Flashcards in Oesophageal Disorders Deck (49):
What is heartburn a consequence of?
Acid and/or bilous gastric content reflux into the oesophagus
What causes gastro-oesophageal reflux disease?
Reduction in lower oesophageal sphincter pressure resulting in persistent reflux and heartburn
What percentage of adults experience daily GORD symptoms?
What is the typical presentation of GORD?
What are the risk factors for GORD?
Drugs lowering LOS pressure
Typical reflux syndrome can be diagnosed on the basis of
characteristic symptoms, without diagnostic testing
Why is endoscopy a poor diagnostic test for GORD?
Most patients with reflux (>50%) will have no visible evidence of oesophageal abnormality on endoscopy
Under what circumstances should an endoscopy be performed in reflux disease?
In the presence of alarm features suggestive of malignancy
What is the aetiology of GORD?
Increased transient relaxations of LOS, LOS hypotension, delayed gastric and oesophageal emptying, decreased oesophageal acid clearance and tissue resistance to acid/bile
What is the aetiology of GORD due to hiatus hernia?
Anatomical distortion of the OG junction
What is the pathophysiology of GORD?
Mucosa exposed to acid, pepsin and bile, increased cell loss and inflammation, erosive oesophagitis
What are the possible complications of GORD?
What are the treatment options for GORD?
Pharmacological - alginates and proton pump inhibitors
Anti-reflux surgery for refractory disease
What are the two types of hiatus hernia?
What are the risk factors for a hiatus hernia?
What happens in Barrett's Oesophagus?
Intestinal metaplasia due to prolonged acid exposure in the distal oesophagus - change from squamous to mucin-secreting columnar epithelial cells
What two conditions can develop from Barrett's oesophagus?
What are the treatment options for Barrett's oesophagus?
Endoscopic mucosal resection
What is dysphagia?
Difficulty swallowing foods and/or liquids
What is odynophagia?
Pain when swallowing
What are the two types of dysphagia?
What are the symptoms associated with dysphagia?
What are the causes of oesophageal dysphagia?
Give an example of a motility disorder which might cause oesophageal dysphagia
What investigations would you do in oesophageal disease?
Upper GI endoscopy
Oesophageal pH and manometry
What are the symptoms of hypermotility?
Severe episodic chest pain
What would be seen in manometry of hypermotility?
Uncoordinated, exaggerated hypertonic contractions
What is hypermotility?
Diffuse oesophageal spasm
What conditions is hypomotility associated with?
Connective tissue disease
What is caused by hypomotility?
Failure of the lower oesophageal sphincter mechanism leading to heartburn and reflux
What is achalasia?
Functional loss of the inhibitory neutrons in the myenteric plexus ganglion cells in the distal oesophagus and lower oesophageal sphincter
At what age is the usual onset of achalasia?
What is the cardinal feature of achalasia?
Failure of the lower oesophageal sphincter to relax
What does achalasia result in?
Functional distal obstruction of the oesophagus
What are the symptoms of achalasia?
What are the possible treatments for achalasia?
Pharmacological - nitrates and CCBs
Endoscopic - Botulinum Toxin
Radiological - pneumatic balloon dilation
Surgical - myotomy
What are the possible complications of achalasia?
Aspiration pneumonia and lung disease
Squamous cell oesophageal carcinoma
What are the most common histological types of oesophageal carcinoma?
Squamous cell carcinoma
What is the 5 year survival of oesophageal carcinoma?
What are the possible presentations of oesophageal cancer?
Anorexia and weight loss
Vocal cord paralysis
What are the typical characteristics and location of squamous cell oesophageal cancer?
Usually large, exophytic, occluding tumours
Occur in proximal and middle thirds of oesophagus
What are the major risk factors for squamous cell oesophageal carcinoma?
What is squamous cell oesophageal cancer associated with?
In what part of the oesophagus does adenocarcinoma typically occur?
What is oesophageal adenocarcinoma associated with?
What are the risk factors for oesophageal adenocarcinoma?
What investigations would be done for oesophageal carcinoma?
Endoscopy and biopsy
Staging: CT, EUS, PET scan, bone scan
What are the treatment options for oesophageal carcinoma?
Oesophagectomy +/- adjuvant/neoadjuvant chemotherapy - only potentially curative option
Combined chemo and radiotherapy