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gastrointestinal > oseophageal function > Flashcards

oseophageal function Flashcards

1
Q

the 3 peristaltic waves

A

primary peristalsis: starts in pharynx at onset of swallowing
secondary peristalsis: starts locally in response to direct stimulation
Tertiary waves: non peristaltic and non propulsive waves

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2
Q

abnormal symptoms

A 
dysphagia
globus
odynophagia: pain 
water brash 
dysphonia 
food regurgitation 
heartburn
chest pain
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3
Q 
causes of dysphagia
malignant
benign
inflammatory 
neuromuscular 
structural
A

malignant
-tumour

structural

  • leiomyomas >5cm
  • webs
  • rings schatzki
  • strictures
  • pouch diverticulum
  • zenkers diveriticulum
  • cricopharyngeal bar

Neuromuscular
-pharyngeal: bulbar palsy, myasthenia gravis
-oesophageal motility disorder
eg achalasia, systemic s

Inflammatory

  • Barrett if malignant
  • reflux oesophagitis
  • eosinophilic oesophagitis
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4
Q

what is a Mallory Weiss tear and who get it

A

lacerations at the gastroesophageal junction resulting in haematemesis
common in alcoholic and prolonged vomiting

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5
Q

what is epitaxis

A

nose bleeding

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6
Q

what is boerhaave syndrome

A

oesophageal rupture

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7
Q

what is zenkers diverticulum

A

diverticulum of the mucosa just above the cricopharyngeal muscle ie a pouch

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8
Q

what is a cricopharyngeal bar
what is it seen on
what can it lead too

A

refers to the appearance of a prominent cricopharyngeus muscle

  • barium swallow
  • increase pressure lead to zenkers diverticulum
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9
Q

4 components of plummer vinson syndrome

A

Glossitis
oesophageal webs
dysphagia
Iron deficiency anaemia

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10
Q

what does globus mean and causes of it

A

feeling of a lump
unknown cause
increased in depression

neuromuscular
-sensory CNS processing
Structural
-obstruction

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11
Q

what is globus pharyngeus

A

globus but with feeling of obstruction but there isn’t one

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12
Q

what does pyrosis mean

A

pain behind the breast bone spreading upwards

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13
Q

what does waterbrash mean

A

reflex hypersalivation secondary to GORD

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14
Q

causes of oesophageal chest pain

A 
neuromuscular
-motility disorders
inflammatory
-reflux
-irritable oesophagus

but usually GI or cardiac cause

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15
Q

signs of oesophageal disease

A 
weight loss
anaemia
lymphadenopathy
food regurgitation
malnourished
dental erosion GORD
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16
Q

investigations for oseophagus

A

endoscopy
barium swallow
manometry
pH monitoring/ imepdence

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17
Q

pros and cons of endoscopy

A 
pros
-direct visualise mucosa
-subtle anomalities detect
-biopsy
-intervention
cons
-invasive
-may not be fit
-cost
-not good at motility abnormalities
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18
Q

pros and cons of barium swallow

A 
pros
-defines anatomy
-webs/ rings
-frail patients
-motility abnormalities
cons
-no biopsy
-no intervention
-can miss mucosal lesion
-radiation
not 1st line
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19
Q

oesophageal manometry is and indications

A

measures intra luminal pressures & co-ordination
assess sphincters
indications
-if structural abnormality excluded
-pre-op for patient considered for anti-reflux surgery

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20
Q

what is ph monitoring/ impedence and indications

A

-probe 5cm above lower sphincter
-record pH for 23 hrs
-reflux when pH>4
INDICATION
-dx is unclear
-inadequate response to therapy
-anti-reflux procedure considered
-non-cardiac chest pain

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21
Q

what prevents GORD normally

A

anatomy
diaphragm
tone of LOS
secondary contractions

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22
Q

what is a hiatus hernia and prevalence

A

bowel through diaphragm into chest
can contribute to reflux
30-50% prevalence

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23
Q

causes of GORD

A
  • hiatus hernia
  • TLOSR
  • low LOSP??
24
Q

what is TLOSR and symptoms

A

transient lower oesophageal relaxation

  • more common
  • daytime reflux
  • small or no HH
  • no oesophagitis
25
Q

low LOSP

A 
less common 20%
nocturnal reflux
often large hiatus hernia
more severe oesophagitis
barrett's
26
Q

grading of oesophagitis on endoscopy

A

grade a=>1 isolated mucosal break <5mm long
grade b=>1 isolated mucosal break >5mm long
grade c=mucosal break bridging the folds but involving <75% of the circumference
grade d=>1 mucosal break bridging the tops of the folds and involving >75% of the circumference

27
Q

4 complications of GORD

A

oesophagitis
peptic strictures
barrett’s oesophagus
adenocarcinoma

28
Q

treatment GORD

A 
lifestyle
-alcohol
-avoid spice,choc
-avoid large meals
-avoid eating before bed
-smoking and weight
antacids and alginates
PPI#
Prokintetics
surgical
29
Q

GORD surgery

A

nissen Fundoplication

30
Q

what is barrett oesophagus and is it malignant

A

change from stratified squamous to simple columnar
often asymptomatic
-pre malignant
low grade dysplasia-> high grade dysplasia-> adenocarcinoma

31
Q

progression percentage from barrett to adenocarcinoma and whose at risk

A

0.3%

older men

32
Q

how is adenocarcinoma prevented

A

screening those with chronic reflux
early resection 90% 5 year survival
ablation

33
Q

primary vs secondary disorders of oesophageal motility

A

primary=oesophagus

secondary=outside eg systemic sclerosis, myasthenia gravis, pseudoachalasia, drugs

34
Q

primary disorgers of motility

A 
achalasia
gord
diffuse oesophageal spasm
nutcracker
jackhammer
absent
35
Q

what are jackhammer oseophagus

A

too powerful contractions

36
Q

incidence of achalasia and age

A

1:100,000 41 years

37
Q

what is achalasia

A

degenerative lesion of inhibitory innervation of the oesophagus

  • failure to relax the LOS
  • aperistalsis of the oesophageal body
38
Q

dx of achalasia

A

normal endoscopy

bird beak sign on x-ray

39
Q

signs of achalasia

A 
food regurgitation 
dysphagia
weight loss
malabsorption
chest pain
40
Q

treatment of achalasia

A

nifedipine
botulinum toxin
pneumatic dilatation (tear on los)
myotomy

41
Q

what is diffuse oesophageal spasm required findings

A 
simultaneous contractions (10% wet swallows) 
intermittent normal peristalsis
42
Q

other finding of dos

A 
repetitive contractions
prolonged durations of contractions
high amplitude 
frequent spontaneous 
LOSP abnormalities
43
Q

treatment for dos

A

nitrates
ca channel blockers
pH

44
Q

what is nutcracker oseophagus

A

average oesophageal peristaltic pressure >2 sd above normal oesophagus (>180mmhg)
-too powerful contractions or too long

45
Q

treatment of nutcracker oseophagus

A

nitrates

ca channel blockers

46
Q

what is eosinophilic oesophagitis and prevalence / age

A

food bolus obstruction, dysphagia
young M>F
50/100000
history of allegies atophy

47
Q

endoscopy signs of eosinophilic oseophagitis

A

furrow
ring
exudates
strictures

48
Q

treatment of EO

A

diet-eliminate
drugs-ppi, steroids
dilatation

49
Q

2 types of oesophageal cancer

A

adenocarcinoma

squamous cell carcinoma

50
Q

where and who is adenocarcinoma found in

A
  • lower 1/3 oesophagus
  • younger
  • reflux
  • obesity
  • more common
51
Q

oesophageal squamous cell carcinoma

A
  • mild/ upper oesophagus
  • older
  • smoking
  • alcohol
  • less common
52
Q

which oesophageal cancer is increasing/ decreasing

A

adeno is increasing

squamous cell is decreasing

53
Q

oesophageal carcinoma 5 year survival 4 grades

A

I=60%
II=20-50%
III=15
iv=0

54
Q

who is offered surgery for oesophageal cancer tnm

A

t1-3
n0-1
m0

55
Q

surgery for oseoph cancer

A
  • pre-chemo to downstage
  • resect
  • chemo
  • radiation
  • laser
  • argon plasma
  • stent for palliative

gastrointestinal (26 decks)

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