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Clin Med I- GI > Intro and Esophagus > Flashcards

Intro and Esophagus Flashcards

1
Q

Where does normal digestion begin and how?

A

In the mouth- mechanical: breaking down food by teeth into smaller pieces. And chemical- salivary amylase from saliva breaks down starch to sugar

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2
Q

How much saliva is produced DAILY?

A

1-1.5L

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3
Q

The esophagus is a hollow tube of muscle that is how long?

A

25-30 cm. long

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4
Q

List the segments within the esophagus

A

Pharygoesophageal, cervical, thoracic, and abdominal segments

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5
Q

List the 2 sphincters associated with the esophagus

A

Upper and lower esophageal sphincters

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6
Q

What is gastric juice secreted by?

A

Chief cells, parietal cells, and mucus cells

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7
Q

What is produced by the stomach to help with vitamin B12 absorption?

A

Intrinsic factor produced by stomach

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8
Q

What stores and concentrates bile vs. manufacturing bile?

A

Liver manufactures bile, gallbladder stores and concentrates bile

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9
Q

What organ has both endocrine and exocrine functions?

A

Pancreas

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10
Q

What is the pancreas’s exocrine function?

A

Producing digestive enzymes (pancreatic juice) and releasing them through the pancreatic ducts into the duodenum

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11
Q

What is the pancreas’s endocrine function

A

Producing multiple enzymes that are released into the bloodstream (insulin, gastrin, etc)

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12
Q

How much fluid enters small intestine a day

A

8-10 L of fluid/day. Of that, 500 ml enters the colon

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13
Q

How is chloride absorbed into the proximal?

A

Passive diffusion

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14
Q

Vitamin absorption in small intestine

A

Duodenum- Iron. Proximal intestine- B1, B2, B6, C, Calcium. Ileum-Vitamin B12. Throughout small I- K, Mg, Phos, and Fat soluble vitamins ADEK

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15
Q

How is calcium absorbed into the proximal small intestine?

A

Via active transport facilitated by Vitamin D

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16
Q

How would deficiency in Vitamin D affect absorption in small intestine?

A

Affects calcium absorption in S.I

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17
Q

Defecation involves contraction and relaxation of…

A

contraction of rectal muscles and relaxation of anal sphincters

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18
Q

Length of rectum

A

15 cm

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19
Q

Dentate line

A

Interface between internal and external anal mucosa

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20
Q

Innervation around dentate line

A

Superior to dentate line- viscera, dull innervation. Inferior to dentate line- sharp, somatic innervation.

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21
Q

Internal and external anal sphincters voluntary/involuntary control-

A

Internal is NOT under voluntary control, but external is.

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22
Q

Diagnostic tests to evaluate esophagus problems (dysphagia, reflex or frequent heartburn, non-cardiac chest pain)

A

Mannometry, 24 hour pH probe or Bravo pH 48-hour probe, EGD, and esophagogram or UGI

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23
Q

Final score of pH probe determined by…

A

DeMeester score

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24
Q

Why is diary of eating, drinking, and pain episodes kept in people that get the pH probe?

A

So that pain episodes and acid level readings of pH probe can be correlated and interpreted

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25
Q

Patient presents with frequent heartburn that does not away despite pills that have been prescribed. You decide to do Bravo 48-hour pH probe and give them diary to record pain episodes. Before you do this, what precaution must you take in relation to medications?

A

Patient must be off of their ppi/h2 blockers for 1 week prior to test. Calcium carbonate can be taken up until the day before. Otherwise, can cause constipation.

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26
Q

Best test to order if worried about functional problem with esophagus (structure looks fine, but does not work properly)

A

Mannometry

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27
Q

Best test to order if worried about structural, physical problem in patient’s esophagus?

A

EGD

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28
Q

What test would be best if you want to r/o Barrett’s esophagus

A

EGD because will detect mucosal changes in esophagus

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29
Q

Procedure in esophagogram

A

Barium swallowed and observed under fluoroscopy

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30
Q

What is the most common cause of esophageal chest pain?

A

Reflux esophagitis

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31
Q

If patient has GERD, what med would you prescribe for them?

A

PPI

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32
Q

If patient presents with persistent GERD despite PPI medication, what diagnostic test would you recommend?

A

EGD

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33
Q

Refux esophagitis is caused by…

A

GERD

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34
Q

Mucosa changes in Barrett’s esophagus

A

Metaplasia from squamous mucosa to columnar epithelium in DISTAL esophagus

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35
Q

Why must Barrett’s esophagus be taken very seriously?

A

Potential to turn into dysplasia and then adenocarcinoma of the esophagus

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36
Q

How to monitor Barrett’s esophagus

A

EGD EVERY 2 YEARS to check for progression to dysplasia and esophageal adenocarcinoma

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37
Q

What will NOT reverse Barrett’s esophagus or prevent progression of the disease?

A

Anti-reflux procedures

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38
Q

Cancers in middle vs. lower esophagus

A

Lower- adenocarcinoma of esophagus (1% of Barrett’s esophagus develops into this). Middle esophagus affected in Squamous cell carcinoma

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39
Q

Squamous cell carcinoma of esophagus associated with

A

HPV, smoking, alcohol

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40
Q

What layer does esophageal cancer lack resulting in cancer spreading?

A

Serosal layer

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41
Q

Which has better survival rate in esophageal cancer- node-negative or node-positive disease?

A

Node-negative disease

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42
Q

How much of the esophageal lumen must be obstructed to produce dysphagia?

A

2/3rds

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43
Q

You are suspicious of esophageal cancer in patient who’s symptoms include dysphagia, coughing, and hoarseness. What specific area are you concerned with?

A

Tumors of cervical esophagus

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44
Q

Definitive diagnosis for esophageal cancer

A

Tissue biopsy in EGD. Can also use barium esophagogram, but not necessary

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45
Q

Tx in esophageal cancer

A

Endoluminal ultrasound- determines depth of invasion and lymph node size. Esophagectomy for resection (if has not spread and no lymph node involvement), chemo, radiation. Otherwise esophageal stenting.

46
Q

Benign esophageal tumors

A

Leiomyomas, leiomyosarcoma, leiomyoblastomas

47
Q

Origin of benign esophageal tumors

A

mesenchymal- GISTs (gastrointestinal stromal tumors)

48
Q

oncogene in GISTs or benign esophageal tumors

A

cKIT oncogene

49
Q

Patient in mid-20’s presents with dysphagia. UGI and EGD show constriction of the esophagus at the aortic arch and great vessels. Diagnosis?

A

Vascular rings

50
Q

Upper esophageal webs aka

A

Plummer-Vinson Syndrome or Sideropenic dysphagia

51
Q

Lower esophageal webs aka

A

Schatzki’s Ring

52
Q

Patient comes in with chronic iron-deficiency anemia. She is 45 years old with koilonychia, glossitis, appears malnourished. How might the esophagus be affected?

A

May see UPPER esophageal webs

53
Q

Upper esophageal web tx

A

esophageal dilation, correction of nutritional deficiency - iron supplements

54
Q

Why is it very important to continue and screen for esophageal webs and take them seriously (esp. upper)

A

Premalignant- 10% progress to squamous cell carcinoma of esophagus, oral cavity, or hypophyarynx

55
Q

Where would you expect to see Schatzki’s ring?

A

Squamocolumnar epithelial junction in distal esophagus- seen on barium swallow or EGD.

56
Q

What symptom is commonly associated with esophageal webs?

A

Dysphagia

57
Q

If patient presents with 20 mm. ring diameter with lower esophageal web, what symptoms would you expect?

A

intermittent dysphagia

58
Q

If patient presents with 13 mm. ring diameter with lower esophageal web, what symptoms would you expect?

A

real dysphagia

59
Q

Esophageal web does not involve the ….

A

muscle, only the mucosa and submucosa

60
Q

How to treat patient with dysphagia and reflux symptoms?

A

serial dilations, ppi

61
Q

Patients with refractory dysphagia and GERD tx

A

intraoperative dilation, anti-reflux procedure (Nissen)

62
Q

Unable to feed baby and regurgitation present. What might you suspect?

A

Congenital esophageal web

63
Q

Tx of congenital esophageal web

A

dilation, transthoracic resection

64
Q

esophageal congenital cysts aka

A

duplication cysts

65
Q

types of esophageal congenital cysts

A

duplications, bronchogenic cysts, and neurenteric cysts

66
Q

What location are esophageal cysts usually found in

A

intrathoracic esophagus- posterior mediastinal mass on xray

67
Q

tx for esophageal cysts

A

resection via VATS, thoracotomy, or endoscopic US with aspiration

68
Q

Disorders of esophageal motility have functional or structural problem?

A

Functional- interfere with swallowing

69
Q

Categories of disorders affecting esophagus motility

A

Upper esophageal sphincter dysfunction and motor disorders of the body of the esophagus

70
Q

Patient presents with lump in throat that makes it difficult to swallow. Has history of GERD. Dysphagia occurs between the thyroid cartilage and suprasternal notch. Hoarseness, expectoration, and weight loss also seen. Diagnosis and tx?

A

Upper esophageal sphincter dysfunction based on barium swallow, pH probe, mannometry, EGD. Tx- cervical esophagomyotomy if persistent dysphagia and abnormal mannometry

71
Q

Most common motor disorder of the body of esophagus?

A

Achalasia

72
Q

esophageal motor body disorders range…

A

hypomotility (achalasia) to hypermotility (diffuse esophageal spasm)

73
Q

Patient presents with dysphagia that has been getting progressively worse the past few years. Regurgitation of undigested food occurs even without acid or bile (No GERD present). The regurgitation occurs pretty effortlessly, aspiration often occurs. You observe that this patient eats very slowly and drinks a lot of water to wash their food out. Diagnosis?

A

achalasia

74
Q

Secondary achalasia caused by

A

parasitic infection with Trypanosoma cruzi (Chagas disease) OR cancer- causes damage to myenteric plexus

75
Q

Achalasia is caused by…

A

degeneration of post-ganglionic inhibitory neurons of the myenteric plexus

76
Q

Diagnostic tests in achalasia

A

Chest xray- mediastinal mass with air-fluid level. Barium esophagogram- dilated esophagus without peristalsis and BIRD BEAD at distal esophagus. Mannometry- failure of LES to relax after swallowing, no peristalsis

77
Q

Tx of Idiopathic achalasia

A

r/o cancer. do EGD. Nitrates, CCB. Definitive tx- myotomy, can be done thoracoscopically or transthoracically

78
Q

Many people with achalasia are misdiagnosed with …

A

GERD- because they present with chest pain and heartburn

79
Q

Patient presents with chest pain and dysphagia. Is very anxious. When eating cold liquids or cold fluids, symptoms get worse. Diagnosis, including tests?

A

Diffuse esophageal spasm based on barium esophagogram shows classic corkscrew appearance or mannometry showing high amplitude, sustained, NON-peristaltic contractions

80
Q

Bird beak on bareium esophagogram signifies

A

achalasia

81
Q

corkscrew appearance on barium esophagogram signifies

A

diffuse esophageal spasm

82
Q

Tx of DES and nutcracker esophagus

A

antispasmodics, CCB, nitrates, bougie dilation. long esophagomyotomy

83
Q

nutcracker esophagus aka

A

super-squeeze esophagus

84
Q

Patient presents with chest pain, dysphagia, and odynophagia. Mannometry shows 180mmHg pressure for more than 6 seconds signifying high pressure contractions for a long amount of time. Diagnosis?

A

Nutcracker esophagus

85
Q

pharyngoesophageal diverticula aka

A

Zenker’s diverticulum

86
Q

What is the most common esophagea diverticulum

A

Pharyngoesophageal diverticula

87
Q

Patient age 65 presents with cervical dysphagia, gurgling during swallowing, regurgitation of undigested food, bad breath, aspiration. Transient incomplete opening of UES seen. Diagnosis?

A

pharyngoesophageal diverticula

88
Q

Mannometry critera for nutcracker esophagus

A

180mmHg pressure for more than 6 seconds in duration

89
Q

Tx of Zenker’s diverticulum

A

Surgery to remove diverticulum- relieves pressure at the UES

90
Q

Collagen vascular diseases that result in esophageal motor disturbances

A

dermatomyositis, polymyositis, lupus erythematosus, scleroderma

91
Q

Most serious complication of zenker’s diverticula

A

aspiration- surgery recommended

92
Q

How is midesophageal diverticula and pharyngoesophageal diverticula diagnosed?

A

esophagogram

93
Q

Midesophageal diverticula- traction or pulsion?

A

Both

94
Q

Epiphrenic diverticula- traction or pulsion?

A

Pulsion

95
Q

When to treat epiphrenic diverticula

A

When diverticuli become symptomatic or larger than 3cm. Tx involves surgery for removal of the diverticulum and esophagomyotomy to relieve the distal obstruction

96
Q

What kind of necrosis do alkalai and acidic substances cause?

A

Alkalai- liquefactive necrosis, deep burning. Acidic- coagulative necrosis, prevents deep burning

97
Q

Is esophagus more resistant to acidic or alkalaic burns?

A

Acidic

98
Q

Solid alkalai vs. liquid alkalai causing caustic injury

A

Solid alkali tends to adhere to oropharynx- more damage proximally. Liquid alkalai readily passed to the esophagus- more damage distally

99
Q

How to manage caustic injury

A

Figure out if acid or alkali agent ingested. Chest and abdominal Xray. EGD.

100
Q

How to handle 1st degree esophageal burns

A

Observation

101
Q

How to handle 2nd and 3rd degree esophageal burns

A

Admit to ICU, NPO, IVF, ABS, serial xrays, etc.

102
Q

Perforation of esophagus can be…

A

iatrogenic, spontaneous, or traumatic

103
Q

Which type of esophageal perforation is most common?

A

Iatrogenic- from EGD, NG, ET tube, chest thoracostomy, neck or chest surgery, etc.

104
Q

Spontaneous rupture of esophagus resulting from straining or vommitting. What is it and where does it most likely occur?

A

Boerhaave’s syndrome- left lower posterior esophagus

105
Q

Patient presents with pain, vomiting, hematamesis, dysphagia, mediastinal crunch, dullness, fever, tachycardia, tachypne, and subcutaneous emphysema. Dx?

A

Perforation- barium esophagogram

106
Q

You suspect perforation in patient’s abdomen. You decide to use esophagogram to see the exact location. What do you use?

A

Abdomen- gastrograffin. If perforation in chest- use barium

107
Q

When diagnosing perforation, use and avoid which tests?

A

Use esophagogram (either barium or gastrograffin). Chest CT ok, AVOID EGD

108
Q

Varices result from..

A

portal hypertension d/t cirrhosis of the liver

109
Q

Tx of varices

A

sclerotherapy, banding, blakemore tube

110
Q

What might you see in belemic patient that forcefully vomits, including hematemesis? Is often self-limited.

A

Mallory-Weiss Tear- tear in the mucosal layer at the junction of the esophagus and stomach

111
Q

Most common cause of esophageal chest pain

A

reflux esophagitis. also advanced achalasia and DES

Clin Med I- GI (10 decks)

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