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Yr3 - General Surgery > Oesophagus > Flashcards

Oesophagus Flashcards

1
Q

What is GORD?

A

Gastro-oesophageal reflux disease

Gastric acid from the stomach leaks up into the oesophagus

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2
Q

Risk factors of GORD

A 
Age
Obesity
Male gender
Smoking
Caffeinated drinks
Fatty or spicy foods
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3
Q

Clinical features of GORD

A

Chest pain - burning retrosternal sensation, worse after meals, lying down or straining
Relieved by antacids
Chronic cough

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4
Q

Red flag symptoms associated with GORD

A 
Dysphagia
Weight loss
Early satiety
Malaise
Loss of appetite
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5
Q

Differential diagnosis of GORD

A

Malignancy - oesophageal or gastric
Peptic ulceration
Oesophageal motility disorders
Oesophagitis

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6
Q

GORD investigations

A

Upper GI endoscopy to exclude malignancy and complications
- if new in onset or worsening despite PPIs
24hr pH monitoring
- failure of medical treatment so surgical options considered

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7
Q

Conservative management of GORD

A

Avoiding known precipitants
Weight loss
Smoking cessation

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8
Q

Medical management of GORD

A

Proton pump inhibitors - lifelong

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9
Q

Surgical management of GORD

A

Fundoplication

- gastro-oesophageal junction and hiatus are dissected and fundus wrapped around GOJ

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10
Q

Indications for surgical management of GORD

A

Failure to respond to medical treatment
Patient preference
Patients with complications of GORD

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11
Q

Complications of GORD

A 
Aspiration pneumonia
Barrett's oesophagus
Oesophagitis
Oesophageal strictures
Oesophageal cancer
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12
Q

Define Barrett’s oesophagus

A

Metaplasia of the oesophageal epithelial lining

- normal stratified squamous epithelium is replaced by simple columnar epithelium

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13
Q

Risk factors for Barrett’s oesophagus

A 
Caucasian
Male
>50 yrs
Smoking
Obesity
Presence of hiatus hernia
Family history
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14
Q

Clinical features of Barrett’s oesophagus

A

History of chronic GORD

Examination unremarkable

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15
Q

Investigations for Barrett’s oesophagus

A

Histological diagnosis - OGD biopsy

Oesophagus appears red and velvety with preserved pale squamous islands

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16
Q

Management of Barrett’s oesophagus

A

PPI
Lifestyle advice
Regular endoscopy - progression to adenocarcinoma

17
Q

Main types of oesophageal cancer

A

Squamous cell carcinoma

Adenocarcinoma - more common in developed world

18
Q

Risk factors for squamous cell carcinoma of oesophagus

A 
Smoking
Excessive alcohol consumption
Chronic achalasia
Low vitamin A levels
Iron deficiency
19
Q

Risk factors for adenocarcinoma of oesophagus

A

Long standing GORD
Obestiy
High dietary fat intake

20
Q

Clinical features of oesophageal cancer

A

Dysphagia

Significant weight loss

21
Q

Investigations for oesophageal cancer

A 
Upper gastrointestinal endoscopy
- biopsy and send for histology
CT Chest-Abdomen-Pelvis and PET-CT
- check for distant metastases
Endoscopic ultrasound 
- measure penetration of oesophageal wall
Staging laparoscopy
22
Q

Curative management of oesophageal cancer

A

Surgery - oesophageal resection
Neoadjuvant chemotherapy
Chemo-radiotherapy

23
Q

Pallative management of oesophageal cancer

A 
Oesophageal stent
Radio/chemotherapy
Photodynamic therapy
Nutritional support
Gastromy tube
24
Q

Define an oesophageal tear

A

Ruptures to any part of the oesophageal wall

25
Q

Define oesophageal perforation

A

Full thickness rupture of the oesophgeal wall
- leakage of stomach contents into mediatinum
- overwhelming inflammatory response
Surgical emergencye

26
Q

Causes of oesophageal perforation

A

Iatrogenic

Severe forceful vomiting

27
Q

Clinical features of oesophageal perforation

A

Retrosternal chest pain
Respioratory distress
Subcutaneous emphysema

28
Q

Investigations for oesophageal perforation

A

Routine bloods - G&S

CT chest-abdo-pelvis with IV or oral contrast

29
Q

Management of oesophageal perforation

A

Urgent and aggressive resuscitation - high flow oxygen, IV access, fluid resuscitation and broad spectrum antibiotics
Control oesophageal leak
Eradication of mediastinal and pleural contamination
Decompress oesophagus
Nutritional support

30
Q

Define a Mallory-Weiss tear

A

Lacerations in the oesophageal mucosa - usually at the gastro-oesophageal junction

31
Q

Define achalasia

A

Primary motility disorder of the oesophagus

Characterised by failure of relaxation of LOS

32
Q

Clinical features of achalasia

A 
Progressive dysphagia
Regurgiation of food
Coughing
Chest pain
Weight loss
33
Q

Investigations for achalasia

A 
OGD
Oesophageal manometry
- absence of oesophageal peristalsis
- failure of relaxation of LOS
- high resting LOS tone
34
Q

Management of achalasia

A 
Conservative
- sleeping with many pillows
- eating slowly
- plenty of fluid with meals
Medical
- calcium channel blockers
- botox injections
Surgical
- endoscopic balloon dilaiton
- laparoscopic Heller myotomy
35
Q

Define diffuse oesophageal spasm (DOS)

A

Multi-focal high amplitude contractions of oesophagus

Yr3 - General Surgery (17 decks)

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