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Flashcards in Esophagus and Stomach DSA Deck (60):
1

causes of nausea and vomiting

visceral afferent stimulation
vestibular disorders
CNS disorders
Irritation of chemoreceptor trigger zone

2

visceral afferent stimulation causes of nausea and vomiting

-infections
-mechanical obstruction
-dysmotility (gastroparesis, scelroderma)
-peritoneal irritation (viruses, food poisoning, appendicitis)
-hepatobillary or pancreatic disorders
-topical GI irritants (antibiotics, alcohol, NSAIDs)
-postoperative
-other

3

vestibular disorders and N/V

labryinthitis, meniere syndrome, motion sickness

4

CNS disorders and N/V

increased intracranial pressure (tumors, hemmor)
migraine
infections (meningitits)
psychogenic (anticipatory vomiting, anorexia, bulemia)

5

irritaiton of chemoreceptor trigger zone and N/V

antitumor chemo
medications and drugs
radiation therapy
systemic disorders

6

medications and drugs with irritation of chemoreceptor trigger zone and N/V

opiods
anticonvulsants
antiparkinsonism drugs
beta blockers, antiarrhythmics, digoxin
nictotine
OCs
cholinesterase inhibitors
diabetes meds like metformin

7

systemic disorders associated with irritation of chemoreceptor trigger zone and N/V

diabetic ketoacidosis
uremia
adrenocortical crisis
parathyroid disease
hypothyroidism
pregnancy
paraneoplastic syndrome

8

causes of oropharyngeal dysphagia

neuro disorders
muscular and rheumatologic disorders
metanbolic disorders
infectious disease
structural disorders
motitility disorders

9

oropharyngeal dysphagia and some neuro disorders that cause it

Guillain-Barre syndrome
parkinsons
huntington
dementia
MS
ALS
brain trauma
mass lesion

10

muscular and rheumatologic disorders with oropharyngeal dysphagia

sjogren syndrome
myopathies

11

metabolic disorders with oropharyngeal dysphagia

amyloidosis
cushing
wilson
med side effects: anticholinergics, phenothiazines

12

infectious disease and oropharyngeal dysphagia

polio
diptheria
botulism
lyme disease
syphilis
mucositis (candida, herpes)

13

structural disordes with oropharyngeal dysphagia

zenker diverticulum
esophageal webs
tumor
postsurgical change
pill induced injury

14

esophageal dysphagia clue: intermittent dysphagia, not progressive

schatzki ring

15

esophageal dysphagia clue: chronic heartburn, progressive dysphagia

peptic stricture

16

esophageal dysphagia clue: progressive dysphagia, age over 50

esophageal cancer

17

esophageal dysphagia clue: yhoung adult, small caliber lumen, proximal stricture, corrugated rings, or white papules

eosinophilic esophagitis

18

what kind of dysphagia is achalasia

progressive

19

esophageal dysphagia clue: intermittient, not progressive, may have chest pain

diffuse esophageal spasm

20

esophageal dysphagia clue: chronic heartburn, raynaud phenomenon

scleroderma

21

esophageal dysphagia clue: intermittent, not progressive, commonly associated with GERD

ineffective esophageal motility

22

endoscopy is the study of choice for evaluating what

persistent heartburn, dysphagia, odynophagia, and structral abnornalities detected on barium esophagography

-allows biopsy of mucosal abnormalitites and of normal mucosa (evaluate for eosinophilic esophagitis) and dilation of strictures

23

what is oropharyngeal dysphagia best evaluated by

rapid sequence videoesophagography

24

what can a barium esophagography help differentiate

btwn mechainical lesion and motility disorder

25

what should be obtained first in pts with suspected motility disorder

barium esophagoscopy

26

in pts with high suspicion of mechanical lesion of esophagus what is done first
but..

endoscopic evaluation although barium study is more sensitive for detecting subtle esophageal narrowing due to rings, achalasia, and porximal esophageal lesions

27

what are the uses of esophageal manometry

1) determine location of LES for placement of electrode pH probe

2) to establish etiology of dysphagia in pts in whom pts with mechanical obstruction cannot be found, especially if achalasia suspected

3) for preoperative assessment of pts being considereed for antireflux surgery to exclude alt diagnosis or possibly to assess peristaltic fnct in esophageal body

28

what are esophageal pH recording and impedence testing used for

moniter pH of espohagus to provide info about amt of esophageal acid reflux and temporal correlations btwn symptoms and reflux

-provide info on amt of esophageal acid reflux but not nonacid refulx, use multichannel intraluminal impedance too to assess nonacid liquid reflux

-useful in pts with atypical reflux symptoms or persistent symptoms despite therapy with PPI to diagnose hypersensitivity, funct symptoms, and symptoms caused by nonacid reflux

29

typical symptom of GERD

what occurs in 1/3 of these pts

heartburn most often 30-60 mintues after meals and upon reclining
-antacids or baking soda helps

-dysphagia in 1/3 of pts

30

atypical or extraesophageal manifestations of GERD

asthma
chronic cough
chronic laryngitis
sore throat
non cardiac chest pain
sleep disturcbances

31

should barium esophagography be used to diagnose GERD

no

32

differential diagnosis of GERD

esophageal motility disorders
peptic ulcer
angina pectoris
functional disorder

33

reflux erosive esophagitits may be confused with

pill induced damage
eosinophiic esophagitis
infections

34

complications of GERD

barrett esophagus-->possible adenocarcinoma
peptic stricture

35

what is mandatory in all cases to differnetiate a peptic stricutre from a stricture by esophageal carcionoma

endoscopy with biopsy

36

how to treat peptic stricutre

dilation with graduated polyvinyl catheters passed over a wire
balloons passed fluorscopically or thorugh an endoscope
luminal diameter of 13-17mm is usually sufficient to relieve dysphagia

-long term therapy with a proton pump inhibitor is required to decrease likelihood of stricture recurrence

37

extraesophageal reflux manifestations
-trial of what to figure out if GERD is contributing factor

asthma, hoarseness, cough, sleep distrucbance
may be contributing factor not sole factor
-trial of TID PPI administered for 2-3 months in pts with extraesophageal GERD or typical GERD symptoms
-improvement of extraesophageal symptoms suggests that GERD is causative factor
-esophageal imedance pH testing may be used in pts who don't get better after 3 months PPIs

38

unresponsive disease

pts who don't respond to 2x daily PPI should undergo endoscopy for detection of severe inadequately treated reflux esophagitis and for other gastroespohageal lesions that may mimic GERD
-presence of active erosive espophagitis usually is indicative of inadequate acid suppression and can be treated with higher dose PPI

39

most common pathogens with infectious esophagitis in immunosuppressed pts

candida albicans
herpes simplex
CMV

40

what infection in those with uncontrolled diabetes

candidda

41

is oral thrush a reliable indicator of casue of esophageal infection

no
not in all pts that have candidal esophagitis

42

pts with esophgaeal CMV infection may have infection at other sites such as

colon and retina

43

diagnosis for esophageal candititis

endoscopy with biopsy and brushing preferred

44

endoscopic signs of candidal esophagitis

diffuse linear, yellow-white plaques adherent to the mucosa

45

CMV esophagitis is charactereized by

one to several large, shallow, superficial ulcerations
-herpes esophagitis results in multiple small, deep ulcerations

46

-herpes esophagitis results in

multiple small, deep ulcerations

47

treatment length of oral candititis

21 days

48

treatment for esophageal candititis

flucanozle
then itraconazole if fluc not working or vaoriconazole
caspofungin for refractory infection (IV)

49

the most common meds that may inure esophagus

NSAIDs
potassium chloride pills
quinidine
zalcitabine
zidovudine
alendronate
risedronate
emepronium bromide
iron
vitamin
c
antibiotics

50

symptoms of pill induced esophagitis

odynophagia, dysphagia, severe retrosternal chest pain
several hours after taking a pill

51

what might endoscopy shows for pill induced esophagitits

one to several discrete ulcers that may be shallow or deep

52

special exam for mallory weiss

upper endoscopy
diagnosis established by .5-4 cm linear mucosal tears usualy at GE junction or more commonly just below the junction in the gastric mucosa

53

eosinophilia of the esophagus is most commonly caused by what conditions

eosinophilic esophagitis
GERD
PPI responsive eosinophilia
celiac disease
chron disease
pephigus (rarely)

54

what is required to establish diagnosis of eosinophilic esophagitis

-what would endoscopy show

endoscopy with esophageal biopsy and histologic evaluation

endoscopy: white exudates or pa[pules, red furrows, corrugated concentric rings and strictures

55

what is the best way to visualize esophageal webs and rings

barium esophagogram with full esophageal distention

56

location of schatzkis rings and almost always associated with what

distal esophagus at squamocolumnar junction
associated with hiatal hernia

57

treatmetn of rings and webs

passage of bougie dilator or endoscopic electrosurgical incision

58

best way to diagnose zenker diverticulum

video esophagography

59

diagnosis of esophageal varices

upper endoscopy

60

number of factors that increased risk of bleed from esophageal varices

-size of varices
-presence at endoscopy of red wale markings (longitud dilated venules on varix surface)
-severity of liver disease
-active alcohol abuse