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CP3 SURGERY > UGI/CR - Oesophagus > Flashcards

UGI/CR - Oesophagus Flashcards

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1
Q

Anatomical causes of GORD (2)

A

Hiatus hernia

Systemic sclerosis

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2
Q

Physiological causes of GORD (7)

A 
Raised IAP 
Large meals, late @ night
Smoking 
High caffeinated drink intake 
High fatty food intake 
Binge drinking 
Dx
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3
Q

Dx that predispose to GORD (4)

A

Anticholinergics
Nitrates
TCAs
CCB

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4
Q

Iatrogenic causes of GORD

A

After Tx for achalasia

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5
Q

Where is the oval aperture

A

R crus of diaphragm at T10

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6
Q

What structures pass through the oval aperture (4)

A

Oesophagus
CNX trunks
Oesoph branches L gastric vessels
Lymphatics

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7
Q

What are the 2 types of hiatus hernia?

A

Sliding hiatus hernia

Rolling hiatus hernia

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8
Q

What is a siding hiatus hernia

A

G-O junction slides through hiatus to live above diaphragm, but sphincter remains competent below diaphragm

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9
Q

PS sliding hiatus hernia

A

Mostly asymp

Or reflux

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10
Q

What % of >50 y/o have sliding hiatus hernia

A

30%

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11
Q

What is a rolling hiatus hernia

A

Lower oesophageal sphincter remains in place

But part of fundus herniates into chest next to it

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12
Q

PS rolling hiatus hernia

A

Severe pain (occasionally)

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13
Q

XR appearance rolling hiatus hernia

A

Thoracic air bubble

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14
Q

What are the 3 types of dyspepsia

A

Reflux type
Ulcer type
Dysmotility type

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15
Q

Reflux type dyspepsia PS (2)

A

Heartburn + regurg

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16
Q

Ulcer type dyspepsia PS

A

Epigastric pain

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17
Q

Dysmotility type dyspepsia PS

A

Bloating

Nausea

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18
Q

Major features of GORD (4)

A

Heartburn/indigestion
Regurg food/acid
Waterbrash
Odynophagia

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19
Q

When is dyspepsia worse

A

Bending/lying down
Drinking hot liquids
Alcohol

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20
Q

What is Waterbrash

A

Sudden fillling of mouth w/ dilute saliva

In response to oesoph acid

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21
Q

ALARMS 55

A 
Anaemia (Fe) 
Loss W 
Anorexia 
Recent onset, progressive Sx 
Melena/haematemesis/mass 
Swallowing difficulties 
>55 y/o
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22
Q

Ix GORD (further - 4)

A

Ba swallow
Sx index/Sx sensitivity index
DeMeester score
24h luminla pH monitoring, manometry if endoscopy normal

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23
Q

What is excessive reflux defined as on 24h luminal pH monitoring

A

pH <4 for >4% of the time

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24
Q

Lifestyle Mx of reflux (5)

A 
W loss 
Smoking cessation 
Small + reg meals 3 h before bed 
Raised head of bed @ night 
Avoid Dx - NSAIDs/K salts
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25
Med Mx of reflux
Antacids H2RA + PPI (2nd line) Metoclopramide/domperidone H pylori test + treat
26
SE Al(OH)3
Constipation
27
SE Mg(OH)2
Diarrhoea
28
What negative SE can PPI's lead to
Achlorhydria --> increase risk of food poisoning
29
Surgical Mx of reflux
Nissen fundoplication
30
LT complications of GORD
Oesophagitis/ulcers Benign strictures Barretts/ oesophageal adenocarcinoma
31
What % adult pop have Barrett's oesophagus
2%
32
What is the histological change in Barrett's oesophagus
Stratified squamous --> glandular columnar ep
33
How is a diagnosis of Barrett's made
UGI endoscopy + biopsy
34
Mx Barretts
Lifestyle nodes | Reg surveillance via endscopy
35
What can Barrett's turn into
Oesophageal adenocarcinoma
36
What is oropharyngeal dysphagia
Difficulty initiating swallow +/- choking/aspiration
37
Common causes of oropharyngeal dysphagia (3)
Stroke Candidiasis Globus
38
Less common causes of oropharyngeal dysphagia (3)
Pharyngeal pouch MND Xerostomia
39
Rare causes of oropharyngeal dysphagia (3)
Oral tumours Severe aphthous ulcers Mm dystrophy/bulbar palsy
40
Ix for oropharyngeal dysphagia
Neuro exam | Videofluoroscopy
41
What is Oesophageal dysphagia
Food sticks are swallowing +/- regurg
42
Common causes of Oesophageal dysphagia (3)
Benign stricture Oesophageal carcinoma Oesophagitis
43
Less common causes Oesophageal dysphagia (4)
Dysmotility - achalasia Dysmotility - diffuse oesophageal spasm Webs/rings External P - hilar nodes/cancer
44
Rare causes of Oesophageal dysphagia (3)
Oesophageal infection Retrosternal goitre Corrosive stricture
45
ix Oesophageal dysphagia (3)
Ba swallow OGD Biopsy
46
Oropharygeal dysphagia - initiating swallow
Difficult
47
Oropharygeal dysphagia - interval to dysphagia after swallow
Instant
48
Oropharygeal dysphagia - progression
Variable
49
Oropharygeal dysphagia - type of food
Liquids
50
Oropharygeal dysphagia - asssoc Sx
Choking Nasal regurg Drooling
51
Oropharygeal dysphagia - assoc signs
CN signs
52
Oesophageal dysphagia (mechanical cause) - initiating swallow
Unaffected
53
Oesophageal dysphagia (mechanical cause) - Interval to dysphagia after swallow
Few s
54
Oesophageal dysphagia (mechanical cause) - progression
Progressively worsening
55
Oesophageal dysphagia (mechanical cause) - type of food
Solids
56
Oesophageal dysphagia (mechanical cause) - assoc Sx
W loss | Prior heartburn
57
Oesophageal dysphagia (mechanical cause) - assoc signs
Cervical LN | Anaemia
58
Oesophageal dysphagia (dysmotility cause) - initiating swwallow
unaffected
59
Oesophageal dysphagia (dysmotility cause) - interval to dysphagia after swallow
few s
60
Oesophageal dysphagia (dysmotility cause) - progression
intermittent
61
Oesophageal dysphagia (dysmotility cause) - type of food
L/S
62
Oesophageal dysphagia (dysmotility cause) - assoc Sx
Odynophagia
63
Who gets Achalasia
Young pt (in their 30s)
64
Pathophysiology achalasia
Oesophageal aperistalsis + failure of relaxation of LOS (NM disorder) Degeneration of ganglia in distal oesophagus + LOS Oesophagus = dilated --> megaoesophagus
65
PS Achalasia (5)
``` Long, non-progressive Hx of Dysphagia Chest pain /substernal cramps Regurg + pulmonary aspiration (LATER) Nocturnal cramps ```
66
Ix Achalasia (5)
``` UGI endoscopy Barium swallow Oesophagoscopy (excl carcinoa) CT High resolution manometry ```
67
What is the gold standard Ix for achalasia
High resolution Manometry
68
Appearance of Achalasia on Ba swallow
Bird beak
69
Mx Achalasia
``` Chew food well Eat upright Drink lots w/ meals Botulinum injection (prov temp relief) Endoscopic balloon dilatation Heller's cardiomyotomy ```
70
What is Heller's Cardiomyotomy
Op for Achalasia | Where cardia mm are divided
71
Which sex is mainly affected by Plummer Vinson syndrome
Females
72
PS Plummer Vinson (triad)
Dysphagia Koilonychia Glossitis
73
Why is Plummer Vinson pre-malignant?
B/c hyperkeratisation of oesophagus --> web
74
Tx Plummer Vinsons
Fe | + dilation of web via OGD
75
Sx oesophageal malignancy (6)
``` Painless, rapidly progressive dysphagia W loss/Anorexia Retrosternal Chx pain (late) Hoarse voice (late) Coughing/aspiration Occasional Cerv lymphadenopathy (late) ```
76
Where are the majority of oesophageal malignancies
Lower 1/3 oesoph
77
What type of cancer are the majority of oesophageal malignancies?
Adenocarinoma
78
RF Oesophageal adenocarcinoma (4)
``` Related to GORD hence: Barretts Smoking Obesity Breast cancer radiotherapy ```
79
How does Oesophageal adenocarcinoma mets?
Via lymphatics | Very early
80
RF SCC oesophagus (8)
``` Heavy smoking Heavy drinking Plummer Vinson Achalasia Corrosive strictures Coeliac disease Breast cancer + radiotherapy Tylosis ```
81
When does SCC oesophagus present?
Late | when tumour is large enough to compromise lumen
82
Spread SCC oesophagus
Regionally - LN | Lungs, liver + bone
83
Ix oesophageal cancer
OGD incl trans-oesoph USS + biopsy 2nd line - CT thorax/pelvis TNM PET - mets Laparscopy - excl peritoneal mets
84
Prognosis oesophageal Ca
17% at 5y
85
Tx stage T1/2 oesophageal Ca
Radical curative eosophagectomy (Ivor-Lewis) | EMR
86
EMR
Endoscopic mucosal resection
87
Tx stage T2-4 oesoph Ca
Chemo/radio
88
Palliation oesoph Ca
Oesophageal stenting

CP3 SURGERY (19 decks)

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