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GI AM > Oesophageal disorders > Flashcards

Oesophageal disorders Flashcards

1
Q

Where does the oesophagus begin?

A

C6

Lower level of the cricoid cartilage

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2
Q

Where des the oesophagus terminate?

A

T11/12

Where it enters stomach

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3
Q

What is the structural difference between the upper 1/3 and lower 2/3 of oesophagus?

A

Upper- striated muscle

Lower- smooth muscle

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4
Q

What is the epithelium of the oesophagus?

A

Stratified squamous non keratinised epithelium

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5
Q

What does the vagus nerve mediate?

A

Peristalsis and relaxation of lower oesophageal sphincter

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6
Q

What is the lower oesophageal sphincter?

A

Striated muscle of the right crus of the diaphragm

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7
Q

What level of reflux is there naturally in the oesophagus?

A

Degree occurs physiologically

Certain drugs and food can lower LOS pressure and increase reflux without pathology

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8
Q

What can persistent reflux cause?

A

Gastro oesophageal reflux disease

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9
Q

What can gastrooesophageal reflux disease cause?

A

Dysphagia and odynophagia

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10
Q

What must be enquired about in dysphagia?

A

Type of food, pattern, associated features, location

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11
Q

What are the possible causes of dysphagia?

A 
Benign stricture
Malignancy stricture
Motility disorders
Eosiniphilic infiltrate
Extrinsic compression
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12
Q

What investigations can be carried out for oesophageal disorders?

A

Endoscopy
Contract radiology- barium swallow
Oesophageal pH and manometry

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13
Q

What are the motility disorders of the oesophagus?

A

Hypermotility
Hypomotility
Achlasia

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14
Q

What is diagnostic of hypermotility of the oesophagus?

A

Corkscrew appearance on barium swallow

Exaggerated, uncoordinated hypertonic contractions with manometry

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15
Q

What are the symptoms of hypermotility of the oesophagus?

A

Severe pain, with or without dysphagia

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16
Q

How is hyper motility of the oesophagus treated?

A

Smooth muscle relaxants

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17
Q

What is hypo motility of the oesophagus often caused by?

A

Connective tissue disease
Diabetes
Neuropathy

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18
Q

What does hypo motility cause?

A

Failure of LOS mechanism, leading to heartburn and reflux symptoms

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19
Q

What is achalasia?

A

Functional loss of myenteric plexus ganglion cells in distal oesophagus and LOS

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20
Q

What is the cardinal feature of achalasia?

A

Failure of LOS to relax causing functional distal obstruction of the oesophagus

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21
Q

What are the symptoms of achalasia?

A 
Progressive dysphagia
Weight loss
Chest pain
Regurgitation
Chest infection
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22
Q

What is the treatment of achalasia?

A

Nitrates and calcium channel blockers
Endoscopic pneumatic balloon dilatation
Surgical myotomy

23
Q

What are the complications of achalasia?

A

Aspiration pneumonia and lung disease

Increased risk of squamous cell oesophageal carcinoma

24
Q

What are the symptoms of gastro-oesophageal reflux disease?

A

Heartburn
Cough
Water brash
Sleep disturbance

25
Q

What are the risk factors for gastrooesophageal reflux?

A 
Pregnancy
Obesity
Drugs lowering LOS pressure
Smoking
Alcohol
Hypomotility
26
Q

How is gastrooesophageal reflux disease diagnosed?

A

On basis of characteristic symptoms without testing

27
Q

When is an endoscopy performed with gastrooesophageal reflux?

A

ALARM features
Dysphagia
Weight loss
Vomiting

28
Q

What can the causes of gastrooesophageal reflux disease be with normal anatomy?

A 
Increased transient relaxations of LOS
Hypotensive LOS
Delayed gastric emptying
Delayed oesophageal emptying
Decreased oesophageal acid clearance
Decreased tissue resistance to acid/bile
29
Q

What can the anatomical causes of gastrooesophageal reflux disease be?

A

Hiatus hernia

30
Q

What are the 2 main types of hiatus hernia?

A

Sliding

PAraoesophageal

31
Q

What is the pathology of hiatus hernia?

A

Fundus of stomach moves proximally through hiatus in diaphragm

32
Q

What is the pathology of gastrooesophageal reflux disease?

A

Mucosa exposed to pepsin and bile
Increased cell loss ad regenerative activity
Erosive oesophagitis

33
Q

What are the complications of gastrooesophageal reflux?

A

Ulceration
Stricture
Glandular metaplasia
Carcinoma

34
Q

What is Barrett’s oesophagus?

A

Intestinal metaplasia related to prolonged exposure to acid in distal oesophagus

35
Q

What histological change is present in Barrett’s oesophagus?

A

Squamous to mucin secreting columnar epithelial cells

36
Q

What is Barrett’s oesophagus a precursor to?

A

Dysplasia or adenocarcinoma

37
Q

What is the treatment of Barrett’s oesophagus?

A

Endoscopic mucosal resection
Rediofrequency ablation
Oesophagectomy

38
Q

What is the treatment of gastrooesophageal reflux disease?

A

Lifestyle measures
Pharmacologocal
For refractory disease- anti reflux surgery

39
Q

What are the types of oesophageal cancer?

A

Squamous cell carcinoma

Adenocarcinoma

40
Q

What is the usual presentation of oesophageal cancer?

A 
Progressive dysphagia
Anorexia and weight loss
Odynophagis
Chest pain
Cough
Pneumonia
Vocal cord paralysis
Haemetemesis
41
Q

What is the pathology of squamous cell carcinoma in the oesophagus?

A

Large exophytic occluding tumours

42
Q

Where do squamous ell carcinomas occur in the oesophagus?

A

Proximal and middle third

43
Q

What is squamous cell carcinoma preceeded by?

A

Dysplasia and carcinoma in situ

44
Q

What is squamous cell oesophageal carcinoma associated with?

A

Achalasia
Caustric strictures
Plummer-Vinson syndrome

45
Q

Where are oesophageal adenocarcinomas situated?

A

Distal oesophagus

46
Q

What is oesophageal adenocarcinoma associated with?

A

Barrett’s oesophagus

47
Q

What are the risk factors for oesophageal adenocarcinoma?

A

Obesity
Male
Middle age
Caucasian

48
Q

Where does oesophageal cancer commonly spread to?

A

Liver
Brain
Lung
Bone

49
Q

What is the issue with presentation od oesophageal cancer?

A

Often presents late when there is already invasion of regional lymph nodes and/or liver

50
Q

What is the prognosis for oesophageal cancer?

A

5 year survival <10%

51
Q

What investigations are done for oesophageal cancer?

A 
Diagnosis- endoscopy and biopsy
Staging- CT
Endocopic ultrasound
PET
Bone scan
52
Q

What is the treatment of oesophageal cancer?

A

Oesophagectomy with or with our neo- and adjuvant therapy

Palliative- chemo, radio, brachytherapy, endoscopic stent, laser/APC orr PEG

53
Q

What is the issue with curative oesophagectomy in oesophageal cancer?

A

Limited to patients with localised disease

Long recovery, high mortality

GI AM (34 decks)

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