oseophageal function Flashcards by Helen Jones

the 3 peristaltic waves

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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abnormal symptoms

dysphagia
globus
odynophagia: pain 
water brash 
dysphonia 
food regurgitation 
heartburn
chest pain

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causes of dysphagia
malignant
benign
inflammatory 
neuromuscular 
structural

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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what is a Mallory Weiss tear and who get it

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

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what is epitaxis

nose bleeding

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what is boerhaave syndrome

oesophageal rupture

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what is zenkers diverticulum

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

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

refers to the appearance of a prominent cricopharyngeus muscle

barium swallow
increase pressure lead to zenkers diverticulum

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4 components of plummer vinson syndrome

Glossitis
oesophageal webs
dysphagia
Iron deficiency anaemia

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what does globus mean and causes of it

feeling of a lump
unknown cause
increased in depression

neuromuscular
-sensory CNS processing
Structural
-obstruction

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what is globus pharyngeus

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

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what does pyrosis mean

pain behind the breast bone spreading upwards

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what does waterbrash mean

reflex hypersalivation secondary to GORD

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causes of oesophageal chest pain

neuromuscular
-motility disorders
inflammatory
-reflux
-irritable oesophagus

but usually GI or cardiac cause

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signs of oesophageal disease

weight loss
anaemia
lymphadenopathy
food regurgitation
malnourished
dental erosion GORD

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investigations for oseophagus

endoscopy
barium swallow
manometry
pH monitoring/ imepdence

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pros and cons of endoscopy

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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pros and cons of barium swallow

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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oesophageal manometry is and indications

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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what is ph monitoring/ impedence and indications

-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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what prevents GORD normally

anatomy
diaphragm
tone of LOS
secondary contractions

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what is a hiatus hernia and prevalence

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

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causes of GORD

hiatus hernia
TLOSR
low LOSP??

what is TLOSR and symptoms

transient lower oesophageal relaxation

more common
daytime reflux
small or no HH
no oesophagitis

low LOSP

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

grading of oesophagitis on endoscopy

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

4 complications of GORD

oesophagitis peptic strictures barrett's oesophagus adenocarcinoma

treatment GORD

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

GORD surgery

nissen Fundoplication

what is barrett oesophagus and is it malignant

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

progression percentage from barrett to adenocarcinoma and whose at risk

0.3% | older men

how is adenocarcinoma prevented

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

primary vs secondary disorders of oesophageal motility

primary=oesophagus | secondary=outside eg systemic sclerosis, myasthenia gravis, pseudoachalasia, drugs

primary disorgers of motility

``` achalasia gord diffuse oesophageal spasm nutcracker jackhammer absent ```

what are jackhammer oseophagus

too powerful contractions

incidence of achalasia and age

1:100,000 41 years

what is achalasia

degenerative lesion of inhibitory innervation of the oesophagus - failure to relax the LOS - aperistalsis of the oesophageal body

dx of achalasia

normal endoscopy | bird beak sign on x-ray

signs of achalasia

``` food regurgitation dysphagia weight loss malabsorption chest pain ```

treatment of achalasia

nifedipine botulinum toxin pneumatic dilatation (tear on los) myotomy

what is diffuse oesophageal spasm required findings

``` simultaneous contractions (10% wet swallows) intermittent normal peristalsis ```

other finding of dos

``` repetitive contractions prolonged durations of contractions high amplitude frequent spontaneous LOSP abnormalities ```

treatment for dos

nitrates ca channel blockers pH

what is nutcracker oseophagus

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

treatment of nutcracker oseophagus

nitrates | ca channel blockers

what is eosinophilic oesophagitis and prevalence / age

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

endoscopy signs of eosinophilic oseophagitis

furrow ring exudates strictures

treatment of EO

diet-eliminate drugs-ppi, steroids dilatation

2 types of oesophageal cancer

adenocarcinoma | squamous cell carcinoma

where and who is adenocarcinoma found in

- lower 1/3 oesophagus - younger - reflux - obesity - more common

oesophageal squamous cell carcinoma

- mild/ upper oesophagus - older - smoking - alcohol - less common

which oesophageal cancer is increasing/ decreasing

adeno is increasing | squamous cell is decreasing

oesophageal carcinoma 5 year survival 4 grades

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

who is offered surgery for oesophageal cancer tnm

t1-3 n0-1 m0

surgery for oseoph cancer

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