Esophagus and stomach CIS Flashcards Preview

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Flashcards in Esophagus and stomach CIS Deck (67):
1

bad taste in mouth

water brash

2

gurgling of stomach

borborygmi

3

bad breath

halitosis

4

GERD

-solids and liquids- intermittent, not progressive
-can have esophageal dysphagia when accompanied by weak peristalsis- motility disorder- ineffective esophageal motility

5

GERD- complications

-esophagitis, stricture, BE, adenocarcinoma

6

GERD- Dx

-ambulatory 24 to 48 hr esophageal pH recording
-EGD if alarm sx

7

GERD- treatment

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

8

GERD- red flags

-weight loss
-persistent vomiting
-constant/severe pain
-dysphagia
-hematemesis
-melena
-anemia
**needs endoscopy (or ABD imaging)!!!

9

GERD- when else do we need endoscopy

-failed response to 4-8 wks of PPI
-when frequent sx relapse after PPI discontinued

10

esophageal stricture- sx, caused by?

-esophageal dysphagia
-progressive- solids--> liquids
-most common is peptic secondary to GERD (can also occur b/c of eosinophilic esophagitis)

11

esophageal stricture- Dx, Tx

-barium swallow/EGD
-dilation, PPI/H2 blocker

12

esophageal ring (Schatzki)- sx

-esophageal dysphagia
-solids; intermittent sx
-"steakhouse syndrome"
->40 yrs- acquired

13

esophageal ring- dx, tx

-barium swallow/EGD
-dilation

14

Barrett esophagus

-specialized columnar metaplasia in distal esophagus- in ppl with GERD!
-esophageal adenocarcinoma!
-at risk- obese white males > 40

15

BE- Dx

-EGD with Bx
-screening EGD in pts with chronic (10 yrs) GERD!

16

BE- Tx

-surveillance endoscopy
-endoscopic ablation
-surgical resection
-PPI!

17

esophageal cancer

-adenocarcinoma
-SCC

18

adenocarcinoma


-M>W
-BE
-distal 1/3 of esophagus

19

SCC

->45, M
-middle 1/3 of esophagus
-smoking, alcohol, HPV
-chemical/thermal injury
-esophageal disorders- Achalasia
-radiation

20

Scleroderma- sx

-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

21

Scleroderma- ab's


-ANA (in 90%)
-Topoisomerase I ab's (anti-Scl-70)- 30% with diffuse dz!!
-Anticentromere ab's- 45% with limited dz!!

22

Diffuse Scleroderma

-diffuse- proximal extremities and trunk
-early and progressive internal organ involvement
-worse prognosis

23

Limited Scleroderma

-fingers, toes, face, distal extremities
-Raynaud's
-CREST syndrome- calcinosis cutis, raynaud's, esophageal dysmotility, sclerodactyly, telangiectasia
-indolent course
-good prognosis

24

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

25

Zenker's diverticulum- Dx, Tx

-Barium swallow
-surgery

26

Test for achalasia

-esophageal manometry

27

seen with Sjogren's syndrome?


B cell non-Hodgkin lymphoma

28

Test for GERD

esophageal pH

29

Sjogren's syndrome- sx

-rheumatologic
-F, mid 50's, postmenopausal
-Sicca sx- dry eyes/mouth- oropharyngeal dysphagia

30

Achalasia- imaging


-bird's beak
-sigmod esophagus

31

Achalasia- causes

-primary- loss of ganglion cells within myenteric plexus!!
-secondary- chagas disease (trypanosoma cruzi- kissing bug vector)

32

Achalasia- Dx

-barium swallow xray and esophageal manometry!!!

33

Achalasia- Tx


-LES pressure can be reduced by nitrates and CCB therapy, pneumatic balloon dilatation, botox injection, or surgical myotomy

34

Achalasia- Manometry

-incomplete LES relaxation
-inc LES tone
-aperistalsis

35

Esophageal webs- sx

-esophageal dysphagia
-intermittent!
-Plummer-Vinson syndrome- iron def anemia, cheilitis, glossitis, koilonychia (spoon nails)- middle aged women!

36

esophageal webs- Dx, Tx

-barium swallow/EGD
-dilatation

37

Plummer-Vinson syndrome

-upper esophagea lwebs
-oropharyngeal dysphagia- intermittent, solids!
-iron def anemia- weakness, fatigue
-angular cheilitis
-glossitis
-koilonychia (spoon nails)
-pallo

38

Assoc with scleroderma?

GAVE

39

Candidiasis- occurs in who?

-uncontrolled diabetes
-immunosuppressed

40

Eosinophilic Esophagitis- sx

-M, allergies, atopic conditions
-dysphagia and esophageal food impactions!!!

41

Eosinophilic Esophagitis- Dx

EGD!
-multiple circular esophageal rings creating a corrugated appearance ("feline esophagus"/ looks like trachea), edema

42

Eosinophilic Esophagitis- Biopsy

-squamous epit eosinophil-predominant infl
->15-20 eosinophils per high-power field

43

Eosinophilic Esophagitis- complications

-esophageal stricture, narrow-caliber esophagus, food impaction, esophageal perforation!!

44

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!!

45

Esophagitis- causes

-dysphagia and odynaphagia!!- mainly solids
-pill- doxycycline, quinidine, phenytoin!!
-infectious
-eosinophilic

46

diffuse esophageal spasm (DES)- sx

(uncoordinated esophageal contraction
-esophageal dysphagia
-solids and liquids- intermittent!
-"corkscrew esophagus"
-LES fxn normal; disordered motility of esophageal body
-dysphagia and chest pain
-"rosary bead esophagus"

47

diffuse esophageal spasm- Dx

-manometry, EGD

48

Nutcracker esophagus


(hypertensive peristalsis)
-greater amplitude and duration but normal coordinated contraction!!
-LES relaxes normally, but has an elevated pressure at baseline!!

49

mechanical obstruction vs motility disorder

-mechanical- solid foods worse than liquids
-motility- solids and liquids

50

Esophageal Perforation- sx

-trauma
-forceful vomiting- rupture at gastroesophageal jxn- Boorhaave's syndrome- pleuritic retrosternal pain- pneumomediastinum, subcutaneous emphysema

51

Esophageal perforation- dx

-CT of chest- detects mediastinal air
-confirmed by contrast swallow, usually gastrografin followed by thin barium

52

esophageal perforation- tx

-NGT suction, NPO parenteral antibx and surgery

53

Mallory-weiss tear

-vomiting
-nontransmural tear at GE jxn
-causes upper GI bleeding

54

mallory- weiss tear- dx, tx

-history, EGD
-bleeding usually abates spontaneously!
-protracted bleeding may respond to local epinephrine!! or cauterization therapy, endoscopic clipping, or angiographic embolization

55

Esophageal varices- sx, dx, tx

-dilated submucosal v's
-asymptomatic or hematemesis- if rupture- emergency!!
-liver dz work up
-Dx- EGD
-Tx- banding, sclerotherapy, balloon tamponade, variceal ligation, B blocker to dec portal HTN

56

stress ulcers- caused by?

-curling ulcer- burns

57

H pylori- assoc with

MALToma

58

ulcer risk

smoking + H pylori

59

peptic ulcer dz- causes

-NSAID, H pylori, EtOH

60

peptic ulcer dz- dx, tx

-EGD +/- H pylori
-H2 blocker, PPI, eradicate H pylori!!

61

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

62

duodenal ulcer- caused by? sx?

-95% secondary to H pylori
-gnawing pain
-1-3 hrs after eating
-relieved by food/eating
-NSAIDs/steroids- risk factors

63

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
-MALToma assoc
-poverty, birth outside US
-person to person (fecal/oral)
-CagA- toxin

64

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!!

65

H pylori- histologic exam


-EGD with biopsy (warthin-starry stain) or rapid CLO

66

H pylori- serology

H pylori abs, IgA

67

Zollinger-Ellison Syndrme

-PUD that isnt responding to tx, is severe, atypical, recurrent
-gastrin secreting tumor (gastrinoma)- pancreas, proximal duodenal, LN's
-25% apart of MEN1
-hypertrophic gastric mucosa
-2/3 are malignant- metastasize to liver!!
-fasting gastrin--> rule out MEN1!!