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

Disorders of Esophagus, Stomach, and Duodenum Flashcards

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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
what are complications of GERD
esophagitis esophageal structure Barrett esophagus esophageal CA
26
What is the only complication of GERD with malignant potential
Barretts esophagus
27
what is the biggest risk factor for GERD and BE
obesity, especially central rather than BMI
28
what is the presentation of BE
symptoms of GERD - chronic GERD symptoms
29
what does diagnosis of BE require
gross endoscopic ID of columnar metaplasia; described as "salmon-pink tongues" of mucosal tissue pathological confirmation of intestinal metaplasia with goblet cells on biopsy
30
what is the treatment of BE
its a burn - put out the fire aka suppress acid/reflux
31
if BE is left untreated what are they at risk of developing
adenocarcinoma
32
what is another name for gastrinoma
zollinger-ellison syndrome; Z-E syndrome
33
where are gastrinomas located
pancreas or duodenal wall
34
what is the result of gastrinomas
gastric acid hypersecretion and aggressive, refractory peptic ulceration
35
how are gastrinomas diagnosed
measuring serum gastrin lovels
36
what is the treatment of gastrinoma
PPI and surgical removal
37
what are symptoms of esophageal motility disorders
symptoms depend on cause but typically: difficulty swallowing (dysphagia) chest pain/pressure heartburn
38
what is the evaluation for esophageal motility disorders
depends on symptoms: upper endoscopy barium swallow esophageal manometry acid-and reflux-related tests
39
what are neurogenic esophageal motility disorders
all affect swallowing but not classified as mitility disorders generalized d/o of neuromusuclar function m.gravis amyotrophic lateral sclerosis stroke parkinsons DM2
40
What is Diffuse Esophageal spasm (DES)
spectrum of motility disorders characterized by non-propulsive contractions, hyperdynamic contractions, or elevated LES pressure
41
what are symptoms of DES
chest pain, dysphagia
42
how is DES diagnosed
barium swallow or manometry
43
what are the treatemnts for DES
Nitrates CCBs (verapamil) botulinum toxin surgical or endoscopic myotomy anti-reflux therapy
44
what is achalasia
neurogenic esophageal motility disorder characterized by impaired esophageal peristalsis and lack of LES relaxation during swallowing
45
what are the symptoms of achalasia
slowly progressive dysphagia, usu. to both liquids and solids regurgitation of undigested foods
46
how is achalasia worked up
manometry barium swallow endoscopy
47
what is the treatment of achalasia
dilation botulinum toxin injection surgical myotomy endoscopic myotomy
48
what causes achalasia
loss of ganglion cells in myenteric plexus of esophagus, resulting in denervation of esophageal muscle
49
What is esophageal diverticula
outpouching of mucosa though muscular layer of the esophagus
50
how is esophageal diverticula diagnosed
barium swallow
51
what is Zenker's (pharyngeal)diverticula
posterior out-pouching of mucosa and submucosa thru cricopharyngeal muscle
52
what is mid-esophageal (traction) diverticula
caused by traction from mediastinal inflammatory lesions or by esophageal motility disorders
53
what is epi-phrenic diverticula
just above the diaphragm usu. with motility disorder (achalasia, DES)
54
what is the clinical presentation of Zenker diverticulum
regugitation of food when bending or lying down asperation pneumonitis as result of nocturnal regurgitation
55
what is the treatment of esophageal diverticula
specific tx usually not required resection occasionally needed for large/symptomatic diverticula
56
what is esophageal obstruction
usually develops slowly and incomplete Intrinsic vs extrinsic obstruction
57
what are intrinsic obstructions
esophageal tumors esophageal rings esophageal webs structures caused by GERD or rare, caustic ingestion
58
what are Extrinsic obstruction
enlarged left atrium aortic aneurysm substernal thyroid gland cervical bony exostosis thoracic tumor
59
What is a lower esophageal ring
aka Schatzki ring; B ring ring like narrowing of distal esophagus resulting in dysphagia
60
What is the treatment of lower esophageal rings
wide-lumen rings: instruct to chew food thoroughly narrow-lumen: dilation by endoscopy surgical resection rarely required
61
what are other names for esophageal webs
plummer-vinson syndrome patterson-kelly syndrome sideropenic dysphagia
62
what is an esophageal web
thin mucosal membrane grows across the lumen, may cause dysphagia; rare without anemia
63
what is the best method of diagnosis for esophageal webs
barium swallow
64
what is the treatment of esophageal webs
correct anemia; can be easily ruptured during endoscopy
65
what is Mallory-Weiss syndrome
non-penetrating mucosal laceration of distal esophagus and proximal stomach caused by vomiting, retching or hiccupping
66
how is Mallory-Weiss syndrome diagnosed
clinical with hx hematemesis after 1+ episodes of non-bloody vomitting endoscopic diagnostic and therapeutic
67
what are esophageal varices
dilated veins in distal esophagus or proximal stomach caused by elevated pressure in portal venous system usu from cirrhosis
68
how are esophageal varicies diagnosed
endoscopy
69
what is the treatment of esophageal varices
airway management, fluid resuscitation, transfusion endoscopic banding and IV octreotide trans-jugular intrahepatic protosystemic shunting procedure
70
what is the presentation of esophageal varices
usually present with sudden, painless, upper GI bleeding, often massive: signs of shcok may be present
71
what is the prognosis of esophageal varices
40% variceal bleeding stops spontaneously mortality depends on severity of liver disease more than volume of bleeding NOT good diagnosis
72
what is TIPS procedure
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
what is erosion of GI mucosa that usuaulyl affects stomach or first few cm of duodenum
PUD
74
what causes PUD
H.pylori or NSAID use
75
what are the symptoms of PUD
burning epigastric pain often RELIEVED by food
76
how is PUD diagnosed
endoscopiy H.pylori testing
77
what is the treatment of PUD
acid suppression, eradication of H.pylori (if present), NSAID avoidance
78
if burning epigastric pain wakens the patient at night, what is this highly suggestive of
duodenal ulcer highly suspicious
79
what are complications of PUD
Hemorrhage performation recurrence

Clin Med - GI (11 decks)

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