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Gastrointestinal STEP 2 > Esophagus > Flashcards

Esophagus Flashcards

(67 cards)

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1
Q

the essential feature of the majority of esophageal disorders

A

dysphagia

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2
Q

dysphagia vs odynophagia - dentition (both can lead to ….(another symptom))

A

dysphagia: difficulty swallowing
odynophagia: pain while swallowing
BOTH CAN LEAD TO WEIGHT LOSS

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3
Q

when severe, some forms of esophageal disroder will give

A

anemia and heme (+) stool

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4
Q

esophageal disorders - alarm symptoms

A
  1. weight loss
  2. Blood in stool
  3. Anemia
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5
Q

esophageal disorders with alarm symptoms - next step

A

indication for endoscopy

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6
Q

Achalasia - definition

A

it is the inability of the LES to relax due to a loss of nerve plexus (myenteric) within the esophagus. Also there is aperistalsis of the esophageal body

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7
Q

achalasia - age / associations with RFs

A 
young patient (under 50)
NO association with alcohol + tobacco use
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8
Q

achalasia - etiology

A

not clear

2ry to Chagas disease (T. cruzi) or extraesophageal malignancies (mass effect o paraneoplastic)

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9
Q

achalasia - characetiristic presentation

A

progressive dysphagia to BOTH solds and liquids at the SAME TIME

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10
Q

achalasia - diagnostic tests (only the names of the tests) - which is the most accurate

A
  1. Barium esophagram
  2. Manometry (the most accurate)
  3. Chest x-ray
  4. Upper endoscopy
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11
Q

achalasia - Barium esophagram

A

bird’s beak as the esophagus comes down to a point

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12
Q

achalasia - manometry

A

the most accurate

failure of the lower esophageal sphincter to relax

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13
Q

achalasia - chest x-ray

A

abnormal wideningof the esophagus,

NEITHER SENSITIVE NOR SPECIFIC

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14
Q

achalasia - upper endoscopy

A

normal mucosa in achalasa –> However useful to exclude malignancy

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15
Q

esophagus disorders - best first test

A

barium studies are acceptable to do first in most patients, ALTHOUGH RADIOLOGIC TESTS ALWAYS LACK THE SPECIFICITY OF ENDOSCOPIC procedures

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16
Q

esophagus - biopsy

A

in the esophagus, only CANCER and BARRET are diagnosed by biopsy

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17
Q

achalasia - treatment (explain - only names)

A

it cannot exactly be cured - nothing can resore the normal function of the missig neuroloical control. All the treatment is based on simple mechanical dilation of the esophagus:

  1. Pneumatic dilation
  2. Surgucal secioning or myotomy
  3. Botulinum toxin injection
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18
Q

achalasia treatment - pneumatic dilation - describe

A

place an endoscope with the ability to inflate a device that will enlarge the esophagus

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19
Q

achalasia treatment - pneumatic dilation - effective?

A

effective in more than 80-85% of patients

it can lead to perforation in less than 3% of patients

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20
Q

achalasia treatment - surgical sectioning or myotomy

A

to alleviate symptoms

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21
Q

achalasia treatment - pneumatic dilation vs surgeon

A

surgeon is more effective and more dangerous

HARD to choose between them

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22
Q

achalasia treatment - Botulinum injection - describe

A

relax tha LES

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23
Q

achalasia treatment - Botulinum injection - effective?

A

the effects will wear off in about 3-6 months, requiring reinjection

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24
Q

esophageal cancer - age / RF

A
  • 50 or older
  • more than 5-10 years of GERD symptoms
  • association with prolonged alcohol and tobacco use
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25
esophageal cancer - characteristic symptoms
dysphagia first for solids, followed (progressing) for dysphagia for liquids
26
esophageal cancer - most important clue id diagnosis
Progressive dysphagia
27
esophageal cancer - diagnosis test (only names)
1. Endoscopy 2. Barium 3. CT and MRI 4. PET
28
esophageal cancer - best initial test
Barium --> but no radiologic test can diagnosed cancer
29
esophageal cancer - endoscopy
indispensible --> only biopsy can diagnose cancer
30
esophageal cancer - CT and MRI
not enogu to diagnose esoph cancer --> they are used to determine the extent of spread into the surrounding tissues
31
esophageal cancer - PET
- to determine the contents of anatomic lesions if you are not certain whether they contain cancer. - to determine is cancer is resectable (local is, widely metastatic is not)
32
cancer - radiologic test for diagnosis
never the most accurate
33
esophageal cancer - treatment
- no resection = no cure - chemotherapy and radiation are used in addition to surgical removal - stent placement
34
esophageal cancer - stent placement
for lesions that cannot be resected surgically just to keep the esophagus open for palliation and ti improve dysphagia
35
esophageal spasm - types
the 2 forms of spastic disorders, diffuse esophageal spasm (DES) and nutcracker esophagus are clinically indistinguishable
36
esophageal spasm - presentation
both types present with the sudden onset of chest pain that is not related to exertion. Therefore, at first it is impossible to distinguish them from some form of atypical coronary artery spasm or unstable angina
37
esophageal spasm - the case will describe
sudden severe chest pain
38
esophageal spasm - ecg
normal
39
esophageal spasm - esophagram + endoscopy
both normal
40
esophageal spasm - DES vs nutcracker
can be distinguished only by the most accurate test: manometry --> different pattern of abnormal contraction in each them
41
esophageal spasm - most accurate test
manometry
42
esophageal spastic disorders - treatment
1. CCBs and nitrates --> simlar to Printzmental treatment | 2. PPIs can improve the number of cases
43
patient with aids and odynophagea - diagnosis
``` esophageal candidiasis (90%) other: CMV hepres ```
44
Dyshagia with HIV CD4 under 100 - steps
empirically start fluconazole (oral): IMPROVMENT? YES: continue therapy and HAART NO: perform upper endoscopy with biopsy --> - large ulcerations --> CMV --> gangiclovir or foscarnet - small ulcerations --> HSV --> acyclovir - if candida --> IV amphoteriicn
45
Dyshagia with HIV CD4 under 100 - IV amphotericin
if confirmed candida not responding to fluconazole
46
candida - nystatin
only oral
47
medications that cause esophagitis in prolonged contact
1. Doxycycline 2. alendronate 3. KCL (Potassium chloride)
48
esophagus - rings and webs - some diseases (also both can cause)
1. Schatzki ring 2. Plummer-Vinson both give dysphagia
49
Schatzki ring - definition / association etc
- it is a type of scarring or tightenning (aka peptic stricture) of the DISTAL esophagis - often from acid reflex and associated with hiatal hernia - intermittent dysphagia
50
Plummer vinson - it is associated with / complications
iron def anemia | - rarely transform to squamous cell cancer
51
Plummer vinson - iron def anema
it is not caused by blood lodd --> plummer vinson is more proximal
52
esophagis - rings and webs - diagnosis
easily detected in barium studies
53
esophagis - rings and webs - treatment
Schatzki ring --> pneumatic dialiation | Plummer vinson --> treated with iron replacement at firs --> (lead to resolution of the lesion)
54
zenker Diverticulum - definition
outpocketing of the posterior pharyngeal constrictor muscles
55
zenker Diverticulum - symptoms
dysphagia, halitosis (Bad breath), regurgitation of food particles some patients suffer from aspiration pneumonia
56
zenker Diverticulum - diagnostic tests
barium studies
57
zenker Diverticulum - nasogastric tube placement
NEVER --> it can cause perforation
58
zenker Diverticulum - upper endoscopy
NEVER --> it can cause perforation
59
zenker Diverticulum - treatment
repaired with surgery | - there is no medical therapy
60
esophageal Scleroderma - these patients present with
symptoms of reflux and have a clear history of scleroderma or progressive systemic sclerosis
61
esophageal Scleroderma - manometry
decreased LES pressure from an inablity to close
62
esophageal Scleroderma - treamtnet
PPI (like any person with reflux)
63
manometry is esophagus - which diseases
1. achalasia 2. spasm 3. scleroderma
64
Mallory-Weiss tear presents with
upper GI bleeding after prolonged or severe vomiting or retching --> repeated retching is followed by hematemesis or bright red blood, or by black stool (CAN BE PAINFUL)
65
esophageal disease without dysphagia / microscopic imafe
Mallory-Weiss tear | nonpenetrating tear of only mucosa
66
Mallory-Weiss tear - treatment
no specific therapy --> it will resolve spontaneously --> if severe --> injection of epinephrine to stop bleeding or the use of electrocautery
67
Boerhaave syndrome?
ful penetration of the esophagus (with pneumodiastinum) --> surgical emergency

Gastrointestinal STEP 2 (8 decks)

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