Oesophageal Medicine Flashcards
Conditions affecting the oesophagus and their treatment.
Hiatus Hernia
part of the stomach rises through diaphragm into chest
2 types of hiatus hernia
Sliding (GOJ slides through hiatus)
Rolling (part of the stomach - usually part of the fundus-rolls up around the oesophagus through hiatus)
What is GORD
Gastric contents returning to the oesophagus. Failure of anti-reflux mechanisms such as relaxation of the Lower Oesophageal Sphincter unrelated to swallowing,
Complications of GORD
Peptic Stricture
Barretts Oesophagus -> Ca
Fe deficiancy
Causes of GORD
LOS hypotension
Hiatus Hernia
Decreased peristalsis and slow gastric emptying
Risk Factors for GORD
H pylori Infection Systemic Sclerosis Obesity Smoking Alcohol ++ Pregnancy Surgical Hx Overeating Acid secretion ++ Drugs - tricyclics, anticholinergics, nitrates
Presentation of GORD
Dyspepsia Waterbrush- increased saliva odynophagia nocturnal asthma chronic cough laryngitis
Investigations and diagnosis of GORD
Clinical diagnosis
2WW ENDOSCOPY: 4/52 vomiting, GI bleed, Anaemia, palable mass, >55yrs, dysphagia, no improvment with PPI
Barium swallow: identify HHernia
Intraluminal pH monitoring: diagnosis remains uncertain after endoscopy
Prague Criteria grading Barretts
By number and position of mucosal breaks. (mucosal break= erosion/ulceration -well demarcated slough with erythema 1. Small <5mm Mucosal Breaks 2. Breaks in 1 mucosal fold only 3 Breaks in multple folds 4. breaks in >75% of circumference
Treament of GORD
Conservative:
raise bed head, weight loss, small regular meals, avoid triggers, smoking cessation, over the counter antacids.
Medical
Aligate antacids, PPI, prokinetic (domperidone) H2 receptor antagonists (ranitidine)
Surgical
medical managment failed in cases with complications / extra oesophageal features.
Achalasia
Aperistalsis and impaired relaxation of LOS
Systemic Sclerosis + Oesophagus
Nearly all patients with SS will have oesophageal involvement
Diffuse Oesophageal spasm
dysmotility. Contractions occur but random and peristalsis is inefficient
Oesphageal diverticulum
outpouchings anywhere along oesophagus. Most commonly pharengeal pouch.
Barretts Oesophagus
Metaplasia of oesophageal SQUAMOUS epithelium into abnormal COLUMNAR mucosa
precancerous condition that follows metaplasia- dysplasia- neoplasia pattern and is graded using Prague criteria (A-D)