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Laura's GI Pathology > GORD, Barrett's and dysmotility of oesophagus and stomach inc. oesophageal pathology > Flashcards

GORD, Barrett's and dysmotility of oesophagus and stomach inc. oesophageal pathology Flashcards

(49 cards)

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1
Q

Define GORD

A

Any symptomatic condition, anatomic alteration or both that results from the reflux of noxious material from the stomach into the oesophagus.

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2
Q

What makes up the noxious material in GORD?

A

Mainly gastric acid but can be pepsin and bile acids in more severe cases

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3
Q

What are the defence against GOR?

A

LOS
Surface mucosa
Bicarbonate ions
Oesophageal clearance

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4
Q

Symptoms of GORD?

A

Heartburn
Acid reflux
Chest pain
Dysphagia

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5
Q

Alarm features of GORD

A

Weight loss
anaemia
recurrent vomiting
dysphagia

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6
Q

Risk factors for GORD

A 
Age 
FH
Smoking, caffeine, alcohol (relax LOS) 
As BMI increases, so does chance of GORD 
Hiatus hernia
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7
Q

Complications of GORD

A 
Oesophagitis 
stricture 
haemorrhage 
barretts oesophagus
adenocarcinoma
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8
Q

What is the main investigation for GORD?

A

Often not required

Gastroscopy

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9
Q

Conservative management for GORD

A

stop smoking, lose weight, avoid large meals late at night, avoid alcohol, avoid fatty foods, elevate head of bed

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10
Q

Pharmacological management for GORD

A

Antacids - Gaviscon, Maalox
PPIs - Omeprazole
H2RA - Ranitidine
Surgery of no drugs work - fundoplication

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11
Q

Describe fundoplication

A

Hiatus hernia fixed, stomach partially wrapped around LOS to stop reflux

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12
Q

Treatment for a benign oesophageal stricture

A

Dilation at endoscopy - short term - risk of severe bleeding/ perforation (risk increased if malignant stricture)
High dose PPI - long term

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13
Q

Describe Barrett’s oesophagus

A

Metaplasia of oesophageal non-keratinized squamous epithelium to gastric columnar epithelium (with extensive tubular secretory glands)

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14
Q

What is Barrett’s?

A

Complication of severe long term GORD
premalignant condition whihc predisposes the pt to oesophageal adenocarcinoma
Protective response for faster regeneration

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15
Q

Management for Barrett’s

A

Surveillance for dysplasia using endoscopy

PPI - Omeprazole

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16
Q

Dysplasia management

A 
More frequent surveillance 
Optimise PPI dose 
Surgery - Endoscopic mucosal resection 
              - Radiofrequency ablation 
Argon gas - tube down oesophagus and argon gas pumped through to remove barrett's lining
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17
Q

What happens in Achalasia?

A

LOS does not relax very well so there is a loss of muscle tone of peristalsis which leads to a dilated oesophagus

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18
Q

How is the oesophagus in achalasia described?

A

“birds beak” oesophagus

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19
Q

What do physical signs in a pt with achalasia show?

A

anaemia or malnutrition

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20
Q

What is the #1 investigation for achalasia?

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A

oesophageal manometry

21
Q

Symptoms of achalasia

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A 
regurgitation of food
cough 
dysphagia (solids and liquids)
chest pain which may increase post-prandial (may be felt in back, neck and arms)
heartburn 
unintentional weight loss
22
Q

Complications of achalasia

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A

Aspiration pneumonia

oesophageal perforation

23
Q

Treatment for achalasia

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A

Botox injections - relax LOS muscles
Long acting nitrates or CaCB - relax LOS
Dilation at endoscopy

24
Q

What is gastroparesis?

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A

Delayed gastric emptying but no physical obstruction

25
Causes of gastroparesis?
``` Idiopathic cannabis use opiates and anti-cholinergics Diabetes mellitus Systemic sclerosis ```
26
Symptoms of gastroparesis
``` Feeling of fullness nausea and vomiting weight loss upper abdominal pain (very non-specific symptoms) ```
27
Investigations for gastroparesis
endoscopy first | gastric emptying studies (type of nuclear test)
28
Management for gastroparesis
``` removal of precipitating factors liquid/sloppy diet eat a little and often low fat diet promotility agents - Domperidone and Metoclopramide (to speed up gastric emptying) ```
29
What is reflux oesophagitis?
Inflammation of oesophagus due to refluxed low pH gastric content May also be caused by defective sphincter mechanism +/- Hiatus hernia , Abnormal oesophageal motility, Increased intra-abdominal pressure (pregnancy)
30
Histological changes in reflux oesophagitis
Basal zone epithelial expansion and lengthening of papillae Intraepithelial neutrophils, lymphocytes and eosinophils
31
In Barrett's oesophagus, how is the mucosa described?
Red velvety mucosa in lower oesophagus
32
What is allergic/ eosinophilic oesophagitis?
Corrugated (feline) or ‘spotty/wrinkled’ oesophagus Food gets stuck in oesophagus - not dysphagia - abnormal oesophageal motility Large numbers of intraepithelial eosinophils pH probe is negative for reflux
33
What is the treatment for allergic oesophagitis?
steroids chromoglycate montelukast
34
What is the most common kind of benign oesophageal tumour?
squamous papilloma
35
Where does squamous cell carcinoma of the oesophagus arise from?
Squamous cell epithelium
36
Where does adenocarcinoma of the oesophagus arise from?
dysplasia in oesophagus
37
Is squamous cell carcinoma more common in females or males?
Males
38
Causes of squamous cell carcinoma
``` Vitamin A, Zinc deficiency Tannic acid/ Strong tea Smoking, Alcohol HPV Oesophagitis Genetic ```
39
What do squamous cell carcinoma cause?
Obstruction and dysphagia
40
Is Adenocarcinoma more common in males or females?
males
41
Which part of the oesophagus is adenocarcinoma most common in?
Lower 1/3rd
42
How do oesophageal cancers spread?
- direct invasion - lymphatic permeation - vascular invasion
43
How do oesophageal cancers present?
dysphagia - due to tumour obstruction odynophagia haematemesis general symptoms of malignancy (anaemia, weight loss, loss of energy) Paraneoplastic syndrome (hypercalcaemia and inappropriate hormone production)
44
How are oesophageal cancers diagnosed?
Upper Gi edoscopy and biopsy #1 barium meal CT/MRI scan of chest and abdomen bronchoscopy (can infiltrate to trachea)
45
Surgical treatment of oesophageal cancer
Removal of oesophagus and lymph nodes | only 50% of pts are suitable
46
Contraindications to oesophageal cancer surgery
- Direct invasion of adjacent structures - Fixed cervical lymph nodes – too advanced - Widespread metastases – far too advanced - Poor medical condition
47
Other forms of treatment for oesophageal cancer
radiotherapy intubations/ stents (only liquid food as no peristalsis) canalisation terminal care
48
Prognosis of oesophageal cancer
dismal prognosis majority die within a year 5 year survival 11%
49
Give 3 drugs which are recognised causes of oesophageal injury
tetracycline catopril slow release theophylline

Laura's GI Pathology (13 decks)

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