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GI and General Surgery > Oesophagus > Flashcards

Oesophagus Flashcards

1
Q

What causes GORD?

A

incompetent LOS - more frequent relaxation causing reflux of gastric contents

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2
Q

What forms the UOS?

A

cricopharyngeus muscle

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3
Q

What are the risk factors for GORD?

A

age
obesity
fatty and spicy foods
alcohol, caffeine, smoking

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4
Q

What are the clinical features of GORD?

A

heartburn - burning, retrosternal sensation
worse after meals, lying down
cough
odynophagia

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5
Q

What are red flags for someone with suspected GORD?

A

dysphagia
weight loss
need to rule out malignancy

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6
Q

How is GORD diagnosed?

A

good history
resolution with PPI trial
OGD - rule out malignancy, complications of GORD
ambulatory pH monitoring (medical treatment failing)
manometry - ?motility disorders

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7
Q

What lifestyle modifications are made for GORD?

A

smoking cessation
weight loss
avoid coffee, alcohol, fatty and spicy food

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8
Q

What is the medical management of GORD?

A 
antacids - symptomatic relief (no healing benefit)
PPIs (potentially lifelong)
H2 antagonists (ranitidine, cimetidine)
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9
Q

When is surgical management considered in GORD?

A

failure to respond to medical therapy
complications of GORD
patient wants to avoid lifelong medication

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10
Q

What is the surgical management of GORD?

A

360 degree Nissan fundoplication

gastric fundus is wrapped around GOJ
crura also tightened (crural repair)

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11
Q

What are the complications of a fundoplication?

A

dysphagia
delayed gastric emptying (damaged vagus nerve)
recurrence
abdominal bloat

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12
Q

What are the complications of GORD?

A

aspiration pneumonia

Barrett’s oesophagus

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13
Q

What is Barrett’s oesophagus?

A

metaplasia of oesophageal mucosa
stratified squamous to columnar
premalignant

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14
Q

What type of cancer usually occurs in the upper and middle 1/3rds of the oesophagus?

A

squamous cell carcinoma

associated with smoking and excessive alcohol

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15
Q

What type of cancer usually occurs in the lower 1/3rd of the oesophagus?

A

adenomacarcinoma

associated with Barretts

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16
Q

What are the clinical features of oesophageal cancer?

A

progressive dysphagia
weight loss (cancer and dysphagia related)
hoarseness
odynophagia

on examination:
evidence of weight loss
supraclavicular lymphadenopathy
metastatic signs - ascites, jaundice, hepatomegaly

17
Q

How is suspected oesophageal cancer investigated?

A 
urgent OGD with biopsy 
CT CAP (mets)
endoscopic USS +/- FNA (for staging)
18
Q

What is the surgical management of oesophageal cancer?

A

oesophagectomy - stomach made into conduit tube
complications
- post op nutrition is hard (may require feeding jejunostomy)
- anastomotic leak

19
Q

What is the management of oesophageal cancer?

A

usually surgery
+/- chemo
+/- radiotherapy

20
Q

How are oesophageal tumours staged?

A

TNM

T1 - within mucosa 
T2 - muscularis propria 
T3 - adventitia 
T4a - local tissue spread 
T4b - distant mets §
21
Q

What is achalasia?

A

primary motility disorder of oesophagus

22
Q

What are the clinical features of achalasia?

A

progressive dysphagia
retrosternal pain
regurgitation
weight loss

23
Q

How is achalasia investigated?

A 
OGD (to investigate dysphagia) - normal 
oesophageal manometry 
- absence of peristalsis 
- LOS failure to relax 
- high resting tone 
barium swallo (rarely done)
- birds beak oesophagus
24
Q

How is achalasia managed?

A

medical: CCBs or nitrates (temporary relief), botox injections (LOS)

endoscopic balloon dilatation (risk of perforation and need for further intervention)
surgery: laparoscopic Heller cardiomyotomy (need life long PPI)

25
Q

What is diffuse oesophageal spasm? How does it present?

A

uncoordinated multifocal high amplitude contractions of oesophagus (seen on manometry)

presents with dysphagia and retrosternal chest pain

26
Q

What are oesophageal tears?

A

rupture to any part of the oesophageal wall

27
Q

What are the subtypes of oesophageal tears?

A

full thickness rupture

superficial mucosal tear (Mallory Weiss)

28
Q

What can cause an oesophageal rupture?

A

iatrogenic - endoscopy

severe, forceful vomiting (Boerhaave’s syndrome)

29
Q

What is Boerhaave’s syndrome?

A

oesophageal rupture caused by vomiting

30
Q

What does oesophageal rupture lead to?

A

leakage of stomach contents into mediastinum and pleural cavity
severe inflammatory response
physiological collapse, multiorgan failure, death

31
Q

What are the clinical features of an oesophageal rupture?

A

severe, sudden onset retrosternal pain
respiratory distress
subcutaneous emphysema

32
Q

What investigations are done for an oesophageal rupture?

A

high clinical suspicion - endoscopy in theatre
routine bloods and group and save
urgent CT CAP with IV and oral contrast
(leakage of oral contrast, air or fluid in mediastinum or peural cavity)

33
Q

How is an oesophageal rupture managed?

A

ABCDE - high flow oxygen, IV access, fluid resus, broad spectrum antibiotics

non surgical: resus, NG tube, chest drain - done if more stable (usually iatrogenic rupture)

surgical: on table endoscopy (site of perforation), emergency thoracotomy (control leak and wash out chest)

34
Q

What is a Mallory Weiss tear?

A

laceration in oesophageal mucosa

generally small and self limiting

35
Q

What usually causes a Mallory Weiss tear?

A

vomiting

36
Q

How is dysphagia investigated?

A

OGD
oesophageal manometry
(barium swallow - rarely performed)

37
Q

What are the emergency causes of haematemesis?

A

oesophageal varices

gastric ulceration

38
Q

What are the non-emergent causes of haematemesis?

A

Mallory Weiss tear
oesophagitis
gastritis

39
Q

How is haematemesis investigated?

A

routine bloods, Group and Save
OGD
erect CXR (perforated peptic ulcer - pneumoperitoneum)
CT abdo with IV contrast (triple phase)

GI and General Surgery (10 decks)

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