Diseases and Injuries of the Oesophagus Flashcards
(43 cards)
How many stages of achalasia of the oesophagus (cardiospasm) are there and what are they called?
There are four stages:
Stage 1 (inconstant spasm of cardia);
Stage 2 (stable spasm of cardia);
Stage 3 (scar changes in cardia and dilation of oesophagus);
Stage 4 (severe scar changes of cardia with excessive dilation and deviation of the oesophagus).
What are the characteristics of stage 1 achalasia of the oesophagus?
Short timing dysphagia (ill-times opening of the cardia); anatomy of the oesophagus and gastric section are normal; active peristalsis up to the cardia; oesophageal evacuation in good time.
What are the characteristics of stage 2 achalasia of the oesophagus?
Expressed dysphagia with slowed emptying of the oesophagus; even distal dilation of the oesophagus (conical narrowing); peristalsis is faster.
What are the characteristics of stage 3 achalasia of the oesophagus?
Fibrosis of the oesophagus leading to scarring; sharp dysphagia; retrosternal pain; regurgitation; conical distal oesophagus; incomplete opening of the cardia; disorderly peristalsis and sharp weak spasms.
What are the characteristics of stage 4 achalasia of the oesophagus?
Intense scarring of the of the cardia leading to narrowing; dilation, curving and lengthening of the oesophagus; atonic wall; delayed emptying of the oesophagus (large volume of liquid in the oesophagus.
What are the primary symptoms of achalasia of the oesophagus?
Dysphagia; regurgitation; retrosternal pain; abundant mucus and hyper-salivaiton.
What are the secondary symptoms of achalasia of the oesophagus?
Aerophagia (swallowing of air); hydrophagia; decrease in body mass; loss of ability to work.
What is the difference between oesophageal vomiting and gastric vomiting?
Oesophageal vomiting: no foul smell; no sour taste; no violation of appetite.
What are the causes of vomiting in the initial and late stages of achalasia of the oesophagus?
In the initial stage vomiting is due to spasm of the oesophageal wall. In the late stage it is due to overfilling and vomiting often occurs at night during the horizontal position.
Why do patients with achalasia of the oesophagus experience aerophagia and hydrophagia?
Improves passage of food through the cardia by increasing pressure.
What factors should be assessed during anamnesis morbi of a patient with achalasia of the oesophagus?
When the disease first started; what foods cause a reaction; characteristics of dysphagia; when oesophageal vomiting began; development of pain.
What additional examinations can be conducted to confirm the diagnosis of achalasia of the oesophagus?
Roentgenoscopy (w/ contrast to examine the oesophagus); oesophagoscopy; oesophageal manometry and PH-metry.
What features of achalasia of the oesophagus can be seen on an ordinary roentgenograph of a patient with achalasia of the oesophagus?
Contours of the oesophagus; horizontal level of liquid; absent gas bubble of stomach.
What features of achalasia of the oesophagus can be seen on a roentgenograph with barium contrast?
Form, position and contours of the oesophagus, wall tone; relief of mucus membrane and motor function.
What features of achalasia of the oesophagus can be seen during oesophagoscopy?
Extended oesophagus; hyperaemic membrane; closed cardiac channel and allows you to differentiate between achalasia and cancer.
What are the differential diagnosis of achalasia of the oesophagus?
Benign and malignant tumours of the oesophagus; diverticulas; strictures. These all have the general symptoms of dysphagia; pain and regurgitation.
How to differentiate between benign / malignant cancer and achalasia of the oesophagus?
Benign tumours are rarer than cardiospasm and dysphagia is a rare symptom. Upon further investigation there will be a defect of filling with smooth contours of the oesophagus. Malignant tumours are more common than cardiospasm. Dysphagia develops quicker with worsening of condition. During cancer there is marked defect of filling with deformed contours of the oesophagus.
What other conditions commonly lead to oesophageal scarring?
Reflux-oesophagitis and chemical burns of the oesophagus.
In what stages of achalasia of the oesophagus can cardiodilation be used?
I - III stage.
What are the indications fro operative treatment of achalasia of the oesophagus?
IV stage of disease (however, contraindicated is there is conomitant pathologies); III stage is 3/4 unsuccessful attempts of cardiodilation have been made or cardiodilator cannot be passed through cardia; if the patient is a child; relapse of the disease.
What conservative therapy can be used in achalasia of the oesophagus?
Conservative therapy is not affective unless used as a precursor for patients undergoing cardiodilation. The conservative treatment in this case is: diet; spasmolitics; sedative drugs and physiotherapy. N.B Botulinum toxin can be used in the early stages of the disease.
Calcium channel blocker- Nifedipine
Long acting nitrates
What are the three main types of cardyodilators used in the treatment of achalasia of the oesophagus?
Stark, pneumatic cardiodilators and Wilson-Cook dilator.
How do you carry out cardiodilation for patients suffering from achalasia of the oesophagus?
Carried out on an empty stomach. Premedication and anaesthesia of pharynx with 1% dicaine. Performed under X-ray. Balloon inserted up to gastro-oesophageal sphincter and inflated (3 - 4 times over period of 3 - 4 days). Manometry used to assess pressure (11 - 22 mmHg).
What are the complications of cardiodilation for the treatment of achalasia of the oesophagus?
Rupture; incompetence of sphincter leading to reflux - oesophagitis.
