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systems- GI > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

where does the oesophagus start and end?

A

Begins at lower level of cricoid cartilage (C6), terminates at T11-12 where it enters the stomach

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2
Q

is the oesophagus striated or smooth muscle?

A

Upper 3-4 cm striated muscle, remainder is smooth muscle

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3
Q

what type of epithelium is the oesophagus?

A

stratified squamous epithelium

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4
Q

what is the function of the oesophagus?

A

Transport of food/liquid from mouth to stomach – active process

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5
Q

how are oesophageal peristalsis produced?

A

by oesophageal circular muscles and propels swallowed materials distally into the stomach

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6
Q

true or false?

Contraction in the oesophageal body (peristalsis) and relaxation of the LOS is mediated via the vagus nerve

A

true

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7
Q

what are the symptoms of heartburn?

A

Retrosternal discomfort or burning

May be associated with: Waterbrash, Cough

Heartburn is a consequence of reflux of acidic &/or
bilious gastric contents into the oesophagus

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8
Q

how can the LOS be reduced?

A

certain drugs/food can reduce it, resulting in increased reflux/ heartburn

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9
Q

what does Persistent reflux and heartburn lead to?

A

gastro-oesophageal reflux disease (GORD) which can in turn cause long-term complications

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10
Q

what is dysphagia?

A

Subjective sensation of difficulty in swallowing foods and/or liquids

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11
Q

what do you enquire about for someone who has dysphagia?

A

Type of food (solid vs liquid) - Pattern (progressive, intermittent)
- Associated features (weight loss, regurgitation, cough

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12
Q

where would the possible locations be for dysphagia?

A

Oropharyngeal -Oesophageal

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13
Q

causes of dysphagia?

A

benign stricture

- malignant stricture (oesophageal cancer)
- motility disorders (eg achalasia, presbyoesophagus)
- eosinophilic oesophagitis 
- extrinsic compression (eg in lung cancer
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14
Q

investigations of dysphagia

A

ENDOSCOPY
Oesophago-Gastro-Duodenoscopy (OGD)
Upper GI Endoscopy (UGIE)

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15
Q

what is hypermotility

A

Corkscrew appearance” on Ba swallow
-Severe, episodic chest pain +/- dysphagia
-Often confused with angina/MI
-Cause unclear (idiopathic)
-Manometry shows exaggerated,
uncoordinated, hypertonic contractions
-Rx smooth muscle relaxants

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16
Q

what is hypomotility

A

Associated with connective tissue disease,
diabetes, neuropathy
-Causes failure of LOS mechanism leading to
heartburn and reflux symptoms

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17
Q

what is achalasia?

A

Degeneration of inhibitory neurons (ganglion cells) in the myenteric plexus in the oesophagus
Often surrounded by lymphocytes- so an inflammatory aetiology is suspected

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18
Q

what are symptoms of achalasia?

A

progressive dysphagia for solids and liquids
weight loss
Chest pain (30%)
Regurgitation and chest infection

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19
Q

what is the treatment for achalasia?

A

Pharmacological - Nitrates,
Calcium Channel blockers

Endoscopic - Botulinum Toxin
Pneumatic balloon dilation

Radiological - Pneumatic balloon
dilation

Surgical - Myotomy

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20
Q

what are complications of achalasia?

A

Aspiration pneumonia and lung disease

Increased risk of squamous cell oesophageal carcinoma

21
Q

what are the symptoms of gastro-oesophageal reflux disease?

A

heartburn, cough, water brash, sleep disturbance

may not experience any symptoms

22
Q

what are the risk factors for gastro-oesophageal refluc disease?

A

Pregnancy, obesity, drugs lowering LOS pressure, smoking, alcoholism, hypomotility

23
Q

who is more likely to get gastro-oesophageal reflux disease?

A

men, caucasian

24
Q

true or false:

The typical reflux syndrome can be diagnosed on the basis of the characteristic symptoms, without diagnostic testing.

A

true

25
Q

why is endoscopy a poor diagnostic test but still performed?

A

. Most patients (>50%) with reflux symptoms have no visible evidence of oesophageal abnormality when endoscopy is performed.

However endoscopy must be performed in the presence of ‘alarm’ features suggestive of malignancy (eg dysphagia, weight loss, vomiting)

26
Q

what is GORD without abnormal anatomy?

A

increased Transient relaxations of the LOS

Hypotensive LOS

Delayed gastric emptying

Delayed oesophageal emptying

decreased Oesophageal acid clearance

decreased Tissue resistance to acid/bile

27
Q

what is GOD due to hiatus hernia?

A

Anatomical distortion of the OG junction

28
Q

what are the two main types of hiatus hernia?

A

Sliding and Para-oesophageal

29
Q

GORD pathophysiology

A

Mucosa exposed to
acid-pepsin and bile

Increased cell loss
and regenerative activity
(ie inflammation)

Erosive oesophagitis

30
Q

GORD complications

A

Ulceration (5%)

Stricture (8-15%)

Glandular metaplasia (Barrett’s oesophagus)

Carcinoma

31
Q

whos more likely to get barretts oesophagus?

A

men

32
Q

what is barretts oesophagus a precurser to?

A

dysplasia

adenocarcinoma

33
Q

what is barretts oesophagus?

A

Intestinal metaplasia related to prolonged acid exposure in distal oesophagus

34
Q

what type of epithelium is in the lower oesophagus?

A

Change from squamous to mucin-secreting columnar (ie gastric type)

35
Q

what is the risk of developing oesophageal cancer ?

A

6% year

36
Q

what is the treatment of barrettsoesophagus?

A 
Endoscopic Mucosal Resection (EMR)
Radio-Frequency Ablation (RFA)
Oesophagectomy rarely (mortality ~10%)
37
Q

GORD treatment?

A

Lifestyle measures

Pharmacological
Alginates (Gaviscon)
H2RA (Ranitidine)
Proton Pump Inhibitor (e.g. Omeprazole, Lansoprazole)

For refractory disease/symptoms
following investigation
Anti-reflux surgery
(Fundoplication – full / partial wrap)

38
Q

oesophageal cancer presentation

A

Progressive dysphagia (90%)

Anorexia and Weight loss (75%)

Odynophagia

Chest pain

Cough

Pneumonia (tracheo-

oesophageal fistula)

Vocal cord paralysis

Haematemesis

39
Q

where does squamous cell carcinoma happen in the oesophagus?

A

Occur in proximal and middle third of oesophagus

40
Q

risk factors for squamous cell carcinoma

A

tobacco and alcohol

41
Q

where does adenocarcinoma happen in the oesophagus?

A

distal oesophagus

42
Q

what are the predisposing factors for adenocrcinoma?

A

obesity, male sex, middle age, caucasian

43
Q

metastases of oesophageal cancer

A

Hepatic, brain, pulmonary, bone

44
Q

oesophageal cancer investigations

A

Diagnosis by Endoscopy & Biopsy

Staging:
CT Scan
Endoscopic ultrasound
PET Scan
Bone Scan

Disease staging by
TNM classification

45
Q

oesophageal cancer treatment

A

Only potential cure is surgical oesophagectomy +/- adjuvant (after) or neoadjuvant (before) chemotherapy

Endoscopic 
   (stent, laser/APC, PEG)
Chemotherapy
Radiotherapy
Brachytherapy
46
Q

what is Eosinophilic Oesophagitis

A

Chronic immune-/allergen-mediated condition defined clinically by symptoms of oesophageal dysfunction, and pathologically by an eosinophilic infiltration of the oesophageal epithelium (≥15 eosinophils per high-power microscopy field on oesophageal biopsy) in the absence of secondary causes of local or systemic eosinophilia.

47
Q

who is more likely to have Eosinophilic Oesophagitis

A

children and young adults of males

48
Q

presentation of Eosinophilic Oesophagitis

A

Dysphagia & Food bolus obstruction

49
Q

treatment of Eosinophilic Oesophagitis

A

topical/swallowed corticosteroids

- dietary elimination 
- endoscopic dilatation

systems- GI (40 decks)

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