Flashcards in Oesophageal Disorders Deck (42):
Where does the oesophagus begin and end in terms of vertebra?
Begins at C6
Terminates at T11-12
What propels food down the oesophagus in peristalsis and what nerve innervates the muscle?
Circular muscles surrounding the oesophagus
How is the "Mucosal Rosette" formed?
The acute angle at the gastroesophageal junction (GOJ)
What symptoms can retrosternal discomfort or burning be associated with?
What are symptoms of oesophageal disease?
LOS pressure decreased to cause increased reflux
Persistent reflux and heartburn leads to GORD
How do you define between oropharyngeal and oesophageal disease?
Oropharyngeal is high dysphagia and may have a more sinister cause e.g. Laryngeal tumour
What are the causes of dysphagia?
Motility disorder e.g. Achalasia
Extrinsic compression e.g. Lung cancer
Oesophageal pH and manometry
What is oesophageal manometry?
Assessing sphincter tonicity, relaxation of sphincters and oesophageal motility
How does hypermotility appear on x-rays?
Corkscrew appearance due to severe muscle spasm with an unclear cause
*Often confused with Angina/MI*
What does hypomotility cause?
A failure of the LOS mechanism leading to heartburn and reflux symptoms
What is hypomotility associated with?
Connective tissue disease
What is achalasia?
The functional loss of myenteric plexus ganglion cells in the distal oesophagus and LOS
What does achalasia result in?
A functional distal obstruction of the oesophagus - Food cannot enter the stomach
What often surrounds achalasia?
What are the symptoms of achalasia?
Chest pain (30%)
Regurgitation & Chest infection
How high is the pressure in the LOS and what does it fail to do after swallowing?
Nitrate and Calcium blockers
Radiological - Pneumatic balloon dilatation
Surgical - Myotomy
What is GORD and how does it occur?
Gastro-Oesophageal Reflux Disease
Acid (and bile) exposure in the lower oesophagus
What are the six GORD risk factors?
Drugs lowering LOS pressure
What happens when there is GORD without abnormal anatomy?
INcreased relaxations of LOS
Delayed gastric emptying
Delayed oesophageal emptying
Decreased oesophageal acid clearance
What happens when GORD is due to a hiatus hernia?
Their is an anatomical distortion of the OG junction
What are the two types of hiatus hernia?
What happens to the stomach fundus in a hiatus hernia?
Moves proximally through the diaphragmatic hiatus
What happens in a sliding hernia?
The hernia moves up and down
What happens in a para-oesophageal hernia?
Fundus moves up and down alongside the oesophagus
What complications arise from GORD?
Glandular metaplasia (Barrett's Oesophagus)
How does erosive oesophagitis occur?
Mucosa is exposed to acid-pepsin and bile
What are the treatments for GORD?
Pharmacological - Rennis, Gaviscon etc.
What are the two types of oesophageal cancer?
Squamous cell carcinoma
What are the symptoms of oesophageal carcinoma?
Anorexia & Weight loss
Vocal cord paralysis
What is odynophagia?
Painful swallowing in the mouth or oesophagus
*Can occur with or without dysphagia*
What nerve must be affected for vocal cord paralysis to occur?
Recurrent laryngeal nerve
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
Where does adenocarcinoma occur?
What are the predisposing factors for adenocarcinoma?
Where does direst spread occur and why?
Mediastinum as there is no peritoneal lining there
What does the oesophagus lack?
A serosal layer
What investigations are done for oesophageal cancer?
Staging - CT/PET scan