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Gastrointestinal System > Yr 3 - 2. Oesophageal Conditions and Stomach Cancer > Flashcards

Yr 3 - 2. Oesophageal Conditions and Stomach Cancer Flashcards

1
Q

What is oesophagitis?

A

Inflammation and ulceration of the oesophagus

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2
Q

What are the possible causes of oesophagitis?

A

GORD - Reflux of acid from the stomach to the oesophagus causing mucosal damage
Drugs (e.g. NSAIDs)
Infection (e.g. CMV, HSV, candida - especially in the immunosuppressed)
Ingestion of caustic substances

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3
Q

What is chronic benign stricture?

A

Scars from recurrent oesophagitis resulting in stricture formation. Most common in elderly women.

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4
Q

How would chronic benign stricture present?

A

Long history of reflux with recent dysphagia
If obstruction is severe undigested food may be regurgitated immediately after swallowing
May be associated with night-time coughing paroxysms due to aspiration of gastric contents
Examination is usually normal

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5
Q

How is chronic benign stricture managed?

A

Refer for urgent endoscopy to confirm diagnosis and exclude carcinoma
Treatment by endoscopic dilation of the stricture

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6
Q

What is presbyoesophagus?

A

Intermittent sensation that food is getting stuck, usually at the back of the throat.
Examination and endoscopy are normal.
Barium swallow or oesophageal motility studies may reveal oesophageal spasm.
Reassure.

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7
Q

What is globus pharyngis (/hystericus)?

A

Sensation of a lump in the throat without any difficulty in swallowing.
It may indicate anxiety.
Reassure if no organic signs and treat any dyspepsia.
If not responding refer to ENT for exclusion of an organic cause.

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8
Q

What is oesophageal achalasia?

A

Failure of relaxation of the circular muscles at the distal oesophageal sphincter.

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9
Q

When is the peak incidence for oesophageal achalasia?

A

30-40 yrs

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10
Q

How would oesophageal achalasia present?

A

Gradual onset of dysphagia over years accompanied by regurgitation of stagnant food and foul belching.
Night-time coughing fits due to aspiration - may result in recurrent chest infections.
Examination normal unless signs of aspiration pneumonia.

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11
Q

How is oesophageal achalasia managed in general practice?

A

CXR to exclude aspiration pneumonia
Endoscopy to confirm diagnosis
Refer for surgery

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12
Q

What causes oesophageal achalasia?

A

Failure of the lower oesophageal sphincter to relax due to degeneration of the myenteric plexus

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13
Q

How is oesophageal achalasia treated?

A

Endoscopic balloon dilatation or Heller’s cardiomyotomy
Then PPIs
Botulinum toxin injection if a non-invasive procedure is needed - repeat every few months
Calcium channel blockers and nitrates may also help relax the sphincter

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14
Q

What is Plummer-Vinson syndrome?

A

Post-cricoid web in the oesophagus causing dysphagia and iron deficiency anaemia.
Presents with high dysphagia and food sticking in the back of the throat +/- retching/chocking sensation.
Pre-malignant condition - refer for dilatation of pharyngeal web; replace iron.

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15
Q

What is a pharyngeal pouch?

A

Pulsion diverticulum of the pharyngeal mucosa through Killian’s dehiscence (area of weakness between the 2 parts of the inferior pharyngeal constrictor).

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16
Q

In which direction does a pharyngeal pouch usually protrude?

A

Develop posteriorly and then protrudes to one side - L > R

As the pouch gets larger the oesophagus is displaced laterally.

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17
Q

How will a pharyngeal pouch present?

A

Dysphagia - the first mouthful is swallowed easily, then fills the pouch which makes further swallowing difficult.
Accompanied by regurgitation from the pouch +/- symptoms of aspiration (night time coughing, recurrent chest infections).
A swelling is palpable in the neck in 2/3 of cases.

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18
Q

What investigations are used to diagnose pharyngeal pouch?

A

Barium swallow

Endoscopy

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19
Q

Oesophageal varices are a result of what?

A

Portal hypertension

20
Q

Oesophageal perforation is rare - what could be the possible causes?

A

Complication of endoscopy

Violent vomiting

21
Q

What would be found on examination of a patient with oesophageal perforation?

A 
Tachycardia 
Shock 
\+/- pyrexia
\+/- breathlessness 
\+/- surgical emphysema in the neck
22
Q

What is the cause of gastro-oesophageal reflux disease (GORD)?

A

Retrograde flow of gastric contents through an incompetent gastric-oesophageal junction. Affects ~5% of the adult population.

23
Q

What are the risk factors for GORD?

A 
Smoking
Alcohol
Coffee
Fatty food
Big meals
Obesity 
Hiatus hernia 
Tight clothes
Pregnancy 
Systemic sclerosis 
Drugs (NSAIDs, TCAs, SSRIs, iron supplements, anti cholinergic, nitrates, alendronic acid)
Surgery for achalasia
24
Q

What conditions are caused by GORD?

A 
Oesophagitis 
Oesophageal ulcer
Benign oesophageal stricture 
Barrett’s oesophagus 
Oesophageal haemorrhage 
Anaemia
25
Q

How might GORD present?

A

Heartburn: most common symptom. Burning retrosternal or epigastric pain, worsens on bending, stooping or lying down. Relieved by antacids.
Other symptoms: waterbash (mouth fills with saliva), reflux of acid into the mouth (especially on lying flat), nausea and vomiting, nocturnal cough/wheeze due to aspiration of refluxed stomach contents.

26
Q

What is a hiatus hernia?

A

Herniation of the proximal stomach through the diaphragmatic hiatus into the thorax

27
Q

What are the two types of hiatus hernia?

A

Sliding hiatus hernia (80%) - the gastric-oesophageal junction slides into the chest

Rolling hiatus hernia (20%) - a bulge of the stomach herniated into the chest alongside the oesophagus, the gastro-oesophageal junction remains in the abdomen

28
Q

Give a risk factor for hiatus hernias.

A

Obesity

29
Q

What is the management for hiatus hernia?

A

Treat as for GORD - lifestyle advice, PPI, H2 receptor antagonist

30
Q

Chronic GORD can lead to what metaplastic change?

A

Barrett’s oesophagus - squamous epithelium to gastric glandular epithelium

31
Q

Barrett’s oesophagus is a precursor to what type of cancer?

A

Adenocarcinoma of the oesophagus

32
Q

How is Barrett’s oesophagus treated?

A

Long term PPIs (e.g. omeprazole 20-40mg od)
+/- Laser therapy
+/- Resection

33
Q

What are the two types of carcinoma of the oesophagus?

A

Squamous cell carcinoma (50%) - predominantly found in the upper 2/3 of the oesophagus

Adenocarcinoma (50%) - predominantly found in the lower 1/3 of the oesophagus

34
Q

What are the common risk factors for squamous cell carcinoma of the oesophagus?

A

Smoking
Alcohol
Low fruit/vegetable intake

35
Q

What are the common risk factors for adenocarcinoma of the oesophagus?

A

Smoking
Obesity
Low fruit/vegetable intake
GORD - particularly Barrett’s oesophagus

36
Q

What other less common risk factors are there for carcinoma of the oesophagus?

A

Previous mediastinal radiotherapy (increased x2 in patients treated for breast cancer, increased x20 in patients treated for Hodgkin’s lymphoma)
Plummer-Vinson syndrome (oesophageal web and iron deficiency anaemia)
Tylosis (rare inherited disorder with hyperkeratosis of the palms, 40% go on to develop oesophageal cancer)

37
Q

How might oesophageal cancer present?

A

Short history of rapidly progressive dysphagia affecting solids and liquids +/- weight loss +/- regurgitation of food and fluids (may be bloodstained).
Retrosternal pain is a late feature.
Other symptoms include hoarseness and/or cough (due to aspiration or fistula formation).
Examination may be normal.
Look for evidence of recent weight loss, hepatomegaly and cervical lymphadenopathy

38
Q

How is carcinoma of the oesophagus managed?

A

Refer for urgent endoscopy if suspected, rapid access dysphagia clinics are run in most areas.
Specialist management involves resection (only 1:3 patients are suitable), chemotherapy, radiotherapy, and/or palliative with a stunting tube (tubes commonly become blocked).
Good palliative care is essential - refer early.
Overall 8% 5 year survival.

39
Q

95% of stomach cancers are what type of carcinoma?

A

Adenocarcinoma

40
Q

What the risk factors for adenocarcinoma of the stomach?

A 
Atrophic gastritis
H.pylori infection 
Smoking
Pernicious anaemia
Adenomatous polyps 
Blood group A
Previous partial gastrectomy 
Social class
Geography - common in Japan
41
Q

How does stomach cancer present?

A 
Often non-specific, may have:
Dyspepsia
Weight loss
Anorexia or early satiety 
Vomiting 
Dysphagia 
Anaemia 
GI bleeding

Suspect in any patient >55 yrs with sudden onset dyspepsia (<1yr) and/or epigastric mass, hepatomegaly, jaundice, ascites, Virchow’s node, acanthosis nigricans.

42
Q

How is stomach cancer managed?

A

If suspected, refer for urgent endoscopy. In early stages total/partial gastrectomy may be curative. Most present at a later stage.
Overall 5 yr survival is 15%.

43
Q

What are the possible post gastrectomy syndromes?

A 
Abdominal fullness
Bilious vomiting 
Dumping 
Diarrhoea 
Anaemia 
Stomach cancer (increased risk of stomach cancer after partial gastrectomy)
44
Q

What is dumping?

A

Abdominal distension, colic and vasomotor disturbance (e.g. sweating, fainting). Affects 1-2% of gastrectomy patients (more common early after surgery - most settle within 6 months).

45
Q

What are the two types of dumping?

A

Early dumping - due to rapid gastric emptying, starts immediately after a meal.
Late dumping - due to rapid gastric emptying which then causes hyperglycaemia. This give hyperinsulinaemia causing a rebound hypoglycaemia.

Gastrointestinal System (13 decks)

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