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GI - Year 2 > Oesophageal Disorders > Flashcards

Oesophageal Disorders Flashcards

1
Q

What is heartburn?

A

Retrosternal discomfort/burning
Waterbrash (acidic taste)
Cough
Consequence of acid reflux

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2
Q

What is dysphagia?

A

Difficulty swallowing foods and/or liquids

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3
Q

In dysphagia, what things should be enquired about?

A

Type of food (solid/liquid)
Pattern
Associated features (weight loss, cough)

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4
Q

What are the 2 locations that dysphagia occur?

A

Oropharyngeal (high)

Oesophageal

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5
Q

What are the causes of oesophageal dysphagia?

A 
Benign stricture
Malignant stricture (cancer)
Motility disorders
Eosinophilic oesophagitis
Extrinsic compression (e.g. lung cancer)
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6
Q

What type of investigations can be done for oesophageal disease?

A 
Oesophago-gastro-duodenoscopy (OGD)
Upper GI endoscopy
Contrast radiology (barium swallow)
pH-metry (for heartburn/reflux)
Manometry
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7
Q

When is an endoscopy used?

A

Investigation of dysphagia or reflux symptoms WITH alarm features

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8
Q

When is a barium swallow used?

A

In high dysphagia to exclude pharyngeal pouch or post-cricoid web prior to endoscopy

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9
Q

What does a pH-metry involve?

A

Nasal catheter with pH sensors placed at both UOS and LOS to monitor reflux

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10
Q

What is manometry?

A

Muscle contraction monitoring

Used in investigation of dysphagia or suspected motility disorder

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11
Q

What does manometry do?

A

Assesses sphincter tonicity, relaxation of sphincters and oesophageal motility

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12
Q

What does hypermotility look like on a barium swallow?

A

Oesophagus has a corkscrew appearance

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13
Q

What are the symptoms of hypermotility?

A

Severe, episodic chest pain with or without dysphagia

Can be confused with angina/MI

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14
Q

What does manometry show for hypermotility?

A

Exaggerated, uncoordinated, hypertonic contractions

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15
Q

What is the treatment for hypermotility?

A

Smooth muscle relaxants

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16
Q

What is hypomotility associated with?

A

Connective tissue disease
Diabetes
Neuropathy

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17
Q

What does hypomotility do?

A

Causes failure of LOS mechanism which leads to heartburn/reflux symptoms

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18
Q

What is achalasia?

A

Degeneration of inhibitory neurons in the myenteric plexus in the oesophagus
Causes failure of LOS to relax which results in functional distal obstruction of oesophagus

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19
Q

What is the incidence of achalasia?

A

1-2 / 100,000

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20
Q

What are the symptoms of achalasia?

A

Progressive dysphagia (solids + liquids)
Weight loss
Chest pain (30%)
Regurgitation + chest infection

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21
Q

What does manometry in achalsia look like?

A

High pressure in LOS at rest
Failure of LOS to relax after swallowing
Absence of useful contractions in lower oesophagus

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22
Q

What are the 4 types of treatment for achalasia?

A

PHARMACOLOGICAL: nitrates, CCBs
ENDOSCOPIC: botulinum toxin pneumatic balloon dilation
RADIOLOGICAL: pneumatic balloon dilation
SURGICAL: myotomy

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23
Q

What are the complications of achalasia?

A

Aspiration pneumonia/lung disease

Increased risk of squamous cell oesophageal carcinoma

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24
Q

What causes gastro-oesophageal reflux disease (GORD)?

A

Due to pathological acid (+ bile) exposure to lower oesophagus

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25
Q

What are the symptoms of GORD?

A

Heartburn
Cough
Waterbrash
Sleep disturbance

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26
Q

What are the risk factors of GORD?

A 
Pregnancy
Obesity
Drugs lowering LOS pressure
Smoking
Alcoholism
Hypomotility
27
Q

What is the role of endoscopy in GORD?

A

Generally, a poor diagnostic test - most patients have no visible evidence of abnormality
Must be done if ALARM features suggest malignancy

28
Q

What causes GORD without abnormal anatomy?

A 
Increased transient relaxations of LOS
Hypotensive LOS
Delayed gastric and/or oesophageal emptying
Decreased oesophageal acid clearance
Decreased tissue resistance to acid/bile
29
Q

What causes GORD with an abnormal anatomy?

A

Hiatus hernia - distortion of the OG junction

30
Q

What are the 2 main types of hiatus hernia?

A

Sliding

Para-oesophageal

31
Q

What is hiatus hernia?

A

Fundus of stomach moves through diaphragmatic hiatus

32
Q

What happens to oesophagus due to GORD?

A

Mucosa is exposed to acid-pepsin and bile
Increased cell loss + regenerative activity (inflammation)
Erosive oesophagitis

33
Q

What are the complications of GORD?

A

Ulceration (5%)
Stricture (8-15%)
Glandular metaplasia (Barrett’s)
Carcinoma

34
Q

What are the treatments for Barrett’s oesophagus?

A

Endoscopic Mucosal Resection (EMR)
Radio-frequency ablation (RFA)
Oesophagectomy (rarely) = mortality ~10%

35
Q

What are the treatments for GORD?

A
  1. Lifestyle measures
  2. Pharmacological: alginates (gaviscon), H2RA (ranitidine), proton pump inhibitor (omeprazole, lansoprazole)
  3. Anti-reflux surgery (fundoplication - full/partial wrap)
36
Q

What are the signs of oesophageal cancer?

A 
Progressive dysphagia (90%)
Anorexia + weight loss (75%)
Odynophagia (pain)
Chest pain
Cough
Pneumonia
Vocal cord paralysis
Haematemesis
37
Q

Where does squamous cell carcinoma occur?

A

Proximal and middle third of oesophagus

38
Q

What is squamous cell carcinoma associated with?

A

Achalasia
Caustic strictures
Plummer-Vinson syndrome

39
Q

Where does adenocarcinoma occur?

A

Distal oesophagus

40
Q

What is adenocarcinoma associated with?

A

Barrett’s oesophagus

41
Q

What is the prognosis for oesophageal cancer?

A

5 year survival <10%

Usually caught late (mostly palliative care)

42
Q

What are the metastases that can occur from oesophageal cancer?

A

Hepatic
Brain
Pulmonary
Bone

43
Q

Why does lymph node involvement occur early in oesophageal tumours?

A

Mucosal layer has a rich lymphatic supply whereas the rest of the GIT lymphatic vessels are in the submucosal layer

44
Q

Why does tumour invasion of surrounding structures (e.g. heart, trachea, aorta) occur more easily?

A

Oesophagus has no serosal layer making tumour invasion into local structures easier

45
Q

How is oesophageal cancer diagnosed?

A

By endoscopy and biopsy

46
Q

How is staging of oesophageal cancer discovered?

A

CT scan
Endoscopic ultrasound
PET scan
Bone scan

47
Q

What is T1 in cancer staging?

A

Tumour invades lamina propria (a) or submucosa (b)

48
Q

What is T2 in cancer staging?

A

Tumour invades muscularis propria

49
Q

What is T3 in cancer staging?

A

Tumour invades adventitia

50
Q

What is T4 of cancer staging?

A

Tumour invades adjacent structures

51
Q

What is N1 in cancer staging?

A

Regional lymph node metastasis

52
Q

What is M1 in cancer staging?

A

Distant metastasis

53
Q

What is stage 1 cancer?

A

T1N0M0

54
Q

What is stage 2a cancer?

A

T2T3/N0M0

55
Q

What is stage 2b cancer?

A

T1T2/N0M0

56
Q

What is stage 3 cancer?

A

T3N1M0, T4, any N, M0

57
Q

What is stage 4 cancer?

A

M1

58
Q

What is the treatment for oesophageal cancer?

A

Oesophagectomy +/- adjuvant/neoadjuvant chemotherapy
Surgery only in patients with localised disease without comorbid disease
Palliative treatment:
- endoscopic (stent, laser/APC, PEG)
- chemotherapy
- radiotherapy
- brachytherapy (specified radiotherapy)

59
Q

What is eosinophilic oesophagitis?

A

Chronic immune/allergen-mediated condition

60
Q

How is eosinophilic oesophagitis defined clinically?

A

Symptoms of oesophageal dysfunction

61
Q

How is eosinophilic oesophagitis defined pathologically?

A

Eosinophilic infiltration of the oesophageal epithelium in the absence of secondary causes of local or systemic eosinophilia

62
Q

What are the signs of eosinophilic oesophagitis?

A

Dysphagia

Food bolus obstruction

63
Q

What is the treatment for eosinophilic oesophagitis?

A

Topical/swallowed corticosteroids or systemic steroids
Dietary elimination
Endoscopic dilatation

GI - Year 2 (39 decks)

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