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GI/Gen surg AM > Oesophageal conditions > Flashcards

Oesophageal conditions Flashcards

1
Q

What is oesophageal hyper motility?

A

Exaggerated, uncoordinated hypertonic contractions of the oesophagus

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2
Q

What are the symptoms of oesophageal hyper motility?

A

Severe episodic pain with or without dysphagia

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3
Q

What investigations are done for oesophageal hyper motility?

A

Barium swallow- corkscrew appearance

Manometry- uncoordinated, exaggerated contractions

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4
Q

What is the management of oesophageal hyper motility?

A

Smooth muscle relaxants

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5
Q

What is the presentation of globus pharyngus?What is globus pharyngus?

A 
Persistent feeling of a lump in throat without anything being there
Dysphagia
Intermittent symptoms
Relieved by swallowing food or drink
Worse swallowing saliva
Painless
History of anxiety
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6
Q

What is achalasia?

A

Functional obstruction caused by loss of myenteric plexus ganglion cells in distal oesophagus and lower oesophageal sphincter –> cannot relax

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7
Q

What are the features of achalasia?

A 
Progressive dysphagia- both solids and liquids from stat
Weight loss
Regurgitation
Chest infections
Chest pain
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8
Q

What investigations are done for achalasia?

A

Manometry- excessive LOS tone that doesn’t relax on swallow

Barium swallow- bird’s beak appearance

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9
Q

What is the management principle of achalasia?

A

Pharm is limited
Endoscopic
Surgical

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10
Q

What pharm management options are available for achalasia?

A

Limited
Nitrates
CCB

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11
Q

What endoscopic and surgical management options are there for achalasia?

A

Pneumatic balloon dilatation
Intra-sphenteric botulinum toxin injection
Myotomy

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12
Q

What are the complications of achalasia?

A

Increased risk SCC

Aspiration and pneumonia

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13
Q

What are the 2 types of causes of GORD?

A

Functional

Anatomical- hiatus hernia

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14
Q

What can cause functional GORD?

A 
Increased transient relaxations of LOS
Hypotensive LOS
Delayed gastric empyting
Delayed oesophageal emptying
Decreased oesophageal acid clearance
Decreased tissue resistance to bile
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15
Q

What are the risk factors for GORD?

A 
Pregnancy
Obesity
Smoking
Alcohol
Hypomotility
Drugs lowering LOS pressure
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16
Q

What is the presentation of GORD?

A

Heartburn
Cough
Water brash
Sleep disturbance

17
Q

What are the alarm features in GORD?

A

Dysphagia
Weight loss
Vomiting

18
Q

What is the pathophysiology in GORD?

A

Mucosa exposed to pepsin and bile causing increased cell loss and regenerative activity, and erosive oesophagitis

19
Q

How is GORD diagnosed?

A

Characteristic history

20
Q

What should eb done if there are alarm features in GORD?

A

Endoscopy

21
Q

How is GORD managed?

A

1st- Lifestyle measures
2nd- PPI
3rd- H2RA
Anti-reflux surgery if severe

22
Q

What are the complications of GORD

A

Ulceration
Stricture
Barrett’s oesophagus
Carcinoma

23
Q

What is Barrett’s oesophagus?

A

Metaplasia of lower oesophageal mucosa- change from start squamous epithelium to simple columnar epithelium with goblet cells

24
Q

What is the main risk factor for Barrett’s?

A

GORD

25
Q

What is the presentation of Barrett’s?

A

Asymptomatic but patients will likely present with GORD

26
Q

How is Barrett’s screened?

A

Endoscopy for males >60 with persistent/treatment resistant GORD

27
Q

What is the management of Barrett’s?

A

Endoscopic surveillance every 3-5 years

High dose PPI

28
Q

What are oesophageal SCCs?

A

Large exophytic occulting tumours occurring in proximal 2/3 oesophagus

29
Q

What are oesophageal SCCs preceded by?

A

Dysplasia and carcinoma in situ

30
Q

What is oesophageal SCC associated with?

A

Achalasia
Caustric strictures
Plummer-Vinson syndrome
Smoking and alcohol

31
Q

What are oesophageal adenocarcinomas?

A

Change of strat squamous epithelium to glandular columnar epithelium in distal 1/3 oesophagus

32
Q

What precedes oesophageal adenocarcinoma?

A

Barrett’s oesophagus

33
Q

What are the risk factors for oesophageal adenocarcinoma?

A

GORD!

Male, middle aged, obese

34
Q

What are the features of oesophageal cancer?

A 
Progressive dysphagia
Odynophagia
Anorexia and weight loss
Chest pain
Cough and haematemesis
Pneumonia
Vocal cord paralysis
Typically presents late
35
Q

How is oesophageal cancer diagnosed?

A

Endoscopy and biopsy

36
Q

How is oesophageal cancer staged?

A

CT
PET
Endoscopic US

37
Q

What is the curative management of oesophageal cancer?

A

Oesophagectomy +/- adjuvant and/or neoadjuvant chemo

38
Q

What options are there for management in oesophageal cancer?

A

Surgery
Combined chemo and radio- localised but non op disease
Palliative

39
Q

What palliative options are available for oesophageal cancer?

A 
Chemo
Radio
Brachytherapy
Stent
Laser
PEG tube

GI/Gen surg AM (28 decks)

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