Erickson: Esophageal Disorders and GERD Flashcards Preview

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Flashcards in Erickson: Esophageal Disorders and GERD Deck (54):
1

What is odynophagia?

**Pain on swallowing

2

What is dysphagia?

**sx resulting from failure to move a food bolus from the mouth to the stomach

3

What happens during normal swallowing?

Liquids/solids move from mouth to esophagus

Transport along esophagus

Liquids/solids delivered from esophagus to stomach

4

You see a pt who is having difficulty swallowing. What may be causing this?

1. Inadequate preparation of what's being swallowed. (decreased saliva/mastication, neuromuscular disorder, impaired mental fxn)

2. Abnormal muscle strenth/fxn (motility disorder)

3. Esophageal passageway narrowed (mechanical obstruction)

5

Difficulty initiating swallowing...

oropharyngeal dysphagia

6

Food stops or STICKS after swallowing initiated

esophageal dysphagia

7

What is a manifestation of oral pharyngeal dysphagia?

Things go down the wrong pipe-->aspiration!

Elderly present w/ recurrent pneumonias

8

What are the goals of therapy for a pt w/ oropharyngeal dysphagia?

protect airway

maintain nutrition (may put in feeding tube)

relieve dysphagia

9

How do you treat oropharyngeal dysphagia?

1. Speech/swallow therapy
2. esophageal dilation (strictures)
3. surgical myotomy (zenker's diverticulum)
4. NPO w/ nutrition support (PEG, PEJ, TPN) --Use gut first

10

What are causes of benign dysphagia in the esophagus?

peptic strictures
rings and webs
caustic scars (not seen often--drinking lye)

11

What cancers can cause esophageal dysphagia?

primary esophageal
extrinsic compression pushing on the esophagus

12

What are neuromuscular causes of dysphagia?

Primary esophageal disease (ACHALASIA, CHAGAS, motor disorders)

Secondary (GERD)

13

What is achalasia?

Loss of inhibitory innervation to the LES

Loss of VIP/NO so only have pro-contraction forces. Progresses as life long dysphagia over decades. Eat and then drink a lot of water to push food through.

Regurgitate
Chest pain
Weight loss

14

Manometry of a pt w/ achalaasia shows...

non relaxing LES
esophageal aperistalsis

15

Barium swallow in a pt w/ achalasia shows...

bird's beak narrowing at LES
dilated esophagus

16

What can cause a secondary achalasia?

carcinoma at the esophagogastric jxn (mimics achalasia)

17

What are two treatments for achalasia?

1. Nifedipine (Prevents contraction)
2. Botulinum Toxin (Prevents release of ACh)
3. Balloon dilation--> tear fibers of lower sphincter
4. Esophagogastric myotomy--> tear fibers of lower sphincter

18

A pt presents to you w/ a diffuse esophageal spasm. What do you see on manometry and barium swallow?

Simultaneous contractions of the esophagus (should be nice and orderly)

19

What do manometry and a barium swallow show you in a pt w/ systemic sclerosis?

Sclerosis is a systemic disease that can lead to NO contractions in the esophagus. It becomes a lead pipe. So pt's have acid reflux all the time

20

What is the MCC of GERD?

Transient LES relaxations

21

*A pt presents who intermittently can't swallow solids?

Lower esophageal ring

Likely related to reflux

22

*A pt presents who progressively can't swallow solids.

Peptic stricture
Cancer (esp if > 50)

23

*A pt presents who intermittently can't swallow solids/liquids.

Diffuse spasm
NEMD
Nutcracker

24

*A pt presents who progressively can't swallow solids or liquids.

Achalasia
Scleroderma

25

What can cause painful swallowing?

1. Tongue, tonsillar, pharyngeal pathology

2. Inflammation of mucosa lining (esophagitis)

3. Muscular spasm

4. Mediastinal disease (structures around the esophagus that are inflamed)

26

What external factors can cause GERD?

Diet
high fat foods
smoking
medication

27

What can cause diminished esophageal clearance affecting GERD?

Peristalsis
Body position
Saliva

28

What can cause an defective anti-reflux barrier leading to GERD?

LES
crural diaphragm
hiatal hernia

29

What are gastric factors that can cause GERD?

Acid
bile acid
gastric emptying
gastric distension

30

What is the classic sx of GERD?

HEARTBURN

31

If you suspect that a pt has GERD, what do you ask them?

1. do you feel substernal burning/regurgitaiton
2. postprandial
3. aggravated by change in position
4. prompt relief by antacids

32

What are common esophageal sxs of GERD

Heartburn
regurgitation
belching
water brash (increase in salivary secretion w/ heart burn)

33

A pt presents w/ chest pain, hoarseness/laryngitis, loss of dental enamel, asthma/chronic cough, dyspepsia. You suspect...

Atypical GERD

34

What sxs are associated w/ complications of GERD?

dysphagia
odynophagia (ulcer related to the bleeding)
bleeding

35

How can hitatal hernias contribute to reflux?

1. No diaphragmatic support of LES

2. HH is reservoir for gastric contents that causes irritation

36

If a pt presents w/ heartburn/regurge, that is postprandial, postural and decreased w/ antacid. What do you do?

Start empiric tx

NO diagnostic studies needed...but make sure it's not cardiac disease

37

Why might we do a barium swallow?

widely available

inexpensive

Good at identifying hiatal hernia, or stricutres

38

Why might we not do a barium swallow?

operator dependent
esophagitis, Barrett's epithelium

39

What is the best initial diagnostic study for pts w/ reflux sxs and dysphagia?

Barium swallow

40

What is the best diagnostic study for evaluating mucosal injury?

Endoscopy w/ biopsy

Good for:
*esophagitis, barrett's epithelium
*Hiatal hernia, strictures

41

What is the best study to confirm GERD?

Ambulatory pH monitorying

42

What assesses LES pressure peristalsis?

Esophageal manometry

43

**What is the cornerstone of GERD therapy?

Life style modifications

-elevate head of bed
-no food 3 hrs before bed time
-stop smoking
- less fat/volume
-avoid peppermint, onions, citrus juice, coffee, tomatoes
-avoid harmful meds
-OTS meds

44

What drugs can decrease LES pressure and make GERD worse?

theophylline
anticholinergics
Ca blockers
nitrates

45

What drugs can injure the mucosa and make GERD worse?

tetracyclines--can directly injure mucosa
quinidine
aspirin/NSAIDS
K tablets
Fe salts

46

Why are cimetidine, ranitidine, famotidine, and nizatidine all good treatments for you pt w/ GERD?

They all SUPPRESS ACID b/c they are H2 receptor ANTAGONISTS

47

Why might omeprazole and lansoprazole also be good tx for your pt w GERD?

Both are PPIs and suppress ACID!

48

What are anti-reflex operations?

Wrap part of the stomach around esophagus

Hill repair
Nissen repair
Belsey repair

49

What is Barrett's esophagus?

COLUMNAR epithelium replaces the SQUAMOUS epithelium in the DISTAL esophagus

50

What causes barrett's esophagus?

GER injures squamous epithelium and promotes repair by columnar metaplasia

51

What is a major risk factor for esophageal adenocarcinoma?

Barrett's esophagus

52

What causes peptic esophageal strictures?

ulceration stimulates fibrosis

Often associated w/ NSAIDs

53

How do you tx peptic esophageal strictures?

Aggressive acid suppression
dilation
surgery

54

Mallory Weiss

Longitudinal esophageal tear related to repeated vomitting