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Flashcards in Oesophageal Disorders Deck (49):
1

What is heartburn a consequence of?

Acid and/or bilous gastric content reflux into the oesophagus

2

What causes gastro-oesophageal reflux disease?

Reduction in lower oesophageal sphincter pressure resulting in persistent reflux and heartburn

3

What percentage of adults experience daily GORD symptoms?

7%

4

What is the typical presentation of GORD?

Heartburn
Cough
Water brash
Sleep disturbance

5

What are the risk factors for GORD?

Pregnancy
Smoking
Obesity
Drugs lowering LOS pressure
Alcoholism
Hypomotility

6

Typical reflux syndrome can be diagnosed on the basis of

characteristic symptoms, without diagnostic testing

7

Why is endoscopy a poor diagnostic test for GORD?

Most patients with reflux (>50%) will have no visible evidence of oesophageal abnormality on endoscopy

8

Under what circumstances should an endoscopy be performed in reflux disease?

In the presence of alarm features suggestive of malignancy

9

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

10

What is the aetiology of GORD due to hiatus hernia?

Anatomical distortion of the OG junction

11

What is the pathophysiology of GORD?

Mucosa exposed to acid, pepsin and bile, increased cell loss and inflammation, erosive oesophagitis

12

What are the possible complications of GORD?

Ulceration
Stricture
Glandular metaplasia
Carcinoma

13

What are the treatment options for GORD?

Lifestyle changes
Pharmacological - alginates and proton pump inhibitors
Anti-reflux surgery for refractory disease

14

What are the two types of hiatus hernia?

Sliding
Para-oesophageal

15

What are the risk factors for a hiatus hernia?

Obesity
Increasing age

16

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

17

What two conditions can develop from Barrett's oesophagus?

Dysplasia
Adenocarcinoma

18

What are the treatment options for Barrett's oesophagus?

Endoscopic mucosal resection
Radio-frequency ablation
Oesophagectomy (rarely)

19

What is dysphagia?

Difficulty swallowing foods and/or liquids

20

What is odynophagia?

Pain when swallowing

21

What are the two types of dysphagia?

Oropharyngeal
Oesophageal

22

What are the symptoms associated with dysphagia?

Weight loss
Regurgitation
Cough

23

What are the causes of oesophageal dysphagia?

Benign stricture
Malignant stricture
Motility disorders
Eosinophilic oesophagus
Extrinsic compression

24

Give an example of a motility disorder which might cause oesophageal dysphagia

Achalasia
Presbyoesophagus

25

What investigations would you do in oesophageal disease?

Oesophago-gastro-duodenoscopy
Upper GI endoscopy
Contrast radiology
Oesophageal pH and manometry

26

What are the symptoms of hypermotility?

Severe episodic chest pain
Dysphagia

27

What would be seen in manometry of hypermotility?

Uncoordinated, exaggerated hypertonic contractions

28

What is hypermotility?

Diffuse oesophageal spasm

29

What conditions is hypomotility associated with?

Connective tissue disease
Diabetes
Neuropathy

30

What is caused by hypomotility?

Failure of the lower oesophageal sphincter mechanism leading to heartburn and reflux

31

What is achalasia?

Functional loss of the inhibitory neutrons in the myenteric plexus ganglion cells in the distal oesophagus and lower oesophageal sphincter

32

At what age is the usual onset of achalasia?

30-50 years

33

What is the cardinal feature of achalasia?

Failure of the lower oesophageal sphincter to relax

34

What does achalasia result in?

Functional distal obstruction of the oesophagus

35

What are the symptoms of achalasia?

Progressive dysphagia
Weight loss
Chest pain
Regurgitation
Chest infection

36

What are the possible treatments for achalasia?

Pharmacological - nitrates and CCBs
Endoscopic - Botulinum Toxin
Radiological - pneumatic balloon dilation
Surgical - myotomy

37

What are the possible complications of achalasia?

Aspiration pneumonia and lung disease
Squamous cell oesophageal carcinoma

38

What are the most common histological types of oesophageal carcinoma?

Squamous cell carcinoma
Adenocarcinoma

39

What is the 5 year survival of oesophageal carcinoma?

< 10%

40

What are the possible presentations of oesophageal cancer?

Progressive dysphagia
Anorexia and weight loss
Odynophagia
Chest pain
Cough
Pneumonia
Vocal cord paralysis
Haematemesis

41

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

42

What are the major risk factors for squamous cell oesophageal carcinoma?

Smoking
Alcohol abuse

43

What is squamous cell oesophageal cancer associated with?

Achalasia
Caustic strictures
Plummer-Vinson syndrome

44

In what part of the oesophagus does adenocarcinoma typically occur?

Distal third

45

What is oesophageal adenocarcinoma associated with?

Barrett's oesophagus

46

What are the risk factors for oesophageal adenocarcinoma?

Obesity
Male sex
Middle age
Caucasian

47

What investigations would be done for oesophageal carcinoma?

Endoscopy and biopsy
Staging: CT, EUS, PET scan, bone scan

48

What are the treatment options for oesophageal carcinoma?

Oesophagectomy +/- adjuvant/neoadjuvant chemotherapy - only potentially curative option
Combined chemo and radiotherapy
Palliative care

49

What options are there for palliative care of oesophageal carcinoma?

Endoscopic stent
APC
PEG
chemo/radiotherapy
brachytherapy