oesophageal bits Flashcards
(14 cards)
2 main causes of oesophageal cancer
adenocarcinoma - hx of GORD, baarrets oesophgus
- commonest in britain/US
squamous - ssmoing, alcohol
- more common in develloping world
different locations of oesophageal cancers
adenocarcinoma - lower 3rd, neaar gaastrooesophageaal junction
squamous - upper two thirdds
oessophageal cancer ix
diagnosis = upper GI endoscopy with biopsy
staging = endoscopic US
CT CAP
oesophaageal cancer mx
operable disease (T1N0M0) –> surgical resection (Ivor-Lewis oesophagectomy)
pathophys of achlasia
fail of peristalsis + relaxation of lower oesophageal sphicter (LOS)
–> due to degenerative loss of ganglia from the myenteric (Auerbachs) plexus
(ie LOS contracted, oesophagus above is dilated)
features of achalasia
dysphagia of BOTH liquids + solids
heartburn
regurg of food - cough, aspiration pneumonia
malignant change in some - squamous
achlasia ix
diagnostic = oesophageal manometry !!
barium swallow - birds beax
CXR = wide mediastinum
achlasia mx
1st = pneumatic (balloon) dilation
- less invasive
- should be low surgical ris
surgical = Heller cardiomyotomy
- if recurrent, persistent sx
pharyngeal pouch (Zeners diverticulum) features
older men
regurg
nec swelling which gurgles on palpation
halitosis !
dyphagia
pharyngeal pouch ix + Mx
barium swallow combined with dynamic video fluroscopy !!
mx = surgery
oesphageal candidiasis
hx of HIV or steroid inhaler use
px = dysphagia and odynophagia
mx = Fluconazole, itraconazole
urgent endocopy 2wee referral criteria
all with dysphagia
all with upper abdo mass (consistent with stomach ca)
patients age >=55 who have weight loss AND any of -
- upper abdo pain
- reflux
- dyspepsia
non-urgent endoscopy criteria
patients with haematemesis
>=55 who have -
- treatment resistant dyspepsia
- upper abdo pain with low Hb
- raised platelet with any of - nausease, vom, weight loss, reflux, dyspep
do you need test of cure for Hpylori
no
if sx have resolved
