Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Gastroenterology > Esophagus DDX > Flashcards

Esophagus DDX Flashcards

(65 cards)

Start Studying
1
Q

Pyrosis

A

Heartburn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Voluntary phase of swallow

A

Oral: tongue pushes the food bolus into the oropharynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Involuntary phase of swallow, Pharyngeal phase:

A

1 food bolus stimulates receptors in pharynx
2 breathing is interrupted
3 elevation of the soft palate
4 glottis is pulled under the epiglottis
5 when the bolus reaches the esophagus the upper esophageal sphincter relaxes then closes behind the food bolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Esophageal phase of swallow, Primary P

A

Primary peristalsis: vagal sense and motor until reaching the LES resulting in relaxation of the LES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Esophageal phase of swallow, Secondary P

A

Repetitive waves required to clear the esophagus of food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Saliva is acidic or alkaline?

A

Alkaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

GERD affects 20 percent of adults weekly and 10% daily

A

usually mild

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Damage in GERD is usually in up to …% of pt’s

A

33%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Contents that could be included in GERD?

A

Most cases: Acidic gastric fluid

other: Bile or alkaline pancreatic secretions may contribute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Common timeframe that there is an issue with GERD

A

post-prandial, acidic reflux episodes after meals when acid is poorly mixed with food in the proximal stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

GJD: 3 aspects:

A

Gastroesophageal Junction Dysfunction
1anti-reflux barrier depends on LES pressure
2intra-abdominal location of the sphincter(flap-valve)
3sphincter by the crural diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Most reflux occurs during the…

A

transient relaxation of the LES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

An incompetent LES can happen when:

and how often

A

An increase in acid reflux.
Usually when supine or with increased intra-abdominal pressures.
Present in up to 50% of pt’s with severe erosive GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hiatal Hernia 25,75,90.
caused by?
(GJD type)

A

25% of pt’s with non-erosive GERD.
75% of pt’s with severe erosive esophagitis.
90% of pt’s with Barrett esophagus.
-Caused by movement of the LES above the diaphragm
-associated with higher amounts of acid reflux and delayed esophageal acid clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Truncal obesity causes GJD how?

A

Increased intra-abdominal pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Abnormal esophageal clearance occurs when…

A

acid is not cleared as it is normally by esophageal peristalsis and neutralized by salivary bicarbonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

50% of GERD pt’s have….

A

Hypotensive peristaltic contractions (leading to abnormal esophageal clearance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Impaired salivation can occur from…

A

Sjogren syndrome, anticholinergic medications and oral radiation therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Signs and symptoms of GERD

A 
Heartburn
Regurgitation
Dysphagia(33%)
Extra-esophageal manifestations(rarer)
PE and labs are normal in uncomplicated cases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Style of heartburn in GERD

A

30-60 min after meals
reclining
relief with antacids or baking soda
severity not correlated with degree of tissue damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Dysphagia in GERD

A

(33%)
erosive esophagitis
abnormal esophageal peristalsis
stricture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Extra-esophageal manifestations of GERD:

A 
asthma
chronic cough
chronic laryngitis
sore throat
non-cardiac chest pain
(In the absence of heartburn or regurgitation, atypical symptoms unlikely to be related to GERD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Alarming features during GERD ddx

A

troublesome dysphagia,
odynophagia,
weight loss,
iron deficiency anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Endoscopy results of GERD

A
  • up to 33% with visible mucosal damage
  • may be healed win patients treated with prior empiric PPI
  • detect other gastroesophageal lesions
  • esophageal stricture
  • barrett esophagus
  • esophageal adenocarcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
DDX of GERD
Esophageal motility disorders - Peptic ulcer - Angina pectoris - Functional disorders - Pill-induced damage - Eosinophilic esophagitis - Infections like CMV, Herpes, Candida
26
Tx of mild GERD
``` Lifestyle, Eating smaller meals, Elimination of acidic foods, Elimination of foods known to cause reflux(fatty foods, chocolate, peppermint, alcohol) Smoking cessation Weight loss as indicated ```
27
Patients with nocturnal symptoms should...
- avoid eating 3 hours prior to laying down and elevate the head of the bed.
28
PRN meds for GERD
Antacids -rapid 2 hour relief | OTC oral H2 receptor antagonists - delayed onset, longer relief 8hrs
29
Tx for troublesome symptoms or with known complications:
Once daily PPI for 4-8 weeks 10-20 % do not achieve relief and require BID PPI dosing. If still inadequate relief, evaluation with upper endoscopy is indicated.
30
If initial 4-8 week therapy followed by BID PPI still does not bring relief then...
endoscope
31
Long term therapy: | If good symptomatic relief is obtained with once daily PPI then...
D/C after 8-12 weeks
32
80% will experience relapse of GERD...tx options include:
tx with continuous PPI (or BID H2 blocker if no erosive esophagitis is present) tx intermittent 2-4 week course tx on demand, pt dosed
33
If twice daily dosing was required, and in pt's with complications of GERD....
maintain on long term PPI therapy with once or BID dosing for symptom control
34
Esophageal pH testing in pt's after...
3months with continued sx
35
Tx of Extra-esophageal manifestations
Trial twice daily PPI for 2-3 months
36
Tx for active erosive esophagitis found on endoscopy:
double PPI dose
37
Refractory esophagitis causes
gastrinoma with gastric acid hypersecretion Pill induced esophagitis Proton pump inhibitor resistance Medical non-compliance Pt's without visible esophagitis should undergo pH monitoring to determine cause
38
New sx of fundoplication
``` dysphagia bloating increased flatulence dyspepsia diarrhea ```
39
Barrett esophagus
squamous epithelium replaced by metaplastic columnar epithelium containing goblet and columnar cells due to chronic reflux induced injury.
40
Specialized intestinal metaplasia
increased risk of dysplasia
41
Presentation rate of barrett's with chronic reflux pt's
10%
42
Pts with Barrett esoph. will complain of a...
long hx of reflux symptoms
43
Tx of Barrett's esophagus:
long-term PPIs
44
Barrett esoph. should be surveilled every ______ to look for low or high grade _______ or ___________
3-5 years | dysplasia or adenocarcinoma
45
Peptic stricture pt's complain of ________ over months to years
gradual development of solid food dysphagia
46
Endoscopy in peptic stricture sus pt's is mandatory bc we need to dif btw....
peptic stricture from esophageal carcinoma
47
Long-term tx of peptic stricture?
PPI to decrease recurrence
48
Common pt cases with infectious esophagitis
AIDS, Solid Organ Transplants, Leukemia, Lymphoma, Immunosuppressive drugs.
49
Most common pathogens of In. Eso.
Candid albicans (uncontrolled diabetes , systemic corticosteroids , radiation therapy , abx) Herpes simplex Cytomegalovirus
50
S/S of In. Eso.
Odynophagia | Dysphagia
51
S/S of In. Eso.
``` Odynophagia Dysphagia Substernal Chest pain Occasionally asymptomatic Oral thrush in 75% in C. Albicans, 25-50% with viral Oral Ulcers ```
52
Tx of Infectious Esophagitis
Candida: Systemic empiric therapy of antifungals...non-responders within 3-5 days should undergo endoscopy with brushings, biopsy and culture. CMV: in HIV pt's HAART: highly active antiretroviral therapy is most effective Herpetic esophagitis: Immunocompetent pt's tx sx; Immunosuppressed pt's tx with oral antivirals.
53
Tx of Infectious Esophagitis
Candida: Systemic empiric therapy of antifungals...non-responders within 3-5 days should undergo endoscopy with brushings, biopsy and culture. CMV: in HIV pt's HAART: highly active antiretroviral therapy is most effective Herpetic esophagitis: Immunocompetent pt's tx sx; Immunosuppressed pt's tx with oral antivirals.
54
Pill-Induced Esophagitis meds:
``` No Pills QARI VcA NSAIDS Potassium Chloride tabs Quinidine Alendronate Risendronate Iron Vitamin C Abx: Doxy, Tetracycline, Clinda, Bactrim ```
55
Most likely to be injured by pills
bed-bound or hospitalized pt's
56
S/S of pill-induced eso.
Severe retrosternal chest pain Odynophagia Dysphagia Chronic injury may cause severe esophagitis(stricture, hemorrhage, perforation-taking pills with water and remaining upright for 30min after ingestion)
57
Caustic esophageal injury
accidental (usually children) or deliberate (suicide) ingestion of liquid or crystalline alkali (drain cleaners) or acid
58
s/s of Caustic esophageal injury
``` Severe burning Chest pain Gagging Hematemesis Dyspnea Dysphagia Drooling Aspiration(stridor, wheezing, pt's without major sx or oropharyngeal lesions have a very low likelihood of severe gastroesophageal injury) ```
59
Tests with suspected caustic eso.
radiograph - pneumonitis, free air under the diaphragm
60
Initial tx of caustic eso.
IV fluids, IV PPI to prevent gastric ulceration, Analgesics
61
Endo within ___-___ hours often shows __ ____ ____ in caustic esophagitis
12-24 hrs | no mucosal injury
62
Findings in pt's with mild damage from caustic eso.
``` Edema Erythema Exudates Superficial ulcers Recover quickly with low risk of developing strictures ```
63
Findings in pt's with severe injury from caustic eso.
Deep, circumferential, necrotic ulcers High risk of acute complications like perforation with mediastinitis or peritonitis, bleeding, stricture, esophageal-tracheal fistulas
64
Tx of severe injury from caustic eso.
Emergency surgery with possible esophagectomy
65
Do not use _______ or _______ in severe caustic eso.
Corticosteroids or abx

Gastroenterology (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions