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GI > Oesophagus > Flashcards

Oesophagus Flashcards

1
Q

Most frequent cause of inflammation of oesophagus?

A

Due to reflux of acidic gastric contents

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2
Q

Dysphagia?

A

Difficulty swallowing

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3
Q

Odynophagia?

A

Pain during act of swallowing

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4
Q

Dyspepsia?

A

Indigestion

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5
Q

What does dyspepsia/ indigestion mean?

A

Disordered digestion, pain in lower chest or upper abdomen after eating.
Sometimes accompanied by nausea, vomiting, feeling of unease/ fullness

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6
Q

What is acid reflux usually a consequence of?

A

Incompetent lower oesophageal sphincter

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7
Q

What conditions can cause acid reflux?

A

Systemic sclerosis
CNS depressants e.g. alcohol
Pregnancy (elevated intra-abdominal pressure)
Hyperthyroidism

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8
Q

How does the oesophageal epithelium appear histologically in reflux?

A

Regenerative and hyperplastic meaning that it is having to replace itself frequently

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9
Q

Reflux oesophagitis?

A

Inflammation of oesophagus due to refluxed low pH gastric content

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10
Q

Causes of reflux oesophagitis?

A

Defective sphincter mechanism
Abnormal oesophageal motility
Inc intra-abdominal pressure (pregnancy)

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11
Q

Microscopic appearance of reflux oesophagitis?

A

Basal zone epithelial expansion
Intraepithelial neutrophils, lymphocytes & eosinophils
Lengthened lamina propria papillae

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12
Q

What is the clinical name for reflux oesophagitis?

A

Gastro-oesophageal reflux disease (GORD)

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13
Q

What is GORD?

A

Chronic acid reflux

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14
Q

Pathophysiology of GORD?

A

Incompetent LOS
Poor oesophageal clearance
Barrier function/ visceral sensitivity

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15
Q

Lower oesophageal sphincter (LOS)?

A

Separates oesophagus & stomach

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16
Q

Features of GORD pain?

A 
Burning
Worse on bending
Seldom radiates to arm
Worse with hot drinks/ alcohol
Relieved by antacids
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17
Q

Diagnosis of GORD?

A

Made without investigations unless alarm signs (dysphagia)

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18
Q

Investigations for GORD?

A

Endoscopy (upper GI)
Intraluminal monitoring (oesophageal manometry & pH)
Barium swallow
Nuclear studies

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19
Q

Complications of GORD?

A

Peptic stricture
BARRETT’S
Oesophageal carcinoma/ adenocarcinoma
Ulceration (bleeding)

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20
Q

Management of GORD?

A

Symptom relief
Healing oesophagi’s
Prevent complications

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21
Q

Lifestyle modifications for GORD?

A

Smoking cessation
Lose weight
Prop up bed head
Avoid provoking factors

22
Q

Drugs for GORD treatment?

A

Antacids
H2 receptor antagonists
PPI’s

23
Q

Antacids for GORD treatment?

A

Symptomatic relief
Alginate containing
Form gel raft with gastric contents to reduce reflux
10ml 3x daily

24
Q

H2 receptor antagonists in GORD treatment?

A

Frequently if antacids fail

Cimetidine & ranitidine

25
Q

PPI’s in GORD treatment?

A

E.g. omeprazole

Reduce gastric acid secretion

26
Q

Drugs of choice in all but mild cases?

A

PPI’s

27
Q

Non erosive reflux disease?

A

No response to PPI’s
Have continuing symptoms
Normal endoscopy
Usually female with functional problems

28
Q

Indications for surgery for GORD/ good result?

A

Typical reflux symptoms with documented acid reflux
Symptoms
Response to PPI

29
Q

Surgery should rarely be done if ?

A

Oesophageal dysmotility unrelated to acid reflux
No response to PPIs
Underlying functional bowel disease

30
Q

Surgery never performed for?

A

Hiatus hernia alone

31
Q

Which surgery for GORD?

A

Fundoplication

Laparoscopic

32
Q

What is the fundoplication procedure?

A

Upper part of stomach os wrapped around lower oesophagus
Nissen (complete/ 360 degrees wrap)
Toupe (partial/ 270)
Laparososcopic

33
Q

Barrett’s oesophagus?

A

Squamous epithelium lining the oesophagus is replaced by columnar epithelium of the type normally lining the intestine caused by chronic inflammation and damage from GORD

34
Q

Microscopic appearance of Barrett’s oesophagus?

A

Columnar (glandular) type metaplasia

35
Q

Explain the events of Barrett’s oesophagus?

A

Squamous epithelium does not cope well with acid from stomach
Gastric acid is neutralised by mucin produced by columnar cells and glands
So a metaplastic change occurs to cope with the new noxious stimulus (potentially tissue damaging)
Epithelium now unstable

36
Q

Where should normal squamocolumnar junction be and where is it in Barrett’s?

A

Should be at gastro-oesophageal junction

In Barrett’s is more proximal

37
Q

Investigations for Barrett’s?

A

Endoscopy (UGI) +/- biopsy

38
Q

Management of Barrett’s?

A

Lifestyle advice
PPI’s (useful for GORD)
Radiofrequency ablation
Oesophagectomy

39
Q

GOLD standard for high grade dysplasia in Barrett’s oesophagus?

A

Oesophagectomy

40
Q

Infectious oesophagi’s?

A

Can be caused by infection from fungi, yeast, virus or bacteria

41
Q

Can candida be associated with oesophagitis?

A

Yes

42
Q

Are people with a normal immune system likely to get infectious oesophagitis?

A

No

43
Q

Eosinophilic oesophagitis?

A

Allergic inflammatory condition of oesophagus that involves eosinophils
Eosinophils migrate to the esophagus in large numbers, then precipitate an allergic reaction when a trigger food is eaten.

44
Q

Common presentation of eosinophilic oesophagitis?

A 
Difficulty swallowing
Food impaction
Stomach pains, 
Regurgitation or vomiting
Decreased appetite
Food bolus stuck in throat
45
Q

Endoscopic appearance of eosinophilic oesophagitis?

A

Corrugated oesophagus ( multiple rings) or trachealisation (fixed oesophageal rings) when concentric rings are seen around the lumen.

46
Q

In eosinophilic oesophagi’s what is recommended if specific allergen identified?

A

Abstinence

47
Q

In cases which show generalised atopy, what may they respond to?

A

Oral sodium cromoglycate

48
Q

Histology appearance of eosinophilic oesophagitis?

A

Very spongiotic epithelium (lots of gaps appearing between the cells) with huge numbers of eosinophils.

49
Q

What may treatment of allergic oeosphagitis include?

A

Steroids
Chromoglycate
Montelukast

50
Q

Hiatus hernia?

A

Most common type of diaphragmatic hernia

Stomach passes partly or completely into chest cavity through the opening (hiatus) for the oesophagus

GI (9 decks)

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