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