Flashcards in Esophagus and stomach CIS Deck (67):
bad taste in mouth
gurgling of stomach
-solids and liquids- intermittent, not progressive
-can have esophageal dysphagia when accompanied by weak peristalsis- motility disorder- ineffective esophageal motility
-esophagitis, stricture, BE, adenocarcinoma
-ambulatory 24 to 48 hr esophageal pH recording
-EGD if alarm sx
trial of acid suppression and lifestyle modification- first line!
-dec Etoh and caffeine
-small low fat meals
-assess psychosocial situation
-PPI- first line
-H pylori eradication if indicated
GERD- red flags
**needs endoscopy (or ABD imaging)!!!
GERD- when else do we need endoscopy
-failed response to 4-8 wks of PPI
-when frequent sx relapse after PPI discontinued
esophageal stricture- sx, caused by?
-progressive- solids--> liquids
-most common is peptic secondary to GERD (can also occur b/c of eosinophilic esophagitis)
esophageal stricture- Dx, Tx
-dilation, PPI/H2 blocker
esophageal ring (Schatzki)- sx
-solids; intermittent sx
->40 yrs- acquired
esophageal ring- dx, tx
-specialized columnar metaplasia in distal esophagus- in ppl with GERD!
-at risk- obese white males > 40
-EGD with Bx
-screening EGD in pts with chronic (10 yrs) GERD!
-distal 1/3 of esophagus
-middle 1/3 of esophagus
-smoking, alcohol, HPV
-esophageal disorders- Achalasia
-esophageal dysphagia- mainly solids
-motility disorder- absent peristalsis, weakness of LES
-30-50 age, F
-microangiopathy and fibrosis of skin and visceral organs!!!
-may present with chronic heartburn and raynaud phenomenon
-ANA (in 90%)
-Topoisomerase I ab's (anti-Scl-70)- 30% with diffuse dz!!
-Anticentromere ab's- 45% with limited dz!!
-diffuse- proximal extremities and trunk
-early and progressive internal organ involvement
-fingers, toes, face, distal extremities
-CREST syndrome- calcinosis cutis, raynaud's, esophageal dysmotility, sclerodactyly, telangiectasia
Zenker's diverticulum- what is it? sx?
-oropharyngeal > esophageal
-false diverticula- b/w the cricopharyngeus m and inferior pharyngeal constrictor m's- in Killian's triangle!!
-sx- dysphagia, regurgitation, choking, aspiration, voice changes, halitosis, weight loss
Zenker's diverticulum- Dx, Tx
Test for achalasia
seen with Sjogren's syndrome?
B cell non-Hodgkin lymphoma
Test for GERD
Sjogren's syndrome- sx
-F, mid 50's, postmenopausal
-Sicca sx- dry eyes/mouth- oropharyngeal dysphagia
-primary- loss of ganglion cells within myenteric plexus!!
-secondary- chagas disease (trypanosoma cruzi- kissing bug vector)
-barium swallow xray and esophageal manometry!!!
-LES pressure can be reduced by nitrates and CCB therapy, pneumatic balloon dilatation, botox injection, or surgical myotomy
-incomplete LES relaxation
-inc LES tone
Esophageal webs- sx
-Plummer-Vinson syndrome- iron def anemia, cheilitis, glossitis, koilonychia (spoon nails)- middle aged women!
esophageal webs- Dx, Tx
-upper esophagea lwebs
-oropharyngeal dysphagia- intermittent, solids!
-iron def anemia- weakness, fatigue
-koilonychia (spoon nails)
Assoc with scleroderma?
Candidiasis- occurs in who?
Eosinophilic Esophagitis- sx
-M, allergies, atopic conditions
-dysphagia and esophageal food impactions!!!
Eosinophilic Esophagitis- Dx
-multiple circular esophageal rings creating a corrugated appearance ("feline esophagus"/ looks like trachea), edema
Eosinophilic Esophagitis- Biopsy
-squamous epit eosinophil-predominant infl
->15-20 eosinophils per high-power field
Eosinophilic Esophagitis- complications
-esophageal stricture, narrow-caliber esophagus, food impaction, esophageal perforation!!
Eosinophilic Esophagitis- Tx
-PPI, elimination diets, swallow topical glucocorticoids, allergist referral
-food allergy elimination- milk, wheat, soy, nuts, seafood- followed by systematic reintroduction
-esophageal dilation- relieves dysphagia
-risk of esophageal perforation!!
-dysphagia and odynaphagia!!- mainly solids
-pill- doxycycline, quinidine, phenytoin!!
diffuse esophageal spasm (DES)- sx
(uncoordinated esophageal contraction
-solids and liquids- intermittent!
-LES fxn normal; disordered motility of esophageal body
-dysphagia and chest pain
-"rosary bead esophagus"
diffuse esophageal spasm- Dx
-greater amplitude and duration but normal coordinated contraction!!
-LES relaxes normally, but has an elevated pressure at baseline!!
mechanical obstruction vs motility disorder
-mechanical- solid foods worse than liquids
-motility- solids and liquids
Esophageal Perforation- sx
-forceful vomiting- rupture at gastroesophageal jxn- Boorhaave's syndrome- pleuritic retrosternal pain- pneumomediastinum, subcutaneous emphysema
Esophageal perforation- dx
-CT of chest- detects mediastinal air
-confirmed by contrast swallow, usually gastrografin followed by thin barium
esophageal perforation- tx
-NGT suction, NPO parenteral antibx and surgery
-nontransmural tear at GE jxn
-causes upper GI bleeding
mallory- weiss tear- dx, tx
-bleeding usually abates spontaneously!
-protracted bleeding may respond to local epinephrine!! or cauterization therapy, endoscopic clipping, or angiographic embolization
Esophageal varices- sx, dx, tx
-dilated submucosal v's
-asymptomatic or hematemesis- if rupture- emergency!!
-liver dz work up
-Tx- banding, sclerotherapy, balloon tamponade, variceal ligation, B blocker to dec portal HTN
stress ulcers- caused by?
-curling ulcer- burns
H pylori- assoc with
smoking + H pylori
peptic ulcer dz- causes
-NSAID, H pylori, EtOH
peptic ulcer dz- dx, tx
-EGD +/- H pylori
-H2 blocker, PPI, eradicate H pylori!!
Gastric ulcer disease- caused by? sx?
-H pylori (75% of time)
-lesser curvature of antrum of stomach
-burning epigastric pain
-worsens within 30 min of eatin
duodenal ulcer- caused by? sx?
-95% secondary to H pylori
-1-3 hrs after eating
-relieved by food/eating
-NSAIDs/steroids- risk factors
Helicobacter pylori- is what? causes what?
-curved gram neg rods that produce urease (microaerophilic spiral gram neg bacilli with flagella)
-chronic gastritis- antrum- inc gastrin- inc Hcl prod by parietal cells- inc risk of duodenal ulcer
-poverty, birth outside US
-person to person (fecal/oral)
H pylori- testing
-Stool ag immunoassay!!
-Carbon 13/14 urea breath test!!
*pt should be off PPI or antibiotics for 7-14 days prior to testing!!
H pylori- histologic exam
-EGD with biopsy (warthin-starry stain) or rapid CLO
H pylori- serology
H pylori abs, IgA