Oral cavity and Oesophagus Flashcards
most common oral cancer
squamous cell carcinoma
causes of oral cancer
tobacco alcohol diet HPV16 candida syphilis dental factors
high risk sites for oral cancer
ventral and lateral tongue
floor of the mouth
soft palate
presentation of oral cancer
- pain less ulcer (indurated with rolled edges if advanced)
- red, white (leukoplakia is premalignant-candida) and red and white lesions
- numb, change in voice, dysphagia
diagnosis of oral cancer
- biopsy
- PET CT of head and neck
define globus
sensation of having a lump in your throat (functional dysphagia) diagnose via ruling out other causes
management of globus
- reassurance
- anti-reflux
- stop smoking
- referral to SALT
define achalasia
lower oesophageal sphincter fails to relax
presentation of achalasia
- heartburn and chest pain (oesophageal spasm has corkscrew appearance of barium swallow)
- dysphagia
- vomiting
- weight loss
diagnosis of achalasia
- manometry (pressure measurement- swallow and identification of muscles)
- endoscopy
- CXR (bird beak appearance in obstruction)
management of achalasia
- muscle relaxations e.g. nitrates or nifedipine
- balloon insertion via OGD
- botox injection OGD
- surgery = Heller’s
- PPIs for oesophageal spasm
define a pharyngeal pouch
bulge in the pharynx - mucosa and submucosa between inferior pharyngeal constrictor muscle (Killian dehiscence)
presentation of a pharyngeal pouch
- dysphagia
- weight loss
- chronic cough
- regurgitation
- aspiration
diagnosis of a pharyngeal pouch
barium swallow (do not do an endoscopy as risk of perforation)
management of pharyngeal pouch
staple smaller lesions
diverticulectomy for big lesions
define GORD
this is acid reflux that irritates the lining of the oesophagus
three causes of GORD
- incompetent LOS
- poor oesophageal clearance
- visceral hypersensitivity
presentation of GORD
- heart burn and chest pain (worse on bending or lying down and with alcohol)
- acid reflux (can cause dental erosion)
- dysphagia and odynophagia
diagnosis of GORD
- OGD
- oesophageal manometry and pH studies
management of GORD
- lifestyle modification e.g. prop head of bed up, weight loss and antacids
- PPIs and H2RAs
- surgery e.g. fundoplication and gastroplication
define oesophagitis
this is inflammation of the oesophagus (acute or chronic), reflux causes epithelial expansion and increased WCC.
what is allergic oesophagitis characterised by?
eosinophils
presentation of oesophagitis
- dysphagia
- chest pain (behind breastbone)
- heartburn and reflux (can cause ulcerations and strictures)
diagnosis of oesophagitis
- pH probe for reflux (negative in allergic)
- bloods for eosinophil count
- endoscopy (feline)
management of allergic oesophagitis
- steroids
- sodium cromoglicae
- montelukast
define Barrett’s oesophagus
replacement of stratified squamous epithelium by columnar epithelium
explain of metaplasia
Barrett’s oesophagus
cause of Barrett’s oesophagus
persistent reflux causes the protective response of faster epithelium generation leading to an unstable mucosa
presentation of Barrett’s
frequent reflux dysphagia chest pain haematemesis often presents with a hiatus hernia
diagnosis of Barrett’s
- OGD with biopsy
- barium oesophagogram for hiatus hernia
management of Barrett’s
- surveillance for adenocarcinoma
- PPIs with radio frequency ablation (eliminate metaplasia-not routine)
- resection and oesophagectomy for high grade dysplasia
presentation of oesophageal cancer
- dysphagia (tumour obstruction)
- anaemia
- weight loss
- malaise
diagnosis of oesophageal cancer
- OGD with biopsy
- CT thorax and abdomen
management of oesophageal cancer
- resection or oesophagectomy
- chemotherapy or radiotherapy
define oesophageal varices
presence of abnormal enlarged veins in the oesophagus which can rupture and bleed (consequence of portal hypertension)
presentation of oesophageal varices
- haematemesis
- spider naevi, ascites, jaundice, encephalopathy (liver disease)
- leukonychia
diagnosis of oesophageal varices
- FBC for anaemia
- OGD
what is the Rockall score used for?
predictor of rebleeding
management of a variceal bleed
- resuscitation
- adrenaline
- antibiotics
- terlipressin, vasoactive drug (reduces blood flow to the oesophagus)
- OGD with EVL
- beta blockers reduce pressure in portal veins
- TIPS
- sclerotherapy to improve appearance of veins
- balloon tamponade
define a mallory-weiss tear
tear in the lining of the oesophagus that can be caused by violent coughing or vomiting
presentation of mallory-weiss tear
- haematemesis
- melaena (stools with digested blood)
- SOB
- dizziness, weakness
diagnosis of a mallory-weiss tear
endoscopy
management of a mallory-weiss tear (only if persistent)
adrenaline injection, band ligation and coagulation
define a peptic ulcer
this is the presence of an ulcer where the mucosa is exposed to HCl or pepsin
causes of peptic ulcer
H. pylori
NSAIDS
presentation of a peptic ulcer
- burning epigastric pain
- acute bleeding (haematemesis and/or melaena)
diagnosis of a peptic ulcer
- gastric biopsy (upper GI endoscopy)
- urea breath test for H. pylori
- faecal antigen test for H. pylori
- serology for IgA antibodies (not diagnostic in elderly)
management of a peptic ulcer
- endoscopy with adrenaline, clip, heater probe coagulation or haemspray
- PPIs and H2RAs
- eradication of H. pyrloi
medication for eradication of H. pylori
PPI
amoxicillin/metronidazole
clarithromycin
define peptic stricture
narrowing in the oesophagus
presentation of peptic stricture
end stage GORD
over 60
intermittent dysphagia for solid which gradually worsens
diagnosis of peptic stricture
OGD
management of peptic stricture
PPIs
if severe then endoscopic dilation
define Bechet’s syndrome
rare disorder of vasculitis that can cause GI bleeding
presentation of Bechet’s
- GI bleeding
- uveitis
- erythema nodosum
- ulcers
management of Bechet’s
steroids and immunosuppression
what causes oral hairy leukoplakia?
EBV
what increases your risk of getting oral hairy leukoplakia?
HIV
what does recent antibiotics increase the risk of in the mouth?
candidiasis
how to tell the difference between candidiasis and leukoplakia?
candidiasis brushes off
management of aphthous ulcers
tetracyclines
topical steroids
analgesia
if severe= systemic corticosteroids or thalidomide
management of candidiasis
nystatin suspension (swill and swallow) fluconazole if oropharyngeal
define microstomia
small mouth from thickening and tightening of perioral skin e.g. burns, systemic sclerosis
other surgical options for pharyngeal pouch
heller’s myotomy
fundoplication
H.H repair
reconstruction
what does intermittent dysphagia suggest?
oesophageal spasm
causes of odynophagia
ulceration
oesophagitis
candidiasis
spasm
causes of congenital dysphagia
cleft palate/ lip
cerebral palsy
what are oesophageal varices?
submucosal venous dilations secondary to increased portal pressures
why is bleeding brisk in varices?
liver complications (coagulation factors)
common locations for varices
gastro-oesophageal junction
ileocacaecal junction
rectum
periumbilical vein (caput medusa)
what is the Rockall score
used for risk of rebleeding
used post-endoscopy
long-term management of varices
beta blockers
describe melaena
black tarry stool from upper GI haemorrhage
what to stop in GI bleed?
NSAIDs
anticoagulants
what is group and save?
patient’s blood group is checked and a sample is kept in case they need to crossmatch
what is crossmatch?
lab finds out if the patient’s blood is compatible and keeps blood in the fridge ready to be used
what is Boerhaave’s syndrome?
complete rupture of the lower thoracic oesophagus
signs of Boerhaave’s syndrome?
hartmann’s sign= crunching sound upon auscultation of the heart
chest pain
shock
subcutaneous emphysema
drug causes of peptic ulcer
SSRIs
NSAIDs
steroids
which location of peptic ulcers are most at risk of bleeding?
posterior duodenal ulcers due to being nearest to the gastroduodenal artery
does eating worsen gastric ulcers?
yes
does eating worsen duodenal ulcers
no
what needs to be done post peptic ulcer treatment?
repeat endoscopy in 6-8 weeks to exclude malignancy
what is the Glasgow-Blatchford score?
severity of upper GI haemorrhage
indicates prognosis/ need for intervention
score of 0 often doesn’t need admission
what is Nissen fundoplication
wrapping fundus of stomach around lower oesophagus in rolling hiatus hernia to prevent volvulus
what is Plummer-Vinson syndrome?
webbing of oesophagus- extension of normal oesophageal tissue
presentation of Plummer-Vinson syndrome
dysphagia
iron deficiency anaemia
oesophageal webs
diagnosis of Plummer-Vinson syndrome
barium swallow
OGD
management of Plummer-Vinson syndrome
increased risk of oesophageal cancer so needs monitoring
iron replacement
dilatation of webs if required
what to do if malignant change in peptic ulcer?
consider distal gastrectomy
- Billroth 1= gastroduodenostomy
- Billroth 2= gastrojejunostomy
