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
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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
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
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video esophagography- used for?
-oropharyngeal dysphagia
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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
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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
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Esophageal pH recording- used for
-amount of esophageal acid reflux
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GERD- sx and signs
-heartburn- typical!!!
-30-60 min after meals, reclining
-regurgitation
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GERD- diff diagnosis
-esophageal motility disorders
-peptic ulcer
-angina pectoris
-fxnal disorders
-pill-induced damage, eosinophilic esophagitis, infectons
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GERD- complications
-BE
-peptic stricture
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GERD- Barrett Esophagus
-from chronic GERD, obesity
-biopsies- confirm diagosis
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Barrett Esophagus- complication
-esophageal adenocarcinoma- do endoscopic surveillance yearly!
-endoscopic therapy- for high-grade dysplasia
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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
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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
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Infectious esophagitis- caused by
-Candida albicans (esp in uncontrolled diabetes), herpes simplex, CMV
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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
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Pill-induced esophagitis
-injury most common if pills swallowed w/o water or supine
-sx- retrosternal chest pain, odynophagia, dysphagia
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Benign esophageal lesions
-Mallory-Weiss Syndrome
-Eosinophilic esophagitis
-esophageal webs and rings
-zenker diverticulum
-esophageal varices
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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
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Zenker diverticuluum
-protrusion of pharyngeal mucosa at the pharyngoesophageal jxn
-loss of elasticity of UES
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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
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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!!!
27
Achalasia- diff diagnosis
-Chagas disease (in pts from Central/South America)
-tumors- "pseudoachalasia"
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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
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Erosive and Hemorrhagic Gastritis- causes?
-stress gastritis
-NSAID gastritis
-alcoholic
-portal HTN
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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
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