oesophagus Flashcards
what does pharynx contain
- naso
- oro
- larynx
what connects throat to oesophagus
laryngeal pharnyx
what does oesophagus connect
pharynx to stomach
what is oesophagus function
to transport food from mouth to stomach
what is oesophagus lined with
stratified squamous epithelium
how is oesophagus separated from pharynx
by upper oesophageal sphincter
what is lower oesophageal sphincter responsible for
prevention of gastric reflux
what is smooth muscle of oesophagus and the LOS supplied by
vagal autonomic motor nerves
what are major oesophageal symptoms
- dysphagia
- odynophagia
- heartburn
- regurgitation
what is dysphagia
difficulty swallowing liquid or solid
what does dysphagia for solid and liquids suggest
achalasia
what is odynophagia
pain whilst swallowing
what is odynophagia suggestive of
oesophagitis
what is heartburn a common symptom of
reflux of gastric contents into oesophagus
when is heartburn worse
lying down at night
what is regurgitation
effortless reflex of oesophageal contents into mouth and pharynx
what are investigations for oesophageal disorders
- barium swallow
- gastroscopy 1st line
- manometry
how does GORD occur
failure of lower oesophageal sphincter
what usually buffers acid in cells
bicarbonate
factors associated with GORD
- pregnancy
- obesity
- fat
- smoking
- drugs
- hiatus hernia
how is diagnosis made for GORD
usually clinical
treatment of GORD
- diet
- lose weight
- raise head of bed at night
- reduce alcohol and coffee - stop smoking
example of H2 receptor antagonist
ranitidine
PPI example
omeprazole
SE of omeprazole
- osteoporosis
- increase in GI infections e.g. c.diff
what can you do if PPI doesn’t work
surgery
what are complications of GORD
- peptic stricture
- barretts oesophagus
symptom of peptic stricture
- intermittent dysphagia for solids
what is Barretts oesophagus
change from stratified squamous epithelium to simple columnar
what is always replaced in Barretts oesophagus
hiatus hernia
how is diagnosis of Barretts oesophagus made
endoscopy
who is most likely to get Barretts oesophagus
middle-aged obese men
what does Barretts oesophagus increase chance of
oesophageal adenocarcinoma
what is treatment for endoscopic treatment of dysplasia
radiofrequency ablation
what is achalasia characterised by
oesophageal aperistalsis and imparted relaxation fo lower oesophageal sphincter
when does regurgitation usually occur in achalasia
at night
what is a complication of achalasia
aspiration pneumonia
what does histology show in achalasia
- inflammation of myenteric plexus of oesophagus
- reduction of ganglion cell numbers
differential diagnosis of achalasia
- genetic syndromes
- infectious diseases
- neoplasms
- chronic inflammatory conditions
investigations for achalasia
- xray
- barium swallow
- oesophagoscopy
- CT
- manometry
what does X-ray of achalasia show
- dilated oesophagus
- fluid behind heart
- fundal gas shadow absent
what does barium swallow in achalasia show
- lack of peristalsis
- ‘birds beak’ appearance due to failure of sphincter to relax
why is oesophagoscopy done
to exclude carcinoma at lower oesophagus
what are all forms of achalasia treatment
palliative
what are drug treatments of achalasia
- nifedipine
what is there an increase of in achalasia
squamous carcinoma of oesophagus
what is diffuse oesophageal spasm
severe form of oesophageal dysmotility the can sometimes produce retrosternal chest pain and dysphagia
what can oesophageal spams accompany
GORD
what is oesophageal spasm on barium swallow show
corkscrew appearance
when are PPI successful i. oesophageal spam
when there is reflux
what is last resort treatment for oesophageal spasm
balloon dilatation or even longitudinal oesophageal myotomy
where do oesophageal diverticulum occur
- immediately above the upper oesophageal sphincter
- near the middle of the oesophagus
- just above the lower oesophageal sphincter
when is oesophageal diverticulum detected
incidentally on a barium swallow
what is an oesophageal web
thin, membranous tissue flap covered with squamous epithelium
where are most oesophageal webs located
anteriorly in postcricoid region
symptom of oesophageal web
dysphagia
what is Plummer-vision syndrome associated with
a web associated with chronic iron deficiency anaemia, glossitis and angular stomatitis
who does Plummer vision usually affect
women
what are 2 types of oesophageal rings
- mucosal
- muscular
where is mucosal oesophageal ring located
squamocolumnar mucosal junction
what is mucosal oesophageal ring associated with
history of intermittent bolus obstruction
where is muscular oesophageal ring located
proximal to the mucosal ring
what is muscular oesophageal ring covered by
squamous epithelium
may cause dysphagia
what is management of oesophageal ring
reasurrance and dietary advice
what can oesophageal ring respond to
PPI
what is most common cause of benign oesophageal stricture
peptic stricture secondary to reflux
what kind of ulceration does TB cause
deep ulceration with associated mediastinal lympadenopathy
when are eosinophils seen in oesophageal mucosa
- eosinophilic oesophagitis
- GORD
what do patients with eosinophilic oesophagitis present with
- dysphagia
- heart burn
- oesophageal pain
1st line treatment for eosinophilic oesophagitis
topical steroids
where do adenocarcinoma arise
in columnar lined epithelium in lower oesophagus
what age do people get carcinoma
60-70
what are most common physical signs of carcinoma
- weight loss
- anorexia
- lymphadenopathy
investigations for carcinoma
- endoscopy
- barium swallow
treatment for carcinoma
surgery
