Oesophageal disease

26 flashcards · Other · by Anonymous Sloth

  1. What are the cardinal symptoms of oesophageal disease

    Heartburn Dysphagia Hoarse voice Nausea Chest pain

  2. Describe heartburn

    RetrosternalConsequence fo acid reflux A degree of reflux is normal (After swallowing) Can be caused by certain drugs/food Persistent reflux and heartburn can lead to GORD with long term complications

  3. Describe dysphagia

    Difficulty swallowing foods and or liquids Maybe accompanied by odynophagia (pain with swallowing Can be caused by strictures, motility disorders, eosinophilic oesophagitis and extrinsic compression (lung cancer)

  4. Investigations in oesophageal disease

    Endoscopy Oesophago-gastro-duodenoscopy (OGD) Upper Gi endoscopy (UGIE) Simple, effective, safe (with experience) Gold standard procedure Contract radiology Barium swallow used fro dysphagia Endoscopy is always preferred pH-metry nasal catheter with pH sensor Used for refractory reflux manometer Senses pressure in the oesophagus iInvestigating sphincter tone, relaxation of sphincter and oesophageal motility

  5. Describe motility disorders

    Hypo and hypermotility Hyper-motility 'corkscrew appearance' Severe, episodic chest pain Idiopathic Hypo-motility Connective tissue disease, Diabetes and neuropathy Failure fo LOS mechanism Causes heartburn and reflux

  6. What is achalasia

    Degeneration of the myenteric plexus ganglion cell in the distal oesophagus Cardinal feature: loss of LOS to relax Causes functional distal obstruction of the oesophagus

  7. Presentation of achalasia

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

  8. Treatment of achalasia

    Pharma - nitrates and CCBs Endoscopic - botulinum toxin pneumatic balloon dilation Radiological - pneumatic balloon dilation Surgical - myotomy Risk of aspiration pneumonia and lung disease Increased risk of squamous cell carcinoma

  9. Definition of GORD

    Gastro-oesophageal reflux disease Pathological acid and bile exposure in lower oesophagus Men > women Caucasian > Black > Asian

  10. Symptoms of GORD

    Heartburn Cough Water brash (sudden salivation) Sleep disturbance Can be asymptomatic in individuals

  11. Risk factors of GORD

    Pregnancy Obesity LOS pressure lowering drugs Smoking Alcohol Hypomotility

  12. Aetiology of GORD

    Without abnormal anatomy Increased transient relaxation of LOS Delayed gastric emptying Delayed oesophageal emptying Decreased acid clearance Decreased tissue resistance to acid/bile Due to hiatus hernia distortion of the oesophago-gastric junction

  13. Features of a hiatus hernia

    Fundus of the stomach moves proximally through the diaphragmatic hiatus Pre-disponsed by obesity and ageing 2 types sliding para-oesophageal

  14. Pathophysiology of GORD

    Stomach acid, pepsin enzyme and bile juices erode the mucous layer Increased loss of cells and inflammation to replace cells Leads to erosive oesophagitis.

  15. Complications of GORD

    Ulceration Stricture Glandular metaplasia (Barrett's oesophagus) Carcinoma

  16. Features of Barrett's oesophagus

    Metaplasia in the distal oesophagus due to acid exposure Change from squamous to mucin-secreting columnar epithelial cells (glandular cancer) Precursor to adenocarcinoma Men > Women

  17. Treatment of Barrett's oesophagus

    Endoscopic mucosal resection (EMR) Radio-frequency ablation Oesophagectomy

  18. Treatment of GORD

    Lifestyle changes Pharmacological (alginates, proton pump inhibitor) Anti-reflux surgery (fundoplication)

  19. Presentation of oesophageal cancer

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

  20. Features of oesophageal cancer

    Histology Squamous cell carcinoma Adenocarcinoma Benign tumour rare Men > women Presents late Poor prognosis (5 yr <10%) Tumour spread to regional nodes and or liver. Can locally invade heart, trachea, aorta. Metastases - liver, brain, lungs, bone

  21. Describe squamous cell carcinoma

    Large occluding tumours Proximal and middle third of oesophagus Risk factor (smoking and alcohol)

  22. Describe adenocarcinoma

    Distal oesophagus Associated with Barrett's oesophagus Risk factors (obesity, male, middle aged, caucasian)

  23. Investigations of oesophageal cancer

    Diagnosed Endoscopy and biopsy Staged (TNM) CT scan Endoscopy ultrasound PET scan Bone scan

  24. Treatment of oesophageal cancer

    Surgical oeosphagectomy Only potential cure Combined with adjuvant (After) Neoadjuvant (before) Associated with m&m Long recovery Chemo + radio = prospect of recovering Symptomatic disease = often incurable. Palliation is the best option. Option Endoscopic stenting, laser Chemo Radiotherapy Brachytherapy (type of radio)

  25. Features of eosinophilic oesophagitis

    Chronic inflammation of the oesophagus due to immune/allergic response. Eosinophils infiltrate the oesophageal epithelium.

  26. Presentation, investigation and treatment of eosinophilic oesophagitis

    Presentation Dysphagia Food bolus obstruction Investigation Endoscopy Treatment Topical/ swallowed corticosteroids Dietary elimination Endoscopic dilation