*Oesophageal and Stomach Disorders (lectures 1 and 2) Flashcards Preview

Study Notes - Gastroenterology > *Oesophageal and Stomach Disorders (lectures 1 and 2) > Flashcards

Flashcards in *Oesophageal and Stomach Disorders (lectures 1 and 2) Deck (27)
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1

What are the 2 possible types of oesophageal cancer?
What is the most common?
Where is each more likely to occur?
what are the main things that increase the incidence of each type?

Adenocarcinoma (distal oesophagus) - more common - GORD
Squamous cell carcinoma (proximal oesophagus) - smoking and drinking

2

signs and symptoms of oesophageal cancer? (8)

dysphagia:
where the patient feels food sticking isn't necessarily where the tumour is
odynophagia
upper GI haemorrhage
anaemia
weight loss
retrosternal pain
if upper tumour, cough and hoarseness

3

What should be performed if you suspect oesophageal cancer? e.g. presence of dysphagia

An urgent upper GI endoscopy
Also perform a colonoscopy if the patent presents with anaemia

4

What 3 things should be done to help choose treatment for oesophageal and gastric cancers?

Determine treatment intent
Assess patient fitness
Accurate staging

5

What is performed to accurately stage an oesophageal cancer?

CT thorax/ abdomen - if normal perform tests below
CT/PET, EUS, Laparoscopy (can spread intra-abdominally causing little seedlings in the abdomen - laparoscopy searches for this)
search hard for metastatic disease
if metastases present = palliative care

6

Palliative treatment options for oesophageal cancer? (3)

Chemotherapy
Radiotherapy
Stenting - not very pleasant to swallow with

7

Treatment options for oesophageal cancer that can be potentially cured?

Surgery with or without NAC - offers better cure rates for early disease
Radical chemoradiotherapy - complications are more manageable

8

What are the adverse prognostic factors for oesophageal cancer? (3)

Oesophageal obstruction
Tumour longer than 5cm
Metastatic disease

9

Staging of oesophageal cancer using TNM?

Tis = carcinoma in situ
T1 = invading lamina propria/ submucosa
T2 = invading muscularis propria
T3 = Invading adventitia
T4 = invasion of adjacent structures
Nx = nodes cannot be assessed
NO = no node spread
N1 = regional node metastasise
M0 = no distant spread
M1 = distant metastasis

10

What types of gastric cancers do you get? (5)
What is the most common type?

Adenocarcinoma - commonest type
Rarer:
lymphoma - better prognosis
Gastrointestinal Stomal Tumours - rarely metastasise = better prognosis
Squamous cell carcinoma
Neuroendocrine tumours

11

Signs and symptoms of gastric cancer? (10)

Dysepsia
Upper GI bleeding
Anaemia
weight loss
Abdominal mass
Anorexia/ early satiety
vomiting
Hepatomegaly
jaundice
ascites

12

How do you accurately stage a gastric cancer?

CT thorax/ abdomen
Laparoscopy/ EUS

13

Palliative treatment for gastric cancer? (3)

Chemotherapy
Radiotherapy
Surgical palliation e.g. for obstruction
(Trastuzamab for Her-2 positive tumours)

14

Treatment for potentially curable gastric cancer?

surgery with or without NAC
surgery based treatment is the only potentially curative option
radiotherapy is not a treatment option for gastric cancers as the stomach is too big an organ and therefore you would poison the patient with radiotherapy

15

Adverse prognostic factors for gastric cancer (6)?

metastatic disease
short history
advanced age
proximal lesions
locally advanced lesion
superficial gross appearance (limits plastica)

16

What is gastro-oesophageal reflux disease?

Reflux of stomach contents which causes troublesome symptoms and/or complications

17

What causes GORD? (3)

Lower oesophageal sphincter doesnt work properly
Increase in intra-abdominal pressure
Gastric acid hyper secretion

18

What type of people have a higher chance of getting GORD? (4)

Pregnant people
Obese people
Smokers
Increased association with alcohol

19

Symptoms of GORD?

Heartburn (burning retrosternal discomfort after meals, lying, stooping or straining)
belching
acid brash (acid/ bile regurgitation)
Waterbrash (increased salivation)
odynophagia (pain on swallowing e.g. from oesophagitis)
nocturnal asthma
chronic cough
laryngitis
sinusitis

20

Complications of GORD?

Oesophagitis
Ulceration
Benign stricture
Iron-deficiency
Barrett’s oesophagus = increased chance of oesophageal cancer

21

What type of classification is used to classify GORD?

Los Angeles Classification

22

Loss Angeles Classification?

“mucosal break” = a well-demarcated area of slough/ erythema) - used to encompass the old terms ulceration and erosion
1 = more than or equal to 1 mucosal break, 5mm long but not extending beyond 2 mucosal fold tops
3 = mucosal break continuous between the tops of 2 or more mucosal folds but which involves less than 75% of the oesophageal circumference
4 = mucosal break involving greater than or equal to 75% of the oesophageal circumference

23

Treatments fo GORD?

Physically repair the defective valve (surgery)
H2 receptor antagonists
PPIs
Anti-acids

24

What causes achalasia?

Lower oesophageal sphincter fails to relx

25

Symptoms of achalasia? (4)

Dysphagia
regurgitation
Substernal cramps
Weight loss

26

Diagnosis of achalasia?

CXR (fluid level in dilated oesophagus)
Barium swallow (dilated tapering oesophagus

27

Treatment of achalasia?

endoscopic balloon dilation
Heller’s Cardiomyotomy
then PPRI
Botulinum toxin injections (non-invasive - required every few months)
calcium channel blockers and nitrates also relax the sphincter
long standing achalasia may cause oesophageal cancer