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Gastro Exam 1 > Esophagus and Stomach > Flashcards

Esophagus and Stomach Flashcards

1
Q

2 functions of the esophagus

A

transport food bolus from moth to stomach

prevent retrograde flow of gastro contents

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2
Q

What does esophageal transport involve and how does it begin?

A

Food is transferred from the mouth and pharynx through the opened upper sphincter (UES) into the esophagus.

When this is occurring there is esophageal peristalsis and relaxation of the lower esophageal sphincter (LES)

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3
Q

What prevents Retrograde flow from the stomach into the esophagus and the esophagus to pharynx?

A

prevented by the LES and UES

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4
Q

Basic Function of the Esophagus

A

Moves food (now called bolus) from the pharynx down to the stomach…

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5
Q

Once food reaches the esophagus is it dependent on gravity?

A

once bolus reaches esophagus it is not dependent on gravity… It is dependent on PERISTALSIS

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6
Q

If food moves backward from stomach to esophagus because LES is opened, what does this cause?

A

Acid reflux

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7
Q

What prevents food form moving into the trachea

A

Epiglottis

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8
Q

What is heart burn aka pyrosis characterized by?

A

burning retrosternal discomfort that moves up and down chest like a wave

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9
Q

If heart burn is severe where may it radiate

A

the sides of the chest, the neck, and angles of the jaw

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10
Q

What is heartburn a characteristic symptom of?

A

reflux esophagitis and may be associated with regurgitation or a warm feeling climbing up throat

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11
Q

What are the pertinent positives for heartburn

A

aggravated by bending forward, straining, or lying recumbent and is worse after meals
relieved by an upright posture, by the swallowing of saliva or water, and, more reliably, by antacids

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12
Q

What resembles cardiac pain but is called non cardiac chest pain or atypical chest pain

A

Esophageal Chest Pain

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13
Q

When may esophageal chest pain often occur

A

GERD or Diffuse Esophageal Spasm (DES)

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14
Q

What should always be excluded prior to assuming it is esophageal chest pain

A

Coronary Artery Disease

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15
Q

What is esophageal chest pain most likely associated with

A

Reflux esophagitis, so investigate for GERD

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16
Q

Treatment for Esophageal chest pain

A

PPI
think about getting esophageal motility study

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17
Q

What is the most common presenting symptom for all motility disorders

A

Dysphagia

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18
Q

Painful swallowing

A

odynophagia

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19
Q

Difficulty swallowing

A

Dysphagia

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20
Q

effortless appearance of gastric or esophageal contents in the mouth

A

Regurgitation

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21
Q

What may regurgitation result in?

A

chronic cough, laryngitis, laryngeal aspiration, awaken from sleep due to cough/choke, lastly, aspiration pneumonia

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22
Q

If you have dysphagia of both solids and liquids at the onset of symptoms what do you want to be thinking of

A

motility disorder

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23
Q

Dysphagia to solids that later involves liquids what should you be thinking

A

mechanical esophageal obstruction

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24
Q

Progressive dysphagia to both liquids and solids, regurgitation. Occasionally chest pain.

A

Achalasia

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25
Q

What is the mechanical deficit in Achalasia

A

decreased peristalsis and increased sphincter tone

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26
Q

Achalasia is the most common ______ disorder caused by idiopathic loss of ____________ __________ causing failure of LES relaxation and lack of peristalsis

A

Motility disorder
Auerbach’s plexus (loss of ganglion cells)

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27
Q

Diagnostic of Achalasia

A

Bird/Parrot Beak on barium swallow with dysphagia to both solids and liquids

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28
Q

Tx of Achalasia - which is most effective

A

Mechanical - dilation/surgery
Pharm - Botox/ Oral Nitrates
Surgery - Heller Myotomy - most effective

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29
Q

With achalasia, what should you get to rule out cancer/secondary causes

A

Endoscopy

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30
Q

What is characterized by strong non-peristaltic esophageal contraction with complaints of STABBING CHEST PAIN that is WORSE WITH HOT OR COLD LIQUIDS AND FOOD

A

Diffuse Esophageal Spasm

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31
Q

Diagnostic of DES

A

Corkscrew appearance on barium swallow

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32
Q

What may you want to evaluate your DES patients for?

A

psychiatric conditions, including depression, psychosomatic complaints, and anxiety

Antidepressants – give tricyclics if the case

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33
Q

If DES patients have persistent symptoms what are some treatment options

A

CCB - dilt 60-90 4xd
botox injection can also be use

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34
Q

Dysphagia to both liquids and solids that is associated with neuromuscular disease, like myasthenia graves, amyotrophic lateral sclerosis, or stroke

A

Neurogenic Dysphagia

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35
Q

sac-like out pouching of the mucosa and submucosa (diverticula)

A

Zenker’s Diverticulum

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36
Q

What will you see with ZD

A

regurgitation of undigested food and liquid into the pharynx SEVERAL HOURS after eating, foul odor of breath

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37
Q

middle age or older adults with progressive dysphagia (usually to solids) and regurgitation of undigested food debris – what are you thinking?

A

Zenker Diverticulum

38
Q

Diagnostic of ZD

A

Barium Swallow
EGD - upper endoscopy (Gold Standard)

39
Q

Treatment of ZD in General

A

observe if small and asymptomatic

diverticulectomy, cricopharyngeal myotomy

40
Q

where does ZD emerge from

A

Killian’s Triangle (hypo pharynx wall formed by pharyngeal constrictor muscle and cricopharynceal muscle)

41
Q

Is Killian’s triangle more prevalent in males or females

A

males

42
Q

Manifestations of ZD

A

small? asymptomatic
large? halitosis, gurgling in throat, mass in new, regurg of food into mouth

43
Q

Complications of ZD

A

aspiration pneumonia, ulceration, fistula, vocal cord paralysis

44
Q

Treatment Specific for ZD

A

asymptomatic? no need to intervene
<2cm? cricopharynxgeus myotomy
>2cm? surgical (open diverticulectomy with cricopharynxgeus myotomy) or endoscopic (diverticulectomy) intervention

45
Q

Scleroderma Esophagus , related to sclerosis, is caused by what

A

Secondary to autoimmune.. aka raynauds

which causes Decreased esophageal sphincter tone and peristalsis

46
Q

Which motility disorder is characterized by patients who present with solid food dysphagia and hx of GERD

A

Esophageal Stricture

47
Q

How would you describe the what an esophageal stricture is

A

narrowing of the lien of the esophagus preventing the passage of foods typically at the distal end of the tube

48
Q

What is an esophageal stricture the result of?

A

scarring after chronic exposure to gastric juice due to GERD, may also be due to trauma or surgery

49
Q

what is the demarcation line or squamocolumnar junction that represents the normal esophogastric junction where squamous mucosa of the esophagus and columnar mucosa of the stomach meet?

A

Z LINE

50
Q

are you typically asymptomatic if you have esophageal rings or webs?

A

yes

51
Q

Is esophageal rings or webs found in the upper part of the esophagus

A

Esophageal Web

52
Q

Are esophageal rings or webs found in the lower part of the esophagus

A

Esophageal rings

53
Q

Where do esophageal webs most commonly occur

A

anteriorly in the cervical esophagus, causing a narrowing of the postcricoid area

54
Q

Where are the 2 rings of the esophageal ring found?

A

Ring A - above the Z line
Ring B - below the Z line

55
Q

What is the B ring also known as? Is it common?

A

Schatzki Ring
Yes, 6-14% with routine GI series have it

56
Q

What is esophageal ring (B) often associated with

A

hiatal hernia (almost always) and eosinophilic esophagitis

57
Q

Schatzki ring is often called what syndrome?

A

Steakhouse syndrome
someone shoving food down throat and not chewing or swallowing “wolfed-down”

58
Q

What does a hiatal hernia do

A

constricts the esophageal lumen

59
Q

Even though most B rings are asymptomatic, at what diameter will patients experience intermittent dysphagia with solids or food imputations?

A

when the diameter of the esophageal lumen is narrowed to 13 mm or less

60
Q

What are esophageal webs associated with?

A

Zenkers Diverticulum, dermatologic and immunologic disorders, and ID anemia

61
Q

thin membranes in mid-upper esophagus which may be congenital or acquired

A

esophageal web

62
Q

The triad of iron deficiency anemia, dysphagia and a cervical esophageal web is associated with what syndrome?

A

Plummer-Vinson Syndrome

63
Q

Who is most likely to develop Plummer Vinson Syndrome

A

white women in 4th to 7th decade of life

64
Q

What is Plummer Vinson Syndrome a risk factor for?

A

Esophageal or pharyngeal squamous cell carcinoma

65
Q

The esophageal strictures (webs and rings) are associated with dysphagia when?

A

With solids

66
Q

Diagnostic test for esophageal stricture/stenosis (ring or web)

A

Barium swallow
Upper endoscopy

67
Q

Treatment for esophageal stricture/stenosis (ring or web)

A

dilation

68
Q

Patient presents with hematemesis, Selena, hematochezia, and maybe signs of hypovolemia (typically bleed massively) is descriptive of what

A

Esophageal Varices

69
Q

what are varies?

A

dilated veins aka varicose veins in the distal esophagus or proximal stomach

70
Q

What is the most common cause of esophageal varicose, and all patients need to be screened for varices when they have this disease

A

CIRRHOSIS

71
Q

3 classifications of esophageal varices

A

F1: small straight varices
F2: occupy less than 1/3 of lumen
F3: coiled-shape; occupy > 1/3 of lumen

72
Q

Diagnostics for Esophageal varices

A

upper endoscopy

73
Q

Treatment of esophageal varices

A
  1. endoscopic banding and IV octreotide (vasoconstrictor)
  2. transjugular intrahepatic shunts
  3. Prevention of repleeds with nonselective BB, isosorbide,
  4. Fluoroquinolones to prevent infectious complications
74
Q

When are patients most likely to have rebleeds with esophageal varicose? is this serious?

A

70% of rebleeds are within 1 year
yes, 1/3 are fatal

75
Q

Patient presents with hematemesis, vomiting, and retching after alcohol intake is characterized by what? “spring breakers”

A

Mallory Weiss Tear

76
Q

What is a mallory weiss tear?

A

linear mucous tear in esophagus at gastroesophageal junction

77
Q

What percentage of MW tears are the cause of acute upper GI bleeds

A

5-10%

78
Q

What history will the patient have with MW tear?

A

alcohol intake and episode of vomiting with blood

79
Q

Diagnostic and treatment for Mallory Weiss Tear

A

upper endoscopy where you will see erosion

usually no treatment needed

80
Q

Patient presents with PROGRESSIVE dysphagia to SOLID foods along with weight loss, chest pain, hoarseness, reflux, and hematemesis

A

Esophageal Neoplams

81
Q

Esophageal Neoplasms can occur due to a complication of what

A

Barrett’s esophagus

82
Q

What is the most common esophageal neoplasm worldwide vs. US

A

Worldwide - squamous cell (90-95%)
US - adenocarcinoma due to complication of GERD/Barretts esophagus

83
Q

What is the 5 year survival rate of esophageal adenocarcinoma and what pt history is it associated with?

A

5-10% very low

Male with hx of smoking and alcohol use

84
Q

Diagnostic of Esophageal neoplasms

A

TOC: endoscopy with biopsy
Staging: CT scan

85
Q

treatment of esophageal neoplasms

A

esophageal resection - radiation and chemo

86
Q

If patient has a hx of Barrett’s esophagus how often due they need endoscopic screening post neoplasm resection?

A

every 3-5 years

87
Q

multiple shallow ulcers - often seen in immunocompromised patients

A

herpes simplex (HSV-1) of the esophagus

88
Q

Treatment of HSV1 herpes simplex of esophagus

A

acyclovir

89
Q

Patient presents with odynophagia, dysphagia, and chest pain, and upon endoscopy you see scattered or coalescent yellow-white mucosal plaques

A

Candidiasis of the esophagus

90
Q

Treatment of Candidiasis of the Esophagus

A

Flucanazole 100mg po QD

91
Q

Exclusively seen in immunocompromised patients who were infected with HIV and have low CD4 counts or malignancy or transplant patients - presents with severe odynophagia with evidence of esophageal ulcers

A

Cytomegalovirus

Gastro Exam 1 (2 decks)

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