a Mallory-Weiss tear
Most settle spontaneously
Acid suppression and endoscopic therapy are rarely necessary
