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G2F > Esophagus and stomach CIS > Flashcards

Esophagus and stomach CIS Flashcards

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1
Q

bad taste in mouth

A

water brash

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2
Q

gurgling of stomach

A

borborygmi

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3
Q

bad breath

A

halitosis

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4
Q

GERD

A
  • solids and liquids- intermittent, not progressive

- can have esophageal dysphagia when accompanied by weak peristalsis- motility disorder- ineffective esophageal motility

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5
Q

GERD- complications

A

-esophagitis, stricture, BE, adenocarcinoma

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6
Q

GERD- Dx

A
  • ambulatory 24 to 48 hr esophageal pH recording

- EGD if alarm sx

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7
Q

GERD- treatment

A

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
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8
Q

GERD- red flags

A
  • weight loss
  • persistent vomiting
  • constant/severe pain
  • dysphagia
  • hematemesis
  • melena
  • anemia
  • *needs endoscopy (or ABD imaging)!!!
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9
Q

GERD- when else do we need endoscopy

A
  • failed response to 4-8 wks of PPI

- when frequent sx relapse after PPI discontinued

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10
Q

esophageal stricture- sx, caused by?

A
  • esophageal dysphagia
  • progressive- solids–> liquids
  • most common is peptic secondary to GERD (can also occur b/c of eosinophilic esophagitis)
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11
Q

esophageal stricture- Dx, Tx

A
  • barium swallow/EGD

- dilation, PPI/H2 blocker

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12
Q

esophageal ring (Schatzki)- sx

A
  • esophageal dysphagia
  • solids; intermittent sx
  • “steakhouse syndrome”
  • > 40 yrs- acquired
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13
Q

esophageal ring- dx, tx

A
  • barium swallow/EGD

- dilation

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14
Q

Barrett esophagus

A
  • specialized columnar metaplasia in distal esophagus- in ppl with GERD!
  • esophageal adenocarcinoma!
  • at risk- obese white males > 40
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15
Q

BE- Dx

A
  • EGD with Bx

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

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16
Q

BE- Tx

A
  • surveillance endoscopy
  • endoscopic ablation
  • surgical resection
  • PPI!
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17
Q

esophageal cancer

A
  • adenocarcinoma

- SCC

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18
Q

adenocarcinoma

A
  • M>W
  • BE
  • distal 1/3 of esophagus
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19
Q

SCC

A
  • > 45, M
  • middle 1/3 of esophagus
  • smoking, alcohol, HPV
  • chemical/thermal injury
  • esophageal disorders- Achalasia
  • radiation
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20
Q

Scleroderma- sx

A
  • 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
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21
Q

Scleroderma- ab’s

A
  • ANA (in 90%)
  • Topoisomerase I ab’s (anti-Scl-70)- 30% with diffuse dz!!
  • Anticentromere ab’s- 45% with limited dz!!
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22
Q

Diffuse Scleroderma

A
  • diffuse- proximal extremities and trunk
  • early and progressive internal organ involvement
  • worse prognosis
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23
Q

Limited Scleroderma

A
  • fingers, toes, face, distal extremities
  • Raynaud’s
  • CREST syndrome- calcinosis cutis, raynaud’s, esophageal dysmotility, sclerodactyly, telangiectasia
  • indolent course
  • good prognosis
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24
Q

Zenker’s diverticulum- what is it? sx?

A
  • 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
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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!!

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