Week 2.5 - Oesophageal Disorders Flashcards
Where does the oesophagus begin and end?
C6 at cricoid and T11-12 at duodenum
What type of muscle is found in the oesopahgus?
top 3-4cm is striated skeletal muscle and rest is smooth muscle
What nerve mediates movement of food in the oesophagus?
vagal nerve
What are the 3 components of the lower oesophageal sphyncter?
- high resting pressure
- striated muscle in diaphragm
- mucosal rosette at angle of his
What are 5 commonly occuring oesophageal disorders?
- achalasia
- oesophageal cancer
- eosinophillic oesophagitis
- barrett’s oesophagus
- gastro-oesophageal reflux disease
What are symptoms of oesophageal disorders?
heart burn (retrosternal discomfort), dysphagia, cough, waterbrash, odynophagia
What is the commonest cause of dysphagia symptoms?
stricture. occurs with
- fibrosis,
- barretts,
- cancer,
- external compression,
- eusinophillic oesophagitis
What are 2 types of motility disorders?
hypermotility or hypomotility
What is an example of a hypermotility disease?
diffuse oesophageal spasm. causes corkscrew appearance and exaggerated uncoordinated contractions on manometry
What tests can we do to investigate oesophageal issues? (4)
- OGD (oesophogastroduodenoscopy)
- upper GI endoscopy (UGIE)
both with barium swallow - pH metry
- manometry
What does manometry measure?
waves within oesophagus. food eaten and liquid drank and measure waves producesd.
What is an example of a hypomotility disease?
connective tissue disease causing LOS failure - heartburn and reflux. stasis of food
What is achalasia?
in late 20’s-30’s functional loss of myenteric plexus ganglion so fail to contract LOS.
What is the appearance of achalasia and symptoms?
rats tail appearance, progressive dysphagia, chest pain, hypomotility
How do you treat achalasia?
- nitrates and calcium channel blockers to relax LOS.
- botox relaxes.
- balloon dilatation
- myotomy of LOS
What is GORD?
gastro-oesophageal reflux disease. acid and bile exposure in lower oesophagus, leading to ulceration, stricture, barrett’s or carcinoma
What are risk factors for GORD?
obesity, pregnancy, collagen disorder, drugs lowering LOS pressure, men and white.
What are symptoms of GORD?
diagnosed based on symptoms:
- heartburn,
- cough,
- water brash,
- sleep disturbance.
How do you treat GORD pharmaceutically?
- omeprazole (PPI)
- Ranitidine (H2RA)
- Gaviscon (alginate foam)
- Stop NSAID’s
- surgery fundoplication
What is barrett’s oesophagus?
intestinal metaplasia in oesophagus from acid exposure. leads to ulceration and fibrosis - precursor for dysplasia.
What is a symptom of barrett’s oesophagus and a possibility?
dysphagia from fibrosis.
6% lead to oesophageal cancer through dysphagia and neoplasia
What is the treatment for barrett’s oesophagus?
- endoscopic mucosal resection
- radio frequency ablation
- oesophagectomy (10% mortality)
What type of oesophageal cancer is common and where?
adenocarcinoma in west europe and USA, squamous in rest of the world
Which part of the oesophagus do we see different types of cancer?
adenocarcinoma in distal oesophagus
squamous carcinoma in first and second 1/3rds
What is the 5YSR of oesophageal cancer?
<10%
What are symptoms of oesophageal cancer?
- dysphagia
- anorexia and weight loss
- odynophagia
- chest pain
- cough
How do you treat oesophageal cancer?
only cure is oesophagectomy.
usually try to cure dysphagia - endoscopic laser/stent or chemo/RT to shrink tumour
What is eosinophillic oesophagitis?
eosinophil infiltration in epithelial lining. leads to dysphagia, strictures and mucosal stripping
How do you treat eosinophillic oesophagitis?
- swallowed/topical corticosteroids
- dietary elimination in kids
- endoscopic dilatation if needed
What is plummer vision syndrome?
triad of dysphagia, iron deficiency anaemia and oesophageal webbing
