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GI II Final DF > Esophagus and Stomach DSA > Flashcards

Esophagus and Stomach DSA Flashcards

(60 cards)

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1
Q

causes of nausea and vomiting

A

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

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2
Q

visceral afferent stimulation causes of nausea and vomiting

A
  • infections
  • mechanical obstruction
  • dysmotility (gastroparesis, scelroderma)
  • peritoneal irritation (viruses, food poisoning, appendicitis)
  • hepatobillary or pancreatic disorders
  • topical GI irritants (antibiotics, alcohol, NSAIDs)
  • postoperative
  • other
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3
Q

vestibular disorders and N/V

A

labryinthitis, meniere syndrome, motion sickness

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4
Q

CNS disorders and N/V

A

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

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5
Q

irritaiton of chemoreceptor trigger zone and N/V

A

antitumor chemo
medications and drugs
radiation therapy
systemic disorders

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6
Q

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

A 
opiods
anticonvulsants
antiparkinsonism drugs
beta blockers, antiarrhythmics, digoxin
nictotine
OCs
cholinesterase inhibitors 
diabetes meds like metformin
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7
Q

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

A 
diabetic ketoacidosis
uremia
adrenocortical crisis
parathyroid disease
hypothyroidism
pregnancy
paraneoplastic syndrome
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8
Q

causes of oropharyngeal dysphagia

A 
neuro disorders
muscular and rheumatologic disorders
metanbolic disorders
infectious disease
structural disorders
motitility disorders
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9
Q

oropharyngeal dysphagia and some neuro disorders that cause it

A 
Guillain-Barre syndrome
parkinsons
huntington
dementia
MS
ALS
brain trauma
mass lesion
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10
Q

muscular and rheumatologic disorders with oropharyngeal dysphagia

A

sjogren syndrome

myopathies

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11
Q

metabolic disorders with oropharyngeal dysphagia

A

amyloidosis
cushing
wilson
med side effects: anticholinergics, phenothiazines

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12
Q

infectious disease and oropharyngeal dysphagia

A 
polio
diptheria
botulism
lyme disease
syphilis
mucositis (candida, herpes)
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13
Q

structural disordes with oropharyngeal dysphagia

A 
zenker diverticulum
esophageal webs
tumor
postsurgical change
pill induced injury
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14
Q

esophageal dysphagia clue: intermittent dysphagia, not progressive

A

schatzki ring

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15
Q

esophageal dysphagia clue: chronic heartburn, progressive dysphagia

A

peptic stricture

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16
Q

esophageal dysphagia clue: progressive dysphagia, age over 50

A

esophageal cancer

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17
Q

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

A

eosinophilic esophagitis

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18
Q

what kind of dysphagia is achalasia

A

progressive

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19
Q

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

A

diffuse esophageal spasm

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20
Q

esophageal dysphagia clue: chronic heartburn, raynaud phenomenon

A

scleroderma

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21
Q

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

A

ineffective esophageal motility

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22
Q

endoscopy is the study of choice for evaluating what

A

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

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23
Q

what is oropharyngeal dysphagia best evaluated by

A

rapid sequence videoesophagography

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24
Q

what can a barium esophagography help differentiate

A

btwn mechainical lesion and motility disorder

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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

GI II Final DF (9 decks)

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