Oesophagus Flashcards
What is achalasia?
Aperistalsis in the body of the oesophagus and failure of relaxation of the LOS on initiation of swallowing
Long history of dysphagia (liquids and solids)
Regurgitation (aspiration pneumonia)
Severe retrosternal pain
What is an upper oesophageal web?
Constriction near the UOS
Asymptomatic or produce dysphagia
Plummer-Vinson- iron deficiency anaemia, glossitis and angular stomatitis, women
What is an oesophageal diverticulum?
Pouch lined with epithelium that can produce dysphagia and regurgitation
Pharyngeal pouch
What is a schatzki ring?
Narrowing of the lower end of the oesophagus due to a ridge of mucosa or a fibrous membrane
Can occasionally produce dysphagia
What is oesophageal candidiasis?
Characterised by white spots in the oropharynx with extension into the oesophagus. Associated with broad spectrum antibiotic usage, immunosupression and immunological disorders.
Malaise, sore throat, odynophagia and dysphagia
What are the causes of dysphagia?
Tonsilitis Pharyngeal disorders Bulbar palsy Motility disorders- Achalasia, Scleroderma, Oesophageal spasm, Presbyoesophagus, Diabetes, Chagas' Mediastinal glands Goitre Enlarged left atrium Foreign body Stricture Benign- peptic, corrosive Malignant- carcinoma Lower oesophageal rings Oesophageal web Pharyngeal pouch
What are the investigations for oesophageal disorders?
Barium swallow and meal
Oesophagoscopy
Manometry- (catheter passed through nose into the oesophagus and measure the pressures generated in the LOS)
pH monitoring- (used to identify reflex episodes pH <4)
Radioisotope studies- (study reflux)
Bernstein test
What is a sliding hiatus hernia?
Gastro-oesophageal junction slides through the hiatus so that it lies above the diaphragm
30% of people who are 50
Doesn’t produce symptoms
Symptoms occur because of associated reflux
What is a para-oesophageal/rolling hernia?
Small part of the funds of the stomach rolls up through the hernia alongside the oesophagus
Sphincter remains below the diaphragm and remains competent
Occasionally produces severe pain and requires surgical treatment for gastric volvulus or strangulation
What are the mechanisms behind GORD?
Transient LOS relaxations
Low resting LOS tone which fails to increase when the patient is lying flat
LOS tone fails to increase when intra-abdominal pressure is increased by tight clothing or pregnancy
Increased oesophageal mucousal sensitivity to acid
Which factors are associated with increased GORD?
Pregnancy or obesity Fat, chocolate, coffee or alcohol ingestion Large meals Cigarette smoking Drugs- anticholinergic, calcium-channel blockers, nitrates Systemic sclerosis After treatment for achalasia Hiatus hernia
What are the complications of GORD?
Peptic stricture- over 60s, intermittent dysphagia over a long period, treated by dilating the stricture
Barrett’s oesophagus- Long standing reflux, columnar epithelium with intestinal metaplasia, common in middle aged men, premalignant for adenocarcinoma
Adenocarcinoma
What causes a mallory-weiss tear?
Longitudinal mucosal laceration at the gastro-oesophageal junction or cardia as a result of repeat retching
What is the gold standard for diagnosis of achalasia?
Oesophageal manometry
