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Flashcards in Esophagus and stomach DSA Deck (37):
1

oropharyngeal dysphagia- causes

-neurologic disorders
-muscular and rheumatologic disorders
-metabolic disorders
-infectious disease
-structural disorders
-motility disorders

2

esophageal dysphagia- mechanical obstruction- causes

(solid foods worse than liquids)
-Schatzki ring- intermittent dysphagia; not progressive
-Peptic structure- chronic heartburn; progressive
-Esophageal cancer- progressive
-Eosinophilic esophagitis- rings or white papules
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3

esophageal dysphagia- motility disorder- causes

-achalasia- progressive
-diffuse esophageal spasm- intermittent, not progressive
-scleroderma- chronic heartburn; Raynaud phenomenon
-ineffective esophageal motility- assoc with GERD

4

Upper Endoscopy- used for?

-heartburn, dysphagia, odynophagia, structural abnormalities detected on barium esophagography

5

video esophagography- used for?

-oropharyngeal dysphagia

6

Barium esophagography- used for

-differentiate b/w mechanical and motility causes of esophageal dysphagia
-should be used first in pts with esophageal dysphagia and high suspicion of motility disorder

7

esophageal manometry- used for

-determine location of LES to allow placement of a pH prob
-esta the etiology of dysphagia where a mechanical obstruction cant be found
-preoperative assessment of pts being considered for antireflux surgery

8

Esophageal pH recording- used for

-amount of esophageal acid reflux

9

GERD- sx and signs

-heartburn- typical!!!
-30-60 min after meals, reclining
-regurgitation

10

GERD- diff diagnosis

-esophageal motility disorders
-peptic ulcer
-angina pectoris
-fxnal disorders
-pill-induced damage, eosinophilic esophagitis, infectons

11

GERD- complications

-BE
-peptic stricture

12

GERD- Barrett Esophagus


-from chronic GERD, obesity
-biopsies- confirm diagosis

13

Barrett Esophagus- complication

-esophageal adenocarcinoma- do endoscopic surveillance yearly!
-endoscopic therapy- for high-grade dysplasia

14

Peptic Stricture

-gradual development of solid food dysphagia
-endoscopy with biopsy!!- differentiate from stricture by esophageal carcinoma

15

Extraesophageal reflux manifestations

(asthma, hoarseness, cough, sleep disturbances)
-if suspected extraesophageal GERD syndromes- trial of PPI- but doesnt not prove a causative connection

16

GERD- unresponsive disease

-if dont respond to PPI- should undergo endoscopy for detection of reflux esophagitis or other lesions that may mimic GERD
-if active erosive esophagitis- treat with higher PPI doses
-other causes- gastrinoma (Zollinger-Ellison syndrome), pill-induced esophagitis, resistance to PPIs, medical noncompliance
-pH study!

17

Infectious esophagitis- essentials of diagnosis

-immunosuppressed pt
-odynophagia, dysphagia, chest pain
-endoscopy with biopsy- diagnosis

18

Infectious esophagitis- caused by

-Candida albicans (esp in uncontrolled diabetes), herpes simplex, CMV

19

Infectious esophagitis- endoscopic signs

-candida- diffuse, linear, yellow-white plaques adherent to mucosa
-CMV- one to several large, shallow, superficial ulcerations
-herpes- mult, small deep ulcerations

20

Pill-induced esophagitis

-injury most common if pills swallowed w/o water or supine
-sx- retrosternal chest pain, odynophagia, dysphagia

21

Benign esophageal lesions

-Mallory-Weiss Syndrome
-Eosinophilic esophagitis
-esophageal webs and rings
-zenker diverticulum
-esophageal varices

22

Mallory-Weiss syndrome- essentials of diagnosis

(mucosal laceration of gastroesophageal jxn)
-hematemesis
-prior history of vomiting, retching (alcoholism)
-endoscopy esta diagnosis

23

Eosinophilic esophagitis

-Food/environmental ag's stim an infl response
-history of allergies/atopic conditions (asthma, eczema)
-endoscopy with biopsy- diagnosis
-endoscopy- corrugated concentric rings

24

Zenker diverticuluum

-protrusion of pharyngeal mucosa at the pharyngoesophageal jxn
-loss of elasticity of UES

25

esophageal varices- essentials of diagnosis


-develop secondary to portal HTN
-found in 50% of pts with cirrhosis
-1/3 will develop upper GI bleeding
-diagnosis- upper endoscopy

26

Achalasia- essentials of diagnosis

-progressive dysphagia for solids/liquids
-regurgitation of undigested food
-barium esophagogram- "bird's beak", sigmoid esophagus (dilated)
-esophageal manometry- confirms diagnosis- complete absence of normal peristalsis and incomplete LES relaxation!!!
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27

Achalasia- diff diagnosis

-Chagas disease (in pts from Central/South America)
-tumors- "pseudoachalasia"

28

Erosive and Hemorrhagic Gastritis (Gastropathy)- essentials of diagnosis

-seen in alcoholic or critically ill pts, or pts taking NSAIDs
-often asymptomatic, may cause epigastric pain, N/V
-may cause hematemesis; usually insignificant bleeding
-upper endoscopy

29

Erosive and Hemorrhagic Gastritis- causes?

-stress gastritis
-NSAID gastritis
-alcoholic
-portal HTN

30

Nonerosive, nonspecific gastritis- causes?

-H pylori gastritis

31

noninvasive tests for H pylori

-fecal ag
-ura breath test

32

endoscopic tests for H pylori

-not indicated to diagnose H pylori infection
-used for pts with suspected MALTomas
-confirm infection in pts with a neg rapid urease test

33

Peptic ulcer Disease- essentials of diagnosis

-hx of dyspepsia
-ulcer sx- characterized by rhythmicity and periodicity
-NSAID-induced ulcers are mostly asymptomatic
-upper endoscopy with gastric biopsy for H pylori- diagnostic
-exclude gastric malignancy

34

peptic ulcer disease- 2 causes

-NSAIDs
-chronic H pylori infection

35

peptic ulcer disease- sx

-epigastric pain (dyspepsia)- hallmark!!
-"hunger-like" pain

36

Zollinger-Ellison Syndrome (gastrinoma)- essentials of diagnosis

-peptic ulcer dz
-gastric acid hypersecretion
-diarrhea common, relieved by nasogastric suction
-most are sporadic, 25% with MEN 1

37

Zollinger-Ellison Syndrome- lab findings

-inc fasting serum gastrin concentration!!
-gastric pH > 3- implies hypochlorhydria- excludes gastrinoma