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Clin Med - GI > Disorders of Esophagus, Stomach, and Duodenum > Flashcards

Disorders of Esophagus, Stomach, and Duodenum Flashcards

1
Q

What is inflammation or injury to esophageal mucosa

A

esophagitis

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2
Q

what is the typical presentation of esophagitis

A

retrosternal chest pain
heart burn
dysphagia
odynophagia

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3
Q

what is the most common cause of esophagitis

A

GERD
other: radiation, infection, local injury

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4
Q

what is the most common cause of infectious esophagitis

A

candida
HSV is most common viral

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5
Q

how can esophagitis be diagnosed/worked up

A

endoscopy/biopsy to differentiate subtypes

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6
Q

What is the treatment of esophagitis

A

acid suppression, lifestyle modifications, liquid/soft/puree diet
topical lidocaine and opioids for pain
AVOID NSAIDS

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7
Q

what is the treatment for erosive/reflux esophatitis

A

H2 blocker or PPI

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8
Q

What are complications of esophagitis

A

Bleeding
stricture
Barrettt’s esophagus
perforation
laryngitis
aspiration pneumonitis

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9
Q

What can cause inflammation of gastric mucosa

A

infection (H. pylori)
drugs (nsaids, alcohol)
Stress
autoimmune phenomena

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10
Q

how is gastritis diagnosed

A

endoscopy

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11
Q

what is the clinical presentation of non-erosive gastritis

A

most asx but may c/o dyspepsia or other vague symptoms

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12
Q

what testing is used for non-erosive gastritis if symptomatic

A

Testing for H/pylori appropriate

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13
Q

What is H.pylori

A

common gastric pathogen causing gastritis, PUD, gastric adeno-carcinoma and gastric lymphoma

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14
Q

how is H.pylori diagnosed

A

urea breath test (m/c and gold standard)
stool antigen test
endoscopic biopsy

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15
Q

what is the treatment of H.pylori

A

Quaduple therapy: PPPI, Bismuth subsalicylate, metronidazole, tetracycline

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16
Q

what are common causes of erosive gastritis

A

NSAIDs
Alcohol
Stress

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17
Q

what is the clinical presentation of erosive gastritis

A

often asx but may c/o dyspepsia, N/v
first sign often hematemesis or melena: usu 2-5 days of inciting event

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18
Q

what is the treatment of erosive gastritis

A

manage bleeding (endoscopic hemostasis, total gastrectomy; acid suppression
mild: remove offending agent, redust gastric acidity

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19
Q

what is incompetence of LES that allows for reflux of gastric contents into esophagus, causing burning pain

A

GERD

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20
Q

What are the typical symptoms of GERD

A

heartburn; usu 30-60 minutes after meals and upon reclining; often report relief from antacids or baking soda

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21
Q

What are factors for reflux

A

weight gain
fatty foods
caffeinated or carbonated beverages
alcohol
tobacco smoking
drugs/meds

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22
Q

What are risk factors for GERD

A

hiatal hernia, pregnancy (weakens LES)
obesity, pregnancy, asthma (increase pressure on stomach)
diabetes, PUD, Connective tissue d/o (conditions that affect transit)

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23
Q

What is the initial treatment of choice for GERD

A

lifestyle modification
elevating head of bed, weight loss

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24
Q

What are the drug treatment options for GERD

A

Anacids
H2-receptor antagonists
PPIs

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25
Q

what are complications of GERD

A

esophagitis
esophageal structure
Barrett esophagus
esophageal CA

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26
Q

What is the only complication of GERD with malignant potential

A

Barretts esophagus

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27
Q

what is the biggest risk factor for GERD and BE

A

obesity, especially central rather than BMI

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28
Q

what is the presentation of BE

A

symptoms of GERD
- chronic GERD symptoms

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29
Q

what does diagnosis of BE require

A

gross endoscopic ID of columnar metaplasia; described as “salmon-pink tongues” of mucosal tissue
pathological confirmation of intestinal metaplasia with goblet cells on biopsy

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30
Q

what is the treatment of BE

A

its a burn - put out the fire aka suppress acid/reflux

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31
Q

if BE is left untreated what are they at risk of developing

A

adenocarcinoma

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32
Q

what is another name for gastrinoma

A

zollinger-ellison syndrome; Z-E syndrome

33
Q

where are gastrinomas located

A

pancreas or duodenal wall

34
Q

what is the result of gastrinomas

A

gastric acid hypersecretion and aggressive, refractory peptic ulceration

35
Q

how are gastrinomas diagnosed

A

measuring serum gastrin lovels

36
Q

what is the treatment of gastrinoma

A

PPI and surgical removal

37
Q

what are symptoms of esophageal motility disorders

A

symptoms depend on cause but typically:
difficulty swallowing (dysphagia)
chest pain/pressure
heartburn

38
Q

what is the evaluation for esophageal motility disorders

A

depends on symptoms:
upper endoscopy
barium swallow
esophageal manometry
acid-and reflux-related tests

39
Q

what are neurogenic esophageal motility disorders

A

all affect swallowing but not classified as mitility disorders
generalized d/o of neuromusuclar function
m.gravis
amyotrophic lateral sclerosis
stroke
parkinsons
DM2

40
Q

What is Diffuse Esophageal spasm (DES)

A

spectrum of motility disorders characterized by non-propulsive contractions, hyperdynamic contractions, or elevated LES pressure

41
Q

what are symptoms of DES

A

chest pain, dysphagia

42
Q

how is DES diagnosed

A

barium swallow or manometry

43
Q

what are the treatemnts for DES

A

Nitrates
CCBs (verapamil)
botulinum toxin
surgical or endoscopic myotomy
anti-reflux therapy

44
Q

what is achalasia

A

neurogenic esophageal motility disorder characterized by impaired esophageal peristalsis and lack of LES relaxation during swallowing

45
Q

what are the symptoms of achalasia

A

slowly progressive dysphagia, usu. to both liquids and solids
regurgitation of undigested foods

46
Q

how is achalasia worked up

A

manometry
barium swallow
endoscopy

47
Q

what is the treatment of achalasia

A

dilation
botulinum toxin injection
surgical myotomy
endoscopic myotomy

48
Q

what causes achalasia

A

loss of ganglion cells in myenteric plexus of esophagus, resulting in denervation of esophageal muscle

49
Q

What is esophageal diverticula

A

outpouching of mucosa though muscular layer of the esophagus

50
Q

how is esophageal diverticula diagnosed

A

barium swallow

51
Q

what is Zenker’s (pharyngeal)diverticula

A

posterior out-pouching of mucosa and submucosa thru cricopharyngeal muscle

52
Q

what is mid-esophageal (traction) diverticula

A

caused by traction from mediastinal inflammatory lesions or by esophageal motility disorders

53
Q

what is epi-phrenic diverticula

A

just above the diaphragm
usu. with motility disorder (achalasia, DES)

54
Q

what is the clinical presentation of Zenker diverticulum

A

regugitation of food when bending or lying down
asperation pneumonitis as result of nocturnal regurgitation

55
Q

what is the treatment of esophageal diverticula

A

specific tx usually not required
resection occasionally needed for large/symptomatic diverticula

56
Q

what is esophageal obstruction

A

usually develops slowly and incomplete
Intrinsic vs extrinsic obstruction

57
Q

what are intrinsic obstructions

A

esophageal tumors
esophageal rings
esophageal webs
structures caused by GERD or rare, caustic ingestion

58
Q

what are Extrinsic obstruction

A

enlarged left atrium
aortic aneurysm
substernal thyroid gland
cervical bony exostosis
thoracic tumor

59
Q

What is a lower esophageal ring

A

aka Schatzki ring; B ring
ring like narrowing of distal esophagus resulting in dysphagia

60
Q

What is the treatment of lower esophageal rings

A

wide-lumen rings: instruct to chew food thoroughly
narrow-lumen: dilation by endoscopy
surgical resection rarely required

61
Q

what are other names for esophageal webs

A

plummer-vinson syndrome
patterson-kelly syndrome
sideropenic dysphagia

62
Q

what is an esophageal web

A

thin mucosal membrane grows across the lumen, may cause dysphagia; rare without anemia

63
Q

what is the best method of diagnosis for esophageal webs

A

barium swallow

64
Q

what is the treatment of esophageal webs

A

correct anemia; can be easily ruptured during endoscopy

65
Q

what is Mallory-Weiss syndrome

A

non-penetrating mucosal laceration of distal esophagus and proximal stomach caused by vomiting, retching or hiccupping

66
Q

how is Mallory-Weiss syndrome diagnosed

A

clinical with hx hematemesis after 1+ episodes of non-bloody vomitting
endoscopic diagnostic and therapeutic

67
Q

what are esophageal varices

A

dilated veins in distal esophagus or proximal stomach caused by elevated pressure in portal venous system
usu from cirrhosis

68
Q

how are esophageal varicies diagnosed

A

endoscopy

69
Q

what is the treatment of esophageal varices

A

airway management, fluid resuscitation, transfusion
endoscopic banding and IV octreotide
trans-jugular intrahepatic protosystemic shunting procedure

70
Q

what is the presentation of esophageal varices

A

usually present with sudden, painless, upper GI bleeding, often massive: signs of shcok may be present

71
Q

what is the prognosis of esophageal varices

A

40% variceal bleeding stops spontaneously
mortality depends on severity of liver disease more than volume of bleeding

NOT good diagnosis

72
Q

what is TIPS procedure

A

emergency intervention of choice for esophageal varices
guidewire passed from vena cava through liver and passage dilated via balloon catheter
stent size is crucial

73
Q

what is erosion of GI mucosa that usuaulyl affects stomach or first few cm of duodenum

A

PUD

74
Q

what causes PUD

A

H.pylori or NSAID use

75
Q

what are the symptoms of PUD

A

burning epigastric pain often RELIEVED by food

76
Q

how is PUD diagnosed

A

endoscopiy
H.pylori testing

77
Q

what is the treatment of PUD

A

acid suppression, eradication of H.pylori (if present), NSAID avoidance

78
Q

if burning epigastric pain wakens the patient at night, what is this highly suggestive of

A

duodenal ulcer highly suspicious

79
Q

what are complications of PUD

A

Hemorrhage
performation
recurrence

Clin Med - GI (11 decks)

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