Disease of Upper GI/Stomach [7] Flashcards Preview

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Flashcards in Disease of Upper GI/Stomach [7] Deck (19):
1

Possible etiologies of obstructive disorders in the oropharyngeal area

Head + neck cancers
Zenker's diverticulum
Radiation therapy (thyromegaly, fibrosis)

2

Possible etiologies of propulsive motility disorders in the oropharyngeal area

Neurologic conditions
- stroke*
- ALS
- MS
- Parkinsons
Myasthenia gravis
Muscular dystrophy

3

Possible etiologies of obstructive disorders in the esophageal area

Esophageal strictures
esophageal rings/schatzki's rings
EoE
Extrinsic compression
Esophageal cancer*

4

Possible etiologies of propulsive motility disorders in the esophageal area

Achalasia*
Scleroderma*

Esophageal spasm "corkscrew eso"

5

What test can you run for obstructive disorders in the oropharyngeal area

barium swallow

*can do this test for propulsive/motility disorders of the oropharyngeal area too

6

What test can you run for obstructive disorders in the esophageal area

EGD (Esophagogastroduodenoscopy)
Esophagram

7

Possible etiologies of propulsive motility disorders in the esophageal area

Esophagram
EGD (to exclude)
Esophageal manometry

8

Possible etiologies of propulsive motility disorders in the oropharyngeal area

Barium swallow

*can do this test for obstructive disorders of the oropharyngeal area too

9

Oropharyngeal dysfxn symptoms

1. oropharyngeal (transfer) dysphagia
2. nasal regurg
3. aspiration (solids/liquids)

10

Esophageal dysfxn with propulsive/motility symptoms

dysphagia to BOTH solids and liquids
Chest pain

11

Achalasia

"No relaxation" "A-chalasia"
Impaired relaxation of esophagus (LES)
- majority is IDIOPATHIC
- dmg to myenteric plexus
- Type I: Swallowing → no significant change in esophageal pressurization

dysphagia to both solids/liq, weight loss, regurg

12

Esophageal dysfxn with obstructive symptoms

Dysphagia to solids (first) then liquid (much later)
Weight loss (ominous)
Heart burn

13

Tx for achalasia

Endoscopic therapy
- GE junction botulinum toxin injxn → inhib of ACh release from nerve endings
- Pneumatic balloon dilation → tear LES muscle fibers
- POEM
- Surgical (hellar) myotomy

meds suck
(nitrates, CCB, sildenafil)

14

Eosinophilic esophagitis EoE
(- obstructive disorders in the esophageal area)
What is it?
How is it dx?
Population affected?

chronic immune/antigen mediated esophageal disease

dx: dysphagia
eosinophilic infiltrate in esophagus
absence of other pot causes of esophageal eosinophilia

White male + assoc. with other allergic diseases

sx: dysphagia, acute food impaction, heartburn, food avoidance, non spec. in kids

15

Tx for EoE

3 D's
Drugs - steroids
Diet - 6 food elim
Dilation

16

Causes of GERD

Inappropriate LES relaxation
Hiatal hernia
gastric/esophageal surgery
dysmotility or obstruction
ZE
Sjogern's
Scleroderma

17

Barretts esophagus
- what is it
- tx?

Consequence of GERD with those at risk (White, male, fat, old)
- Metaplasia of esophageal squamous cells into columnar intestinal cells
- risk of dysplasia → adenocarcinoma

Tx: endoscopic treatment for high grade dysplasia and early esophageal adenocarcinomas
(ablation of Barretts tissue and resection of visible lesions )

18

Esophageal cancer. which is more prevalent in US? World wide?

US: adenocarcinoma
World wide: Squamous

*note: adenocarcinoma is almost always in distal esophagus or gastric cardia

19

Risk factors for esophageal SCC and Adenocarcinoma

SCC:
Old age, Alcohol/tobacco, caustic injuries
4M:1F
8AA:1 Cauc

Aden:
Old age, SMOKING, obesity, GERD, BARRETTS
8M:1F