Oesophageal disorders Flashcards
(41 cards)
At what veretbral levels does the oesophagus start and finish?
Begins at lower level of cricoid cartilage (C6), terminates at T11-12 where it enters the stomach
What are the varying muscle types of muscle in the oesophagus?
Upper 3/4cm is striated (skeletal) muscle
Remainder is smooth muscle
(although other lectures say its the top 1/3rd that is skeletal)
What type of lining is in the oesophagus?
Non-keritanised stratified squamous
What muscles produce peristaltic movement for food in the oesophagus?
Circular muscles in Muscularis externa
What mediates peristaltic contractions in the oesophagus and relaxation of the Lower oesophageal sphincter?
The vagus nerve
Peristalsis and LOS relaxation are coordinated
What ligament attaches the oesophagus to the diaphragm?
Phreno-oesophageal ligament
What is the name given to this area in the stomach?
(blocked out label)
Mucosal rosette
Formed by the ‘Angle of His’
What is heartburn?
Retrosternal discomfort or burning
How would heartburn present?
- Retrosternal discomfort or burning feeling
- Sometimes experienced with:
- Waterbrash (sudden rush of saliva)
- Cough
What causes heartburn?
Consequence of reflux of acidic &/or bilious gastric contents into the oesophagus
What causes reflux?
Certain drugs/foods:
- Alcohol
- nicotine
- dietary xanthines (caffeine etc I think)
These lower the LOS pressure leading to increased reflux
However, there is a degree of reflux that takes place normally (after swallowing etc)
What is the problem with having persistant relfux/heartburn?
Gastro-oesophageal reflux disease (GORD) can develop
This can in turn cause long-term complications
What is dysphagia?
Subjective sensation of difficulty in swallowing foods and/or liquids
What is the difference between Dysphagia and Odynophagia?
Dysphagia - Difficulty swallowing
Odynophagia - Pain with swallowing
(often accompany eachother)
What aspects of a a patient’s dysphagia is it important to ask about in histories?
- Type of food (solid vs liquid)
- Pattern (progressive, intermittent)
- Associated features (weight loss, regurgitation, cough
What are the possible locations of dysphagia?
Oropharyngeal
Oesophageal
What are the causes of oesophageal dysphagia?
- Benign stricture
- Malignant stricture (oesophageal cancer)
- Motility disorders (eg achalasia, presbyoesophagus)
- Eosinophilic oesophagitis
- Extrinsic compression (eg in lung cancer)
What are the investigations for oesophageal disease (Reflux etc)
Endoscopy:
- Oesophago-Gastro-duodenoscopy (OGD)
- Upper GI endoscopy (UGIE)
Imaging:
- Barium swallow
Other:
- pH monitoring
- Manometry
When is Endoscopy used for investigation in oesophageal disease?
used in investigation of dysphagia or reflux symptoms with alarm features
Endoscopy is pretty much always first line for this (preferred to Barium swallows)
How does pH monitoring of the oesophagus work and when is it done?
Nasal catheter containing pH sensors at both sphincters (UOS and LOS) sphincters is placed in oesophagus
used in investigation of refractory heartburn/reflux
How does Manometry work and when is it used?
Nasal catheter containing multiple pressure sensors is placed in oesophagus to assess its motility
used in investigation of dysphagia / suspected motility disorder (usually after endoscopy)
What are the different types of motility disorders?
Hypermotility (oesophageal spasm)
Hypomotility
Achalasia
How does Hypermotility of the oesophagus present?
Severe episodic chest pain +/- dysphagia
(Easily confused with angina/MI)
How is hypermotility of the oesophagus investigated?
Barium swallow - will show corkscrew appearance
Manometry - exaggerated, uncoordinated, hypertonic contractions
