Oesophageal Disorders Flashcards Preview

GI System > Oesophageal Disorders > Flashcards

Flashcards in Oesophageal Disorders Deck (42):
1

Where does the oesophagus begin and end in terms of vertebra?

Begins at C6
Terminates at T11-12

2

What propels food down the oesophagus in peristalsis and what nerve innervates the muscle?

Circular muscles surrounding the oesophagus
Vagus nerve

3

How is the "Mucosal Rosette" formed?

The acute angle at the gastroesophageal junction (GOJ)

4

What symptoms can retrosternal discomfort or burning be associated with?

Waterbrash
Cough

5

What are symptoms of oesophageal disease?

Reflux
LOS pressure decreased to cause increased reflux
Persistent reflux and heartburn leads to GORD

6

How do you define between oropharyngeal and oesophageal disease?

Oropharyngeal is high dysphagia and may have a more sinister cause e.g. Laryngeal tumour

7

What are the causes of dysphagia?

Benign/Malignant structure
Motility disorder e.g. Achalasia
Eosinophilic oesophagitis
Extrinsic compression e.g. Lung cancer

8

Dysphagia investigations?

Endoscopy
Barium swallow
Oesophageal pH and manometry

9

What is oesophageal manometry?

Assessing sphincter tonicity, relaxation of sphincters and oesophageal motility

10

How does hypermotility appear on x-rays?

Corkscrew appearance due to severe muscle spasm with an unclear cause
*Often confused with Angina/MI*

11

What does hypomotility cause?

A failure of the LOS mechanism leading to heartburn and reflux symptoms

12

What is hypomotility associated with?

Connective tissue disease
Diabetes
Neuropathy

13

What is achalasia?

The functional loss of myenteric plexus ganglion cells in the distal oesophagus and LOS

14

What does achalasia result in?

A functional distal obstruction of the oesophagus - Food cannot enter the stomach

15

What often surrounds achalasia?

Lymphocytes

16

What are the symptoms of achalasia?

Progressive dysphagia
Weight loss
Chest pain (30%)
Regurgitation & Chest infection

17

How high is the pressure in the LOS and what does it fail to do after swallowing?

Above 45mmHg
Relax

18

Achalasia investigations?

CXR
Manometry
OGD
Barium swallow

19

Achalasia treatment?

Nitrate and Calcium blockers
Endoscopic
Radiological - Pneumatic balloon dilatation
Surgical - Myotomy

20

What is GORD and how does it occur?

Gastro-Oesophageal Reflux Disease
Acid (and bile) exposure in the lower oesophagus

21

GORD symptoms?

Heartburn
Cough
Waterbrash
Sleep disturbance

22

What are the six GORD risk factors?

Smoking
Obesity
Alcohol
Hypomotility
Pregnancy
Drugs lowering LOS pressure

23

What happens when there is GORD without abnormal anatomy?

INcreased relaxations of LOS
Hypotensive LOS
Delayed gastric emptying
Delayed oesophageal emptying
Decreased oesophageal acid clearance

24

What happens when GORD is due to a hiatus hernia?

Their is an anatomical distortion of the OG junction

25

What are the two types of hiatus hernia?

Sliding
Para-oesophageal

26

What happens to the stomach fundus in a hiatus hernia?

Moves proximally through the diaphragmatic hiatus

27

What happens in a sliding hernia?

The hernia moves up and down

28

What happens in a para-oesophageal hernia?

Fundus moves up and down alongside the oesophagus

29

What complications arise from GORD?

Ulceration
Stricture
Glandular metaplasia (Barrett's Oesophagus)
Carcinoma

30

How does erosive oesophagitis occur?

Mucosa is exposed to acid-pepsin and bile

31

What are the treatments for GORD?

Lifestyle measures
Pharmacological - Rennis, Gaviscon etc.
Anti-reflux surgery

32

What are the two types of oesophageal cancer?

Adenocarcinoma
Squamous cell carcinoma

33

What are the symptoms of oesophageal carcinoma?

Progressive Dysphagia
Anorexia & Weight loss
Odynophagia
Chest pain
Cough
Pneumonia
Vocal cord paralysis
Haematemsis

34

What is odynophagia?

Painful swallowing in the mouth or oesophagus
*Can occur with or without dysphagia*

35

What nerve must be affected for vocal cord paralysis to occur?

Recurrent laryngeal nerve

36

Where does squamous cell carcinoma occur and how does it appear?

Proximal and middle third of oesophagus
Large exophytic tumours preceeded by dysplasia and carcinoma in situ

37

Where does adenocarcinoma occur?

Distal oesophagus

38

What are the predisposing factors for adenocarcinoma?

Obesity
Male
Middle ages
Caucasian

39

Where does direst spread occur and why?

Mediastinum as there is no peritoneal lining there

40

What does the oesophagus lack?

A serosal layer

41

What investigations are done for oesophageal cancer?

Endoscopy/Biopsy
Staging - CT/PET scan

42

How does the staging work for Oesophageal cancer?

T1 – Tumour invades lamina propria/ submucosa (a-lamina propria, b-submucosa)
T2 – Tumour invades muscularis propria
T3 – Tumour invades adventitia
T4 – Tumour invades adjacent structures
N1 – Regional lymph node metastasis
M1 – Distant metastasis