Oesophagus diseases Flashcards
What is oesophagitis
Inflammation of the oesophagus due to refluxed low pH gastric contents
Which is more common: acute or chronic oesophagitis
chronic
What are the risk factors for reflux oesophagitis (3)
defective lower oesophageal sphincter
Abnormal oesophageal motility
Increased intra-abdominal pressure
What are potential complications of oesophagitis (4)
ulceration
Haemorrhage
Stricture
Barrett’s oesophagus
What signs aid diagnosis of eosinophilic oesophagitis (2)
PH probe is negative for reflux
Increased eosinophils in blood
What drugs are used to manage eosinophilic oesophagitis (2)
PPI
Steroids
What non-pharmacological measures can be used to manage eosinophilic oesophagitis (2)
Avoidance of allergens
Dilation of strictures/stenosis
What is Barrett’s oesophagus
when there is Metaplasia of cells within the oesophagus from squamous to columnar epithelium
what causes Barrett’s oesophagus
Due to persistent reflux of acid/bile
Metaplasia occurs as a protective mechanism against the acid
What does Barrett’s oesophagus increase the risk of (2)
Developing dysplasia
Developing carcinoma
What are the risk factors for Barrett’s oesophagus (4)
Chronic GORD
Smoking
Obesity
Family history
How can Metaplasia occur in Barrett’s oesophagus (3)
molecular reprogramming of oesophageal progenitor cells
Transdifferentiation
Migration of gastric progenitor cells
What is used to manage Barrett’s oesophagus
radiofrequency ablation
What are the possible complications of Barrett’s oesophagus (5)
Chest pain
Dysphagia
Strictures
Bleeding
Perforation
What are the types of benign oesophageal sphincters (5)
squamous papilloma
Leiomyomas
Lipomas
Fibrovascular polyps
Granular cell tumour
Describe squamous papilloma (3)
associated with HPV
Forms papillae
Asymptomatic
What are the types of malignant oesophageal tumours (2)
Squamous cell carcinoma
Adenocarcinoma
Which oesophageal tumour type is associated with Barrett’s oesophagus
adenocarcinoma
Describe the pathogenesis of adenocarcinoma (4)
chronic reflux oesophagitis
Barrett’s oesophagus
Dysplasia
Adenocarcinoma
Clinical presentation of oesophageal tumours
Dysphagia, odynophagia
Persistent indigestion/heartburn
Vomiting/regurgitation of food
Loss of appetite/weight loss
Epigastric/chest/back pain
Anaemia
Lethargy
Malaise
Hoarse voice
What investigations are used for oesophageal tumours (3)
Endoscopy
CT chest abdomen and pelvis
CT PET
What are examples of haemorrhaging conditions affecting the oesophagus (2)
Mallory Weiss tear
Oesophageal varices
What causes a Mallory Weiss tear
Prolonged/recurrent vomiting
Describe a Mallory Weiss tear (3)
a tear in the oesophagus which results in haemorrhage
The tear is longitudinal and affects superficial mucosa
The tear usually occurs at the gastro-oesophageal junction
Describe oesophagus varies (2)
enlarged and weakened veins in the oesophagus which can rupture and cause massive GI haemorrhage
What condition are oesophageal varices associated with
Portal hypertension
What are symptoms of acid peristalsis (2)
Dysphagia
Reflux
What are the diagnostic criteria for absent peristalsis (2)
no contractions
Normal oesophageal sphincter relaxation
How is absent peristalsis treated (2)
acid suppression
Dietary and lifestyle modification
What are the types of oesophageal dysmotility (4)
absent peristalsis
Jackhammer oesophagus
Distal oesophageal spasms
Achalasia
What are the symptoms of jackhammer oesophagus (2)
dysphagia
Retro sternal pain
How is jackhammer oesophagus managed (2)
botulinum toxin injection.
POEM
What are the symptoms of distal oesophageal spasms (2)
dysphagia
Retro sternal pain
What are the diagnosis criteria for distal oesophageal spasms (3)
Norma lower oesophageal sphincter contraction
Premature contractions
Impaired inhibitory innervation
How are distal oesophageal spasms managed (2)
nitrates
Calcium channel blockers
Describe the pathophysiology of achalasia (3)
lower oesophageal sphincter fails to relax
Peristalsis is absent
Functional obstruction of the lower oesophageal sphincter (stasis, dilation)
What are the symptoms of achalasia (4)
dysphagia
Regurgitation
Weight loss
Chest pain
What investigations are used for achalasia (3)
CXR
Barium swallow
OGD
What risk increases with achalasia
risk of squamous cell carcinoma
What is a distinct feature of type one achalasia
simultaneous contractions of low amplitude
What is a distinct feature of type two achalasia
Pan oesophageal pressurisation
What is a distinct feature of type three achalasia
Premature spastic contractions
What medical treatments exist for achalasia (2)
nitrates
Calcium channel blockers
What endoscopic treatments exist for achalasia (3)
Botulinum toxin
Balloon dilation
POEM
What surgical treatment exists for achalasia
Heller’s myotomy
