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CP3 SURGERY > UGI/CR - Oesophagus > Flashcards

UGI/CR - Oesophagus Flashcards

1
Q

Anatomical causes of GORD (2)

A

Hiatus hernia

Systemic sclerosis

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2
Q

Physiological causes of GORD (7)

A 
Raised IAP 
Large meals, late @ night
Smoking 
High caffeinated drink intake 
High fatty food intake 
Binge drinking 
Dx
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3
Q

Dx that predispose to GORD (4)

A

Anticholinergics
Nitrates
TCAs
CCB

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4
Q

Iatrogenic causes of GORD

A

After Tx for achalasia

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5
Q

Where is the oval aperture

A

R crus of diaphragm at T10

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6
Q

What structures pass through the oval aperture (4)

A

Oesophagus
CNX trunks
Oesoph branches L gastric vessels
Lymphatics

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7
Q

What are the 2 types of hiatus hernia?

A

Sliding hiatus hernia

Rolling hiatus hernia

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8
Q

What is a siding hiatus hernia

A

G-O junction slides through hiatus to live above diaphragm, but sphincter remains competent below diaphragm

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9
Q

PS sliding hiatus hernia

A

Mostly asymp

Or reflux

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10
Q

What % of >50 y/o have sliding hiatus hernia

A

30%

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11
Q

What is a rolling hiatus hernia

A

Lower oesophageal sphincter remains in place

But part of fundus herniates into chest next to it

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12
Q

PS rolling hiatus hernia

A

Severe pain (occasionally)

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13
Q

XR appearance rolling hiatus hernia

A

Thoracic air bubble

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14
Q

What are the 3 types of dyspepsia

A

Reflux type
Ulcer type
Dysmotility type

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15
Q

Reflux type dyspepsia PS (2)

A

Heartburn + regurg

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16
Q

Ulcer type dyspepsia PS

A

Epigastric pain

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17
Q

Dysmotility type dyspepsia PS

A

Bloating

Nausea

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18
Q

Major features of GORD (4)

A

Heartburn/indigestion
Regurg food/acid
Waterbrash
Odynophagia

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19
Q

When is dyspepsia worse

A

Bending/lying down
Drinking hot liquids
Alcohol

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20
Q

What is Waterbrash

A

Sudden fillling of mouth w/ dilute saliva

In response to oesoph acid

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21
Q

ALARMS 55

A 
Anaemia (Fe) 
Loss W 
Anorexia 
Recent onset, progressive Sx 
Melena/haematemesis/mass 
Swallowing difficulties 
>55 y/o
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22
Q

Ix GORD (further - 4)

A

Ba swallow
Sx index/Sx sensitivity index
DeMeester score
24h luminla pH monitoring, manometry if endoscopy normal

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23
Q

What is excessive reflux defined as on 24h luminal pH monitoring

A

pH <4 for >4% of the time

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24
Q

Lifestyle Mx of reflux (5)

A 
W loss 
Smoking cessation 
Small + reg meals 3 h before bed 
Raised head of bed @ night 
Avoid Dx - NSAIDs/K salts
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25
Q

Med Mx of reflux

A

Antacids
H2RA + PPI (2nd line)
Metoclopramide/domperidone
H pylori test + treat

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26
Q

SE Al(OH)3

A

Constipation

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27
Q

SE Mg(OH)2

A

Diarrhoea

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28
Q

What negative SE can PPI’s lead to

A

Achlorhydria –> increase risk of food poisoning

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29
Q

Surgical Mx of reflux

A

Nissen fundoplication

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30
Q

LT complications of GORD

A

Oesophagitis/ulcers
Benign strictures
Barretts/ oesophageal adenocarcinoma

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31
Q

What % adult pop have Barrett’s oesophagus

A

2%

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32
Q

What is the histological change in Barrett’s oesophagus

A

Stratified squamous –> glandular columnar ep

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33
Q

How is a diagnosis of Barrett’s made

A

UGI endoscopy + biopsy

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34
Q

Mx Barretts

A

Lifestyle nodes

Reg surveillance via endscopy

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35
Q

What can Barrett’s turn into

A

Oesophageal adenocarcinoma

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36
Q

What is oropharyngeal dysphagia

A

Difficulty initiating swallow +/- choking/aspiration

37
Q

Common causes of oropharyngeal dysphagia (3)

A

Stroke
Candidiasis
Globus

38
Q

Less common causes of oropharyngeal dysphagia (3)

A

Pharyngeal pouch
MND
Xerostomia

39
Q

Rare causes of oropharyngeal dysphagia (3)

A

Oral tumours
Severe aphthous ulcers
Mm dystrophy/bulbar palsy

40
Q

Ix for oropharyngeal dysphagia

A

Neuro exam

Videofluoroscopy

41
Q

What is Oesophageal dysphagia

A

Food sticks are swallowing +/- regurg

42
Q

Common causes of Oesophageal dysphagia (3)

A

Benign stricture
Oesophageal carcinoma
Oesophagitis

43
Q

Less common causes Oesophageal dysphagia (4)

A

Dysmotility - achalasia
Dysmotility - diffuse oesophageal spasm
Webs/rings
External P - hilar nodes/cancer

44
Q

Rare causes of Oesophageal dysphagia (3)

A

Oesophageal infection
Retrosternal goitre
Corrosive stricture

45
Q

ix Oesophageal dysphagia (3)

A

Ba swallow
OGD
Biopsy

46
Q

Oropharygeal dysphagia - initiating swallow

A

Difficult

47
Q

Oropharygeal dysphagia - interval to dysphagia after swallow

A

Instant

48
Q

Oropharygeal dysphagia - progression

A

Variable

49
Q

Oropharygeal dysphagia - type of food

A

Liquids

50
Q

Oropharygeal dysphagia - asssoc Sx

A

Choking
Nasal regurg
Drooling

51
Q

Oropharygeal dysphagia - assoc signs

A

CN signs

52
Q

Oesophageal dysphagia (mechanical cause) - initiating swallow

A

Unaffected

53
Q

Oesophageal dysphagia (mechanical cause) - Interval to dysphagia after swallow

A

Few s

54
Q

Oesophageal dysphagia (mechanical cause) - progression

A

Progressively worsening

55
Q

Oesophageal dysphagia (mechanical cause) - type of food

A

Solids

56
Q

Oesophageal dysphagia (mechanical cause) - assoc Sx

A

W loss

Prior heartburn

57
Q

Oesophageal dysphagia (mechanical cause) - assoc signs

A

Cervical LN

Anaemia

58
Q

Oesophageal dysphagia (dysmotility cause) - initiating swwallow

A

unaffected

59
Q

Oesophageal dysphagia (dysmotility cause) - interval to dysphagia after swallow

A

few s

60
Q

Oesophageal dysphagia (dysmotility cause) - progression

A

intermittent

61
Q

Oesophageal dysphagia (dysmotility cause) - type of food

A

L/S

62
Q

Oesophageal dysphagia (dysmotility cause) - assoc Sx

A

Odynophagia

63
Q

Who gets Achalasia

A

Young pt (in their 30s)

64
Q

Pathophysiology achalasia

A

Oesophageal aperistalsis + failure of relaxation of LOS (NM disorder)
Degeneration of ganglia in distal oesophagus + LOS
Oesophagus = dilated –> megaoesophagus

65
Q

PS Achalasia (5)

A 
Long, non-progressive Hx of
Dysphagia 
Chest pain /substernal cramps
Regurg + pulmonary aspiration (LATER)
Nocturnal cramps
66
Q

Ix Achalasia (5)

A 
UGI endoscopy 
Barium swallow 
Oesophagoscopy (excl carcinoa)
CT
High resolution manometry
67
Q

What is the gold standard Ix for achalasia

A

High resolution Manometry

68
Q

Appearance of Achalasia on Ba swallow

A

Bird beak

69
Q

Mx Achalasia

A 
Chew food well 
Eat upright 
Drink lots w/ meals 
Botulinum injection (prov temp relief)
Endoscopic balloon dilatation 
Heller's cardiomyotomy
70
Q

What is Heller’s Cardiomyotomy

A

Op for Achalasia

Where cardia mm are divided

71
Q

Which sex is mainly affected by Plummer Vinson syndrome

A

Females

72
Q

PS Plummer Vinson (triad)

A

Dysphagia
Koilonychia
Glossitis

73
Q

Why is Plummer Vinson pre-malignant?

A

B/c hyperkeratisation of oesophagus –> web

74
Q

Tx Plummer Vinsons

A

Fe

+ dilation of web via OGD

75
Q

Sx oesophageal malignancy (6)

A 
Painless, rapidly progressive dysphagia 
W loss/Anorexia 
Retrosternal Chx pain (late)
Hoarse voice (late) 
Coughing/aspiration 
Occasional Cerv lymphadenopathy (late)
76
Q

Where are the majority of oesophageal malignancies

A

Lower 1/3 oesoph

77
Q

What type of cancer are the majority of oesophageal malignancies?

A

Adenocarinoma

78
Q

RF Oesophageal adenocarcinoma (4)

A 
Related to GORD hence: 
Barretts 
Smoking 
Obesity 
Breast cancer radiotherapy
79
Q

How does Oesophageal adenocarcinoma mets?

A

Via lymphatics

Very early

80
Q

RF SCC oesophagus (8)

A 
Heavy smoking
Heavy drinking 
Plummer Vinson 
Achalasia 
Corrosive strictures
Coeliac disease
Breast cancer + radiotherapy 
Tylosis
81
Q

When does SCC oesophagus present?

A

Late

when tumour is large enough to compromise lumen

82
Q

Spread SCC oesophagus

A

Regionally - LN

Lungs, liver + bone

83
Q

Ix oesophageal cancer

A

OGD incl trans-oesoph USS + biopsy
2nd line - CT thorax/pelvis TNM
PET - mets
Laparscopy - excl peritoneal mets

84
Q

Prognosis oesophageal Ca

A

17% at 5y

85
Q

Tx stage T1/2 oesophageal Ca

A

Radical curative eosophagectomy (Ivor-Lewis)

EMR

86
Q

EMR

A

Endoscopic mucosal resection

87
Q

Tx stage T2-4 oesoph Ca

A

Chemo/radio

88
Q

Palliation oesoph Ca

A

Oesophageal stenting

CP3 SURGERY (19 decks)

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