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GI - 2 > Esophageal Dysphagia > Flashcards

Esophageal Dysphagia Flashcards

1
Q

Esophageal Dysphagia is localized to what locations?

A

Neck/chest - lower esophagus

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2
Q

With Esophageal Dysphagia, where do patients feel food sticking?

A

Mid to lower sternal area

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3
Q

What is Schatzki’s Ring?

A

Distal smooth ring

- Associated with GERD and Hiatal Hernia

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4
Q

Schatzki’s Ring - constant or progressive?

A

Constant

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5
Q

Symptoms of Schatzki’s Ring?

A

Intermittent dysphagia with solids, reflux is common

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6
Q

What is a possible complication with Schatzki’s Ring?

A

Food bolus impaction which can cause a perforation or ulcer

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7
Q

Where are Esophageal Strictures common?

A

Gastroesophageal junction

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8
Q

What usually causes an Esophageal Stricture?

A

Peptic stricture secondary to GERD

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9
Q

Esophageal Strictures - constant or progressive?

A

Progressive

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10
Q

Describe the progression of Esophageal Strictures

A
  • Heartburn and weight loss
  • Dysphagia with solids and then solids and liquids
  • IMPROVEMENT/LESS heartburn!!!
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11
Q

As an Esophageal Stricture progresses, the initial heartburn decreases. Why?

A

As the stricture grows, it acts as a barrier to the reflux

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12
Q

What test is mandatory for Esophageal Strictures?

A

EGD to differentiate from esophageal carcinoma

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13
Q

Barrett’s Esophagus

A

Columnar epithelium replaces stratified squamous epithelium at the distal esophagus

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14
Q

With Barrett’s Esophagus, ____ epithelium replaces _______ epithelium at the distal esophagus

A

Columnar epithelium replaces stratified squamous epithelium

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15
Q

What usually causes Barrett’s Esophagus?

A

Chronic GERD or Truncal obesity

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16
Q

What patient population usually has Barrett’s Esophagus?

A

Obese, white >50 year old males who smoke

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17
Q

Symptoms of Barrett’s Esophagus?

A

ASYMPTOMATIC

- GERD symptoms

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18
Q

What can Barrett’s Esophagus progress to?

A

Esophageal Adenocarcinoma

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19
Q

What can Barrett’s Esophagus progress to?

A

Esophageal Adenocarcinoma

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20
Q

What will an EGD with biopsy show with Barrett’s Esophagus?

A

Orange goblet and columnar cells in distal esophagus

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21
Q

Treatment for Barrett’s Esophagus?

A

Acid reduction and surveillance to monitor for adenocarcinoma

22
Q

Is surgical resection recommended for Barrett’s Esophagus?

A

NO

23
Q

Most common esophageal cancer in the world?

A

Squamous

24
Q

Most common esophageal cancer in the USA?

A

Adenocarcinoma

25
Q

Risk factors for Squamous esophageal cancer?

A

Smoking + Alcohol, esophageal disorders, injury

26
Q

Risk factors for Adenocarcinoma esophageal cancer?

A

Smoking, obesity, GERD -> Barrett’s esophagus

27
Q

Symptoms of Squamous and Adenocarcinoma Esophageal Cancer?

A

PROGRESSIVE DYSPHAGIA

  • Weight loss, reflux, bleeding
  • Hoarseness, cough, odynophagia
  • Decreased iron
28
Q

Symptoms of Squamous and Adenocarcinoma Esophageal Cancer?

A

PROGRESSIVE DYSPHAGIA

  • Weight loss, reflux, bleeding
  • Hoarseness, cough, odynophagia
  • Decreased iron
29
Q

Test to order for Squamous esophageal cancer?

A

EGD with biopsy of middle 1/3

30
Q

Test to order for Adenocarcinoma esophageal cancer?

A

EGD with biopsy of lower 1/3

squamous –> columnar

31
Q

Treatment for Squamous Esophageal cancer?

A

Surgery (esophagectomy)

– poor survival

32
Q

Treatment for Adenocarcinoma Esophageal cancer?

A

Endoscopic Ablation

33
Q

Name 2 motility disorders?

A

Achalasia

Scleroderma

34
Q

Name 2 motility disorders?

A

Achalasia

Scleroderma

35
Q

What is Achalasia?

A

Loss of peristalsis because Lower Esophageal Sphincter does NOT relax

36
Q

LES not relaxing is?

A

Achalasia

37
Q

What causes the LES to not relax with Achalasia?

A

Denervation due to loss of nitric oxide producing inhibitory neurons in myenteric plexus

38
Q

What causes the LES to not relax with Achalasia?

A

Denervation due to loss of nitric oxide producing inhibitory neurons in myenteric plexus

39
Q

Achalasia can be secondary. What causes that?

A

Chagas Disease

40
Q

Achalasia - constant or progressive?

A

Progressive

41
Q

What is seen with Achalasia?

A

Bird’s beak tapering of distal esophagus

42
Q

Symptoms of Achalasia?

A

Regurgitation, chest discomfort, adaptive maneuvers to eat successfully

43
Q

What are the extra symptoms of Secondary Achalasia?

A

Unilateral periorbital swelling (romana sign), fever, arrythmias

44
Q

What microbe causes Secondary Achalasia (due to chagas disease)?

A

Trypanosoma Cruzi

45
Q

What is Scleroderma?

A

Autoimmune disorder - smooth muscle fibrosis

46
Q

Scleroderma - constant or progressive?

A

Progressive

47
Q

Limited Scleroderma symptoms?

A

CREST

  • Calcinosis cutis
  • Raynauds
  • Esophageal dysmotility
  • Sclerodactyly
  • Telangiectasia
48
Q

Limited Scleroderma Symptoms?

A

CREST

  • Calcinosis cutis
  • Raynauds
  • Esophageal dysmotility
  • Sclerodactyly
  • Telangiectasia
49
Q

What is (+) with Limited Scleroderma?

A

Anti-centromere antibodies

50
Q

Diffuse Scleroderma symptoms?

A

Heartburn, strictures, BE
Regurgitation, cough, hoarseness
Dry mouth

51
Q

What is (+) with Diffuse Scleroderma?

A

Topoisomerase 1 Antibodies

scl-70

GI - 2 (61 decks)

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