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Flashcards in Oesophagus Deck (64):
1

What is GORD

Gastro-oesophageal reflux disorder

2

When does a patient with GORD typically have worsening symtpoms

After meals

3

What prevents reflux in health

Lower oesophageal sphincter pressure
Angle of Hiss: oblique angle between cardia and oesophagus - anatomical barrier
Oesophageal clearance: any material that gets back into the oesophagus will be rapidly cleared by peristaltic contractions

4

What is a hiatus hernia

herniation of the stomach in to the thorax

5

Are all hiatus hernias symptomatic

No

6

What are the 2 forms of hiatus hernia

Sliding and rolling

7

What is the most common form of hiatus hernia

Sliding

8

How does a hiatus hernia cause reflux

Reducing the LOS pressure
Increasing the TLSORs
Straightening out the angle of Hiss

9

What is a gastric volvulus

When the stomach twitsts on itself causing severe pain and dysphagia

10

Define gastroparesis

Any condition that delays gastric emptying

11

What can increase the gastric volume

Pregnancy, binge drinking, poorly controlled diabetes

12

What can cause an increase n the intra-abdominal pressure

Pregnancy
Obesity
Chronic cough

13

What increases the gastric acid production in the stomach

Smoking
eating fat and calorie rich foods
binge drinking
regular use of NSAIDs

14

What are some of the clinical features of GORD

Heartburn
Fluid/ Food regurgitaiton
Waterbrash
Nocturnal cough
Chest pain
Dysphagia or odynophagia

15

What is the first line investigation

Endoscopy

16

What is helpful if surgery is being considered

24 h pH measurement

17

What is helpful if surgery is being considered

24 h pH measurement

18

What is oesophagitis

Endoscopic change ranging from minor erythmea to frank ulceration and stricturing

19

What does an oesophageal stricture result in

Narrowing of the distal oeosphagus following repeated peptic ulceration and scarring

20

How does an oesophageal stricture present

Dysphagia

21

What is the treatment for an oesophageal stricture

Endoscopic dilatation and long term PPIs

22

What is Barrett's oesophagus

A metaplasia of distal oesophageal mucosa from squamous to columnar epithelium caused by an adaptive response to chronic acid exposure

23

Barrett's oeosphagus is usually symptomatic. True or False.

False. It is usually asymptomatic

24

What are 4 risk factors for Barrett's oesophagus developing into carcinoma

White males
OVer 50 year olds
Obese
Smokers

25

How is a diagnosis of Barrett's oesophagus made

BAsed on mucosal appearances and histology

26

What are the treatment options for Barrett's oeosphagus

Endoscopic ablation through photodynamic therapy - has lots of side effects

27

What might be considered when high-grade dysplasia is observed

Oesophagectomy

28

What are the 2 main forms of conservative management for GORD

Lifestyle modification - weight loss, smoking cessation, elevation of bed head, avoiding fatty meals before bed
Antacids - provide symptoms relief

29

What are the 2 main medical ways of managing GORD

H2 receptor antagonists- need to be taken less frequently than anatacids but are just as effective
PPI - achieve symptom relief - they also heal oesophagitic mucosa

30

Who is laparoscopic or open fundoplication suitable for

Patients with large hiatus hernias

31

What is corrosive ingestion

Deliberate self-harm through ingestion of bleach or battery acid

32

What is the management for corrosive infestion

Analgesia
Antiemetics
NBM

33

What is the major risk with corrosive ingestion

Oesophageal perforation

34

What drugs cause drug induced oeopshageitis

NSAIDs
potassium supplements
bisphosphonates

35

What should be considered for patients with known strictures

Liwuid or paarenteral preparations

36

What is achalasia

Failure of propagation of peristalsis in the body of the oeosophagus
Progressive dilatation of the body of the oesophagus
Failure of relaxation of the LOS
High pressure LOS

37

What is the cause of achalasia

THe degeneration of the ganglia in the distal oesophagus and LOS

38

What are the clinical features of achalasia

Dysphagia (for solids)
Heartburn
Chest pain
Regurgitation (late disease)
Pulmonary aspiration (late disease)

39

What is commonly seen in a CXR of achalasia

Bird beak appearance

40

What is the endoscopic management for Achalasia

Forced pneumatic dilatation
LOS botulinium toxin injection

41

What types of operation indicated for young patients or those requiring multiple dilatations

Heller's myotomy

42

What does diffuse oesophageal spasm typically present with

Angina like chest pain in middle age

43

What is required for the diagnosis of difffuse oeosphageal spasm

Oesophageal manometry and 24hour pH

44

Gastrointestinal stromal tumours (GISTs) are malignant tumours. True or false

False - they are benign lesions

45

What is the treatment for GISTs

None - the do not cause symptoms

46

What are the 2 different types of oesophageal carcinoma

Adenocarcinoma and Squamous carcinoma

47

Where does adenocarcinoma typically appear in the oesophagus

Lower third (barrett's oesophagus)

48

is the incidence of adenocarcinoma increasing or decreasing

Increasing

49

Where does squamous carcinoma typically appear in the oesophagus

Anywhere along the oesophagus

50

What are the risk factors for squamous carcinoma

Smoking
alcohol
betel nut
tobacco chewing
achalasia
post circoid web
coeliac and post corrosive ingestion

51

What are the clinical features of oesophageal carcinoma

Painless, rapidly pregressive dysphagia
weight loss
chest pain
hoarse voice
coughing after swallowing

52

What should be looked for during examination

Cervical nodes

53

What are the investigations for oesophageal carcinoma

Upper GI endoscopy
Barium swallow
CT of the thorax and abdomen
Endoscopic ultrasound

54

What is the management for oesophageal carcinoma

30% have operable disease - oesophagectomy or preoperative chemo
70% have inoperable: palliation of dysphagia
palliation of pain
squamous cancers: radiotherapy
Provision of nutritional supplementation

55

What is the prognosis for oesophageal carcinoma

Overall 5 year survival is

56

What is a pharyngeal pouch also known as

Zenker's diverticulum

57

If Zenker's diverticulum is suspected, what is the first line investigation

Barium swallow

58

Males are affected by eosiniphilic oesophagitis twice as often as females. True or false

True

59

What are the 2 age peaks for eosinophilic oesophagitis

children and early 30s

60

What is a Schatzkis's ring

A cricumferential narrowing in the mid or lower third of the oesophagus

61

What is Plummer-Vinson syndrome

When iron-deficiency anaemia is associated with an oesophageal web

62

What is a Mallory-Weiss Tear

A cause of haematemesis .
Is is caused by recurrent retching or forceful vomiting (typically after alcohol binges) resulting in mucosal tear of the oesophogastric junction

63

What is the characteritic history of a Mallory-Weiss tear

That the initial vomit did not contain blood

64

What is the treatment for a Mallory-Weiss tear

Most settle spontaneously
Acid suppression and endoscopic therapy are rarely necessary