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Gastro Exam 1 > Esophagus and Stomach > Flashcards

Esophagus and Stomach Flashcards

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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
What is the mechanical deficit in Achalasia
decreased peristalsis and increased sphincter tone
26
Achalasia is the most common ______ disorder caused by idiopathic loss of ____________ __________ causing failure of LES relaxation and lack of peristalsis
Motility disorder Auerbach's plexus (loss of ganglion cells)
27
Diagnostic of Achalasia
Bird/Parrot Beak on barium swallow with dysphagia to both solids and liquids
28
Tx of Achalasia - which is most effective
Mechanical - dilation/surgery Pharm - Botox/ Oral Nitrates Surgery - Heller Myotomy - most effective
29
With achalasia, what should you get to rule out cancer/secondary causes
Endoscopy
30
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
Diffuse Esophageal Spasm
31
Diagnostic of DES
Corkscrew appearance on barium swallow
32
What may you want to evaluate your DES patients for?
psychiatric conditions, including depression, psychosomatic complaints, and anxiety Antidepressants -- give tricyclics if the case
33
If DES patients have persistent symptoms what are some treatment options
CCB - dilt 60-90 4xd botox injection can also be use
34
Dysphagia to both liquids and solids that is associated with neuromuscular disease, like myasthenia graves, amyotrophic lateral sclerosis, or stroke
Neurogenic Dysphagia
35
sac-like out pouching of the mucosa and submucosa (diverticula)
Zenker's Diverticulum
36
What will you see with ZD
regurgitation of undigested food and liquid into the pharynx SEVERAL HOURS after eating, foul odor of breath
37
middle age or older adults with progressive dysphagia (usually to solids) and regurgitation of undigested food debris -- what are you thinking?
Zenker Diverticulum
38
Diagnostic of ZD
Barium Swallow EGD - upper endoscopy (Gold Standard)
39
Treatment of ZD in General
observe if small and asymptomatic diverticulectomy, cricopharyngeal myotomy
40
where does ZD emerge from
Killian's Triangle (hypo pharynx wall formed by pharyngeal constrictor muscle and cricopharynceal muscle)
41
Is Killian's triangle more prevalent in males or females
males
42
Manifestations of ZD
small? asymptomatic large? halitosis, gurgling in throat, mass in new, regurg of food into mouth
43
Complications of ZD
aspiration pneumonia, ulceration, fistula, vocal cord paralysis
44
Treatment Specific for ZD
asymptomatic? no need to intervene <2cm? cricopharynxgeus myotomy >2cm? surgical (open diverticulectomy with cricopharynxgeus myotomy) or endoscopic (diverticulectomy) intervention
45
Scleroderma Esophagus , related to sclerosis, is caused by what
Secondary to autoimmune.. aka raynauds which causes Decreased esophageal sphincter tone and peristalsis
46
Which motility disorder is characterized by patients who present with solid food dysphagia and hx of GERD
Esophageal Stricture
47
How would you describe the what an esophageal stricture is
narrowing of the lien of the esophagus preventing the passage of foods typically at the distal end of the tube
48
What is an esophageal stricture the result of?
scarring after chronic exposure to gastric juice due to GERD, may also be due to trauma or surgery
49
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?
Z LINE
50
are you typically asymptomatic if you have esophageal rings or webs?
yes
51
Is esophageal rings or webs found in the upper part of the esophagus
Esophageal Web
52
Are esophageal rings or webs found in the lower part of the esophagus
Esophageal rings
53
Where do esophageal webs most commonly occur
anteriorly in the cervical esophagus, causing a narrowing of the postcricoid area
54
Where are the 2 rings of the esophageal ring found?
Ring A - above the Z line Ring B - below the Z line
55
What is the B ring also known as? Is it common?
Schatzki Ring Yes, 6-14% with routine GI series have it
56
What is esophageal ring (B) often associated with
hiatal hernia (almost always) and eosinophilic esophagitis
57
Schatzki ring is often called what syndrome?
Steakhouse syndrome someone shoving food down throat and not chewing or swallowing "wolfed-down"
58
What does a hiatal hernia do
constricts the esophageal lumen
59
Even though most B rings are asymptomatic, at what diameter will patients experience intermittent dysphagia with solids or food imputations?
when the diameter of the esophageal lumen is narrowed to 13 mm or less
60
What are esophageal webs associated with?
Zenkers Diverticulum, dermatologic and immunologic disorders, and ID anemia
61
thin membranes in mid-upper esophagus which may be congenital or acquired
esophageal web
62
The triad of iron deficiency anemia, dysphagia and a cervical esophageal web is associated with what syndrome?
Plummer-Vinson Syndrome
63
Who is most likely to develop Plummer Vinson Syndrome
white women in 4th to 7th decade of life
64
What is Plummer Vinson Syndrome a risk factor for?
Esophageal or pharyngeal squamous cell carcinoma
65
The esophageal strictures (webs and rings) are associated with dysphagia when?
With solids
66
Diagnostic test for esophageal stricture/stenosis (ring or web)
Barium swallow Upper endoscopy
67
Treatment for esophageal stricture/stenosis (ring or web)
dilation
68
Patient presents with hematemesis, Selena, hematochezia, and maybe signs of hypovolemia (typically bleed massively) is descriptive of what
Esophageal Varices
69
what are varies?
dilated veins aka varicose veins in the distal esophagus or proximal stomach
70
What is the most common cause of esophageal varicose, and all patients need to be screened for varices when they have this disease
CIRRHOSIS
71
3 classifications of esophageal varices
F1: small straight varices F2: occupy less than 1/3 of lumen F3: coiled-shape; occupy > 1/3 of lumen
72
Diagnostics for Esophageal varices
upper endoscopy
73
Treatment of esophageal varices
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
When are patients most likely to have rebleeds with esophageal varicose? is this serious?
70% of rebleeds are within 1 year yes, 1/3 are fatal
75
Patient presents with hematemesis, vomiting, and retching after alcohol intake is characterized by what? "spring breakers"
Mallory Weiss Tear
76
What is a mallory weiss tear?
linear mucous tear in esophagus at gastroesophageal junction
77
What percentage of MW tears are the cause of acute upper GI bleeds
5-10%
78
What history will the patient have with MW tear?
alcohol intake and episode of vomiting with blood
79
Diagnostic and treatment for Mallory Weiss Tear
upper endoscopy where you will see erosion usually no treatment needed
80
Patient presents with PROGRESSIVE dysphagia to SOLID foods along with weight loss, chest pain, hoarseness, reflux, and hematemesis
Esophageal Neoplams
81
Esophageal Neoplasms can occur due to a complication of what
Barrett's esophagus
82
What is the most common esophageal neoplasm worldwide vs. US
Worldwide - squamous cell (90-95%) US - adenocarcinoma due to complication of GERD/Barretts esophagus
83
What is the 5 year survival rate of esophageal adenocarcinoma and what pt history is it associated with?
5-10% very low Male with hx of smoking and alcohol use
84
Diagnostic of Esophageal neoplasms
TOC: endoscopy with biopsy Staging: CT scan
85
treatment of esophageal neoplasms
esophageal resection - radiation and chemo
86
If patient has a hx of Barrett's esophagus how often due they need endoscopic screening post neoplasm resection?
every 3-5 years
87
multiple shallow ulcers - often seen in immunocompromised patients
herpes simplex (HSV-1) of the esophagus
88
Treatment of HSV1 herpes simplex of esophagus
acyclovir
89
Patient presents with odynophagia, dysphagia, and chest pain, and upon endoscopy you see scattered or coalescent yellow-white mucosal plaques
Candidiasis of the esophagus
90
Treatment of Candidiasis of the Esophagus
Flucanazole 100mg po QD
91
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
Cytomegalovirus

Gastro Exam 1 (2 decks)

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