Esophageal Disorders Flashcards

Question

What is achalasia?

Answer 1

failure of smooth muscle fibers to relax, which can cause a sphincter to remain closed and fail to open when needed

Answer 2

unknown, damage to nerves secondary causes are: -Chagas disease T. cruzi--> parasite -Malignancy related

Answer 3

``` Backflow (regurgitation) of food Chest pain, which may increase after eating or may be felt in the back, neck, and arms Cough Difficulty swallowing liquids and solids Heartburn Unintentional weight loss ```

Answer 4

Manometry: Aperistalsis Impaires LES relaxation ``` Barium Study (Esophagogram): “Bird Beak” ``` Endoscopy: Exclude “pseudoachalasia”

Answer 5

1. Injection with botulinum toxin (Botox). This may help relax the sphincter muscles, but any benefit wears off within a matter of weeks or months. 2. Medications, such as long-acting nitrates or calcium channel blockers, which can be used to relax the lower esophagus sphincter 3. Surgery (called an esophagomyotomy), which may be needed to decrease the pressure in the lower sphincter 4. Widening (dilation) of the esophagus at the location of the narrowing (done during esophagogastroduodenoscopy)

Answer 6

``` Diet High fat foods Smoking Medications spicy foods ```

Answer 7

Transient LES relaxation: Inappropriate non-swallow-related LES relaxation

Answer 8

- Impairs esophageal emptying - Acts as reservoir of acid - Lose of diaphragmatic “pinch” - Augments LES tone - Susceptibility to reflux correlates with hiatal hernia size

Answer 9

1. esophagitis 2. bleeding : rare 3. peptic stricture: dilation may be needed 4. Barrett's esophagus

Answer 10

``` Specialized columnar epithelium (goblet cells=intestinal metaplasia) Seen in 10-20% of GERD patients Strong male and caucasian predominance Results from severe, long-standing reflux Single most important risk factor for esophageal adenocarcinoma ```

Answer 11

esophageal adenocarcinoma

Answer 12

with PPIs but it doesn't eliminate the lesions, just prevents them from getting worse -screen patient ever 3-5 years

Answer 13

Pulmonary: Asthma, chronic cough,recurrent aspiration, subglottic stenosis Ears, nose & throat: Hoarseness, laryngitis, chronic sinusitis, laryngeal cancer, globus sensation Other: Dental erosion

Answer 14

Lifestyle modification Pharmacologic agents Anti-reflux surgery Endoluminal Therapies

Answer 15

i. Lifestyle modifications ii. Medication interventions PRN iii. Weight loss and smoking cessation iv. Elevation of bed, avoid laying down for 3 hours after eating v. Antacids (immediate) are good for initial treatment, <2 hours vi. H2 receptor antagonist → 8 hour protection 1. Cimetidine 200 mg 2. Ranitidine and Nizatidine 75 mg 3. Famotidine 10mg

Answer 16

e. Troublesome Symptoms i. Intitial therapy: 1. Treat with PPI a. Omeprazole, rabeprazole 20 mg b. Lansoprazole c. Esomeprazole d. TAKE 30 min before breakfast for 4-8 weeks e. If patient does not get adequate relief after taking a PPI twice daily, then upper GI study is indicated ii. Long-Term Therapy 1. In those who achieve relief, it is okay to discontinue after 8-12 weeks. a. Some have withdrawal heartburn, and those can continue to use a PPI intermittently for 2-4 weeks until symptoms resolve. 2. Side effects are mainly related to decreased calcium absorption, so they should take dairy products at different time if calcium is an issue.

Answer 17

wrap the top part of the stomach around the esophagus to help tighten the LES ``` Indications: need for continous drug treatment and… Young otherwise healthy Financial burden Noncompliant with drug therapy Patient preference Refractory patient (rare) ``` 10% relapse in 10 years

Answer 18

Endoscopic suturing/plication system Delivery of radiofrequency energy to the GE junction Injection/implantation of materials into the GE junction

Answer 19

Benign: Leiomyoma Lipoma Malignant: Squamous cell cancer Adenocarcinoma Lymphoma

Answer 20

- very low, 5% - often present after the disease is far gone - Symptoms gradual in onset including dysphagia, weight loss, odynophagia

Answer 21

- More common in men - Blacks > whites (6:1) - Uncommon before age 25 - Most common in mid-esophagus - Risk Factors: - Tobacco - Alcohol - Head and neck cancer

Answer 22

``` Increasing incidence More common in men Whites > Blacks (4:1) Uncommon before age 25 Most common in distal esophagus Risk factors: Barrett´s esophagus GERD ```

Answer 23

Occur at the GE junction Account for 5-10% of all UGI Bleeds Usually stop bleeding spontaneously Mechanism unclear (usually emesis)

Answer 24

1. mallory-weiss tear 2. varices 3. ulcers

Answer 25

Due to portal hypertension Mortality: 40% each episode >50% have another bleeding episode in the first year

Answer 26

perforation

Esophageal Disorders Flashcards

(52 cards)