Disorders of Esophagus and Stomach Flashcards Preview

Clin Med III Exam I > Disorders of Esophagus and Stomach > Flashcards

Flashcards in Disorders of Esophagus and Stomach Deck (80)
Loading flashcards...
1
Q

Which esophageal spinchter is voluntary?

A

UES b/c it is striated muscle

LES is smooth muscle–>involuntary

2
Q

Four regions of the stomach

A

cardia, fundus, body, antrum

3
Q

PUD is an imbalance between what

A

aggressive factors and defense mechanisms (H pylori, NSAIDs, ETOH)

4
Q

Signs of a gastric ulcer

A

pain shortly after or during eating

5
Q

Signs of a duodenal ulcer

A

pain hours after eating

pain wakes patient up at night

6
Q

Presentation of PUD

A
  • epigastric pain (gnawing/burning)
  • dyspepsia
  • chest pain/heart burn
  • hematemesis, coffee ground emesis, melena, hematochezia
  • sx’s of anemia
7
Q

Difference of an ulcer vs erosion

A

ulcers go into muscularis, erosions are more superficial

8
Q

Whats the number 1 thing you should think of with PUD

A

H pylori

9
Q

Risk factors for PUD

A
  • alcohol
  • H pylori
  • NSAIDs
  • caffeine
  • smoking/tobacco
  • physiological stress
  • genetics
10
Q

What would a sudden onset of pain suggest in PUD

A

perforation or peritonitis

11
Q

Exam findings in PUD

A
  • abd tenderness
  • GUAIAC +
  • gastric outlet obstruction w/ chronic duodenal ulcer
12
Q

What is the work up for PUD

A
  • H pylori testing (urea breath test)
  • endoscopy
  • fasting gastrin level
  • CXR
  • upper GI contrast study
13
Q

Gold standard for PUD diagnosis

A

endoscopy

14
Q

What will an endoscopy show if pt has PUD

A

discrete mucosal lesion w/ punched out smooth ulcer base

15
Q

When would you do a CXR in patietns with PUD

A

if they look sick, looking for perforation or pneumomediastinum

16
Q

Treatment for PUD in a stable patient

A
  • endoscopy- epi injection, hemoclips, thermal coagulation
  • PPI

if H pylori tx w/ tripple therapy

17
Q

What is the triple therapy for H pylori

A

PPI and Clarithro and amox or flagyl

18
Q

Treatment for PUD in an unstable patient

A
  • ABCs
  • IVF resucitation
  • PPI infusion
  • NGT
  • GI consult
19
Q

When would you consult surgery for a patient with PUD

A

of perforation present or failed EGD for hemostasis

20
Q

What is a dysmotility disorder

A

dysfunction of coordianted peristalsis/motility pattern of the esophagus

21
Q

Achalasia

A

obstruction and proximal dilation of esophagus w/ food bolus stasis due to loss of ganglion cells from esophagus wall causing LES to fail to completely relax

(failure to relax)

22
Q

Diffuse esophageal spasm

A

functional imbalance between excitaroy and inhibitory pathyway–>disrupted peristalsis (entire esophagus contracts)

manometry w/ >20% simultaneous contractions

23
Q

Nutcracker esophagus

A

distal esophagus mmhg @ peristalsis >220 at LES

high pressure

24
Q

HTN LES

A

chronic high pressure at LES

25
Q

Scleroderma esophagus

A
  • smooth muscle atrophy and fibrosis

- smooth muscle is replaced by scar tissue and lose peristalsis and LES tone

26
Q

Presentation of dysmotility syndromes

A

DEPENDS ON THE CAUSE

  • dysphagia
  • chest pain
27
Q

Work up for dysmotility disorders

A

BARIUM ESOPHAGRAM

  • manometry (measure the pressure)
  • endoscopy
  • CXR
28
Q

Tx for dysmotility disorders

A
  • start with dietary changes
  • nitrates and CCB
  • TCA (pain modifier)
  • botox in LES
  • endoscopy therapy (pneumatic dilation)
29
Q

If all other methods fail how do you treat dysmotility disorder

A

surgery- Heller myotomy

-decreases the pressure at LES by cutting the muscle

30
Q

What is an esophageal stricture

A

narrowing of lumen of the esophagus

31
Q

Causes of distal strictures

A
  • GERD
  • adenocarcinoma
  • collagen vascular disease
  • extrinsic compression
  • prolonged NGT
32
Q

Causes of proximal/mid strictures

A
  • caustic ingestions
  • malignancy
  • mediastinal radiation
  • various types of esophagitis
  • dermal disease (pemphigoid)
33
Q

Sx of stricture

A
  • dysphagia (most common)
  • odynophagia
  • heartburn
  • food impaction
  • chest pain
  • chronic cough
34
Q

What is the biggest contributer to strictures

A

GERD

35
Q

Work up for strictures

A
  • basic labs
  • endoscopy (rule out malignancy)
  • barium esophagram: shows size of structure
  • CT: stage malignancy
  • manometry: suspected dysmotility
36
Q

Treatment of strictures. What is the treatment of choice

A
  • PPI
  • adjust diet
  • esophageal dilation via EGD
  • intralesional steroid injection if all else fails

dilation is treatment of choice

37
Q

What is a mallory-weiss tear

A

upper GI bleed d/t longitudinal mucosal lacerations

38
Q

What causes a mallory weiss tear

A

persistent wretching/vomiting

39
Q

Where is the location of mallory weiss tears

A

distal esophagus

40
Q

Risk factors for mallory weiss tears

A

anticoags, excessive ETOH

41
Q

Treatment for mallory weiss tears

A

typically nothing, self limiting

-supportive

42
Q

Sx’s of esophagitis

A
  • heartburn
  • DYSPHAGIA
  • odynophagia
  • sour taste in mouth
  • nausea
  • bloating
  • abd pain/ chest pain
  • cough/wheeze/hoarseness
43
Q

Number one cause of esophagitis

A

reflux

44
Q

Tx of esophagitis

A
  • pain
  • PPI
  • sucralfate
45
Q

How would you treat infectious esophagitis? Candidia, HSV, CMV

A

-candida: fluconazole, clotrimazole, amphotercin B

HSV: acyclovir

CMV: gangiclocvir and fosacarnet

46
Q

5 causes of esophagitis

A
  • reflux
  • infection
  • radiation
  • medication
  • systemic disease
47
Q

How do you treat eosinophillic esophagitis

A
  • determine allergen
  • leukotriene inhibitors
  • steroids
48
Q

What are some complications of esophagitis

A
  • esophageal stricures
  • malnutrition
  • perforation and/or GI bleeding
  • Barretts esophagus
49
Q

Where does erosive gastritis typically occur

A

at greater curvature of stomach

50
Q

What typically causes erosive gastritis

A

NSAIDs

51
Q

Most common cause of non erosive gastritis

A

H pylori

52
Q

What would an EGD show in a patient with gastritis

A

thick, edema, erosions, erythematous gastric folds

53
Q

Sx’s of gastritis

A
  • burning/gnawing epigastric pain
  • N/V
  • melena/hematemesis/ hematochezia/coffee ground emesis
54
Q

Tx of gastritis

A
  • triple therapy w/ H pylori infection
  • D/C offending agents
  • antacid
  • sucralfate
  • H2 blocker
  • PPI
55
Q

What can cause GERD

A
  • impairment or failure of LES
  • delayed gastric emptying
  • decreased esophageal motility
56
Q

What is the most common cause of GERD

A

hiatal hernia

57
Q

Sx’s of GERD

A
  • heartburn
  • dysphagia
  • regurgitation
  • sour taste in mouth
  • night time cough
  • chest pain
  • asthma/hoarseness
  • aspiration pneumonia
58
Q

Tx of GERD

A
  • lifestyle modifications
  • antacid
  • H2 blocker
  • PPI
  • corrective surgery (last resort)
59
Q

When would a patient get anti reflux surgery for GERD

A
  • poorly controlled on PPI
  • barretts esophagitis
  • young age
  • poor therapy compliance
  • extra esophageal sx
  • medical therapy too expensive
60
Q

What is the corrective surgery for GERD

A

Nissen Fundoplication

61
Q

Complications of GERD

A
  • strictures

- Barrett esophagus

62
Q

Where are small cell carcinomas of the esophagus found? What are the main causes?

A

upper half of the esophagus

caused by smoking and ETOH

63
Q

Where are adenocarcinomas of the esophagus located? What causes it?

A

lower half of the esophagus

caused by GERD/Barrett esophagus

64
Q

What is Barrett esophagus

A

chronic reflux and esophageal exposure causes metaplasic conversion of distal squamous epithelium to columnar epithelium

65
Q

Presentation of esophageal CA

A
  • dysphagia
  • weight loss/cachexia
  • regurgitate food
  • epigastric pain
  • chronic cough
  • hoarseness/dysphonia
66
Q

What would an endoscopy of early esophageal cancer show

A

superficial plaque, nodule, ulceration

67
Q

What would an endoscopy show in advance esophageal cancer

A

stricture, ulcerated mass, circumferential mass, large ulceration

68
Q

How is used to stage esophageal cancer

A
  • endoscopic ultrasound (T and N staging)

- CT/PET scan/bone scan (M staging)

69
Q

When would you do a bronchospy in a pt with esophageal CA

A

if CA found in middle upper 1/3 of esophagus or above the carina

70
Q

What is the definitive tx for esophageal CA

A

esophagectomy

71
Q

What is the therapy for non surgical candidates

A
  • chemo/radiation
  • laser therapy
  • stents
72
Q

What are the contraindications of an esophagectomy

A
  • N2 or greater
  • mets to solid organs
  • invasion of local structures
  • severe comorbidity
73
Q

What are the complications of an esophagectomy

A
  • anastamotic leaks

- stricture

74
Q

What is correlated with gastric cancer

A
  • what you are eating

- H pylori

75
Q

What type of cancer is gastric cancer (typically)

A

adenocarcinoma

76
Q

Risks for gastric cancer

A
  • family hx
  • h pylori
  • smoming
  • pernicious anemia
  • previous gastric surgery
  • obesity
  • diet
77
Q

Sx’s of gastric cancer

A
  • insidious presentation of vague symptoms
  • weightloss/anorexia
  • gastric outlet obstruction
  • small bowel obstruction
  • palpable enlarged stomach
78
Q

What are the signs of hematongenous spread of gastric cancer

A
  • sister mary joseph node
  • virchow node
  • hepatomegaly
  • pleural effusion
79
Q

Tx of gastric cancer

A

pre op chemo + surgery

80
Q

Why types of surgery do you do for gastric CA

A
  • total gastrectomy
  • esophagastrectomy
  • subtotal gastrectomy