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Clin Med- GI > Esophagus lecture > Flashcards

Esophagus lecture Flashcards

(61 cards)

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1
Q

Difficulty initiating swallow reflex

Usually neuromuscular disorder causing weakness or lack of coordination

ie… CVA, parkinsons

A

Oropharyngeal dysphagia

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2
Q

Arises in body of esophagus, LES, or cardia

Usually due to mechanical problem or motility disturbance

ie.. stricture, tumor, radiation, scleroderma

A

Esophageal dysphagia

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3
Q

Sharp substernal pain on swallowing

*usually reflects severe erosive disease

A

Odynophagia

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4
Q

3-4 cm long segment of smooth muscle at distal end of esophagus

*prevents reflux of stomach contents back into esophagus

A

Lower esophageal sphincter (LES)

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5
Q

Occurs when LES is weak or relaxes inappropriately

A

GERD

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6
Q

Severity of GERD depends on?

A
  1. acidity
  2. duration
  3. amount

…of refluxed fluid in esophagus

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7
Q

Occurs when the LES, upper part of stomach moves up into chest through a small opening in the diaphragm (the diaphragmatic hiatus)

*can lead to GERD

*can be detected on XRay

A

Hiatal hernia

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8
Q
  • Abx (tetracycline)
  • Bisphosphonates
  • Iron
  • NSAIDs
  • Anticholinergics
  • CCBs
  • Narcotics
  • Benzos

….do what to GERD?

A

Worsen GERD

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9
Q

MC disorder of esophagus
Mostly mild dz but 50% will develop esophagitis
Common in N. America and Europe
MC in caucasians

Common in pregnancy due to increased hormones and increased intrabdominal pressure

A

GERD

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10
Q

Presentation:
Heartburn
Odynophagia
Dysphagia
Belching
Nausea
Anorexia/wt loss

atypical sxs: sore throat, dental carries, chronic cough, asthma, recurrent pneumonia

A

GERD

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11
Q

MC sx of GERD?

A

Heartburn 30-60 mins after meal

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12
Q

Symptoms of GERD are temporarily relieved by…

A

Antacids

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13
Q

Sxs of GERD are aggravated by…

A

Recumbent position

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14
Q

Diagnostic of choice for GERD?

A

Upper endoscopy with biopsy

(esophagogastroduodenoscopy, EGD)

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15
Q

Age >50
Wt loss
Melena
Difficulty/pain swallowing
Heavy ETOH/ tobacco
Non responsive to tx
PPIs

…should pursue what?

A

Upper endoscopy with biopsy

(Esophagogastroduodenoscopy, EGD)

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16
Q

Metaplastic changes which stratified squamous epithelium change to intestinal columnar epithelium

*increases risk for developing adenocarcinoma!

A

Barrett’s esophagus

(a complication of GERD)

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17
Q

Where do changes orginally occur in Barrett’s and how do they spread?

A

Originate at gastroesophageal junction

Extend proximally

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18
Q

in Barrett’s, how frequently do you repeat endoscopy with bx?

A

every 2 years

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19
Q

What percentage of pts who undergo endoscopy for GERD have Barrett’s?

A

5-15 %

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20
Q

In Barrett’s, if high grade dysplasia risk increases to 25%, what must you consider?

A

Surgical resection or ablative therapy

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21
Q

Avoid chocolate, peppermint, ETOH, coffee and fatty foods

Avoid acidic foods: red wine, OJ

Decrease portion size
Lose weight
avoid eating 2-3 hours before bed
elevate head of bed
quit tobacco (causes hyposalivation)

A

Non pharm tx for GERD

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22
Q

“-tidine” drugs

A

H2 blockers

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23
Q

“-prazole” drugs

A

PPIs

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24
Q

Motility disorder

usually associated with CP and/or dysphagia

Nutcracker esophagus (increased pressure >180 mmHg during peristalsis)

Rx: Nitrates, CCBs (Diltiazem)

A

Esophageal spasm

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25
Increased pressure \>180 mmHg during peristalsis
Nutcracker esophagus
26
Esophageal manometry shows: ## Footnote **aperistalsis (no relaxation of LES)**
Achalasia
27
Esophageal manometry shows: ## Footnote **hypercontractile, esp at LES**
Nutcracker esophagus
28
HSV Varicella Zoster CMV Candidia
Can all cause infectious esophagitis
29
Intraluminal mucosal tear of **distal esophagus** or gastric cardia \*a linear mucosal tear in esophagus, generally **at gastroesophageal junction** \*caused by increase in intra-abdominal pressure
Mallory-Weiss Syndrome
30
Occurs with foreceful vomiting or retching, causing hematemesis **accounts for 5-10% of upper GI bleeds** \*\*\*generally occcurs with alcohol use but should always be suspected in an upper GI bleed
Mallory-Weiss Syndrome
31
How do you dx a Mallory-Weiss tear?
Endoscopy
32
Control bleeding endoscopically via coag techniques ## Footnote **most bleeding resolves spontaneously \*typically benign, self limiting**
Mallory Weiss Syndrome
33
If Mallory-Weiss pt is... - Hemodynamically unstable - Has an extreme in age - Has underlying medical issue
ADMIT
34
Dilated submucosal veins develop in pts with **portal HTN** \*blood flow thru liver is diminished so blood flow increases thru microscopic blood vessels within esophageal wall, which causes the vessels to dilate
Esophageal varices
35
MC cause of portal HTN?
Cirrhosis (other causes= Portal vein thrombosis, Budd Chiari Syndrome, Infiltrative liver dz)
36
Mortality rate for first time esophagaeal varcies rupture
40-70%
37
38
Varices here are most likely to rupture bc they are superficial
GE junction
39
Hematemesis (\>50% stop bleeding spontaneously) Melena Weakness/fatigue Tachycardia Hypotension, syncope Abd pain Jaundice
Esophageal varices
40
MUST STOP BLEEDING ASAP! tx: ligation with rubber band sclerotherapy balloon tamponade | (most stop spontaneously but ~75% mortality rate for those who continue to bleed)
Esophageal varices
41
The underlying cause in adults is portal HTN, MC caused by cirrhosis (either from alcohol abuse or chronic viral hepatitis) \*use of NSAIDs can exacerbate
Esophageal varices
42
Beta blockers and nitrates to decrease portal HTN Shunts Liver transplant long term tx for?
Esophageal varices
43
Ring of tissue located at jxn of esophagus and stomach, **Schatzki's Ring** \*usually congenital \*can be due to chronic GERD, scar tissue sx: dysphagia (esp with solids)
Esophageal ring
44
Similar to esophageal rings but occur in **mid to upper esophagus** lead to intermittent dysphagia of solid food
Esophageal web
45
Dx of esophageal web or rings Tx?
Dx: Barium Esophogram EGD Tx: mechanical dilation with balloon
46
Loss of peristalsis in distal esophagus and failure of the LES to relax Food backs up and ferments in esophagus, causing it to distend and dilated causes include: damage to nerves of esophagus, infection (Chagas), hereditary
Achalasia
47
MC symptom= dysphagia Chest pain Regurgitation Difficulty belching Weight loss
Achalasia
48
Dx of Achalasia made with...
Chest X ray Barium swallow Manometry Endoscopy
49
**Bird's beak** seen on barium swallow X ray
Achalasia
50
Pneumatic dilation with balloon inflation can be used in tx of... (60-90% effective and can last for 10 years)
Achalasia
51
After the lower end of the esophagus is found and moved into position, the muscular ring surrounding the LES is cut, allowing it to open more easily. 95% success rate in treating achalasia
Myotomy
52
Surgical Procedure to Rx GERD/Hiatal Hernia Gastric Fundus is wrapped around Lower end of Esophagus Can be done Laproscopically Complications: Gas Bloat syndrome (can’t belch), Dysphagia, Dumping Syndrome(Food passes thru stomach too fast)
Nissen Fundoplication
53
What is diagnosed more: Adenocarcinoma or squamou cell carcinoma (for esophageal cancer)
Pretty much equal
54
5 year survival rate for esophageal cancer?
10-13%
55
3x more common in **males** 6x more common in **blacks** MC found in **middle esophagus** Risks: **smoking, ETOH**
Squamous cell carcinoma
56
7x more common in **males** 4x more common in **whites** MC found in **distal esophagus** Risks: **Barrett's esophagus**
Adenocarcinoma
57
Achalasia (16 fold increase) Caustic esophageal injury due to lye (ie suicide attempt) Partial gastrectomy ..increase risk of?
Esophageal (squamous cell) carcinoma
58
Obesity is a risk factor for....
Adenocarcinoma
59
An esophageal lumen diameter of less than 13 cm indicates...
Severe dz! (will have dysphagia)
60
Tracheobronchial fistulas are a late complication of....
Esophageal cancer (fistulas caused by direct invasion thru the esophageal wall and into the main stem bronchus) **life expectancy is less than 4 weeks if this complication develops**
61
Budd-Chiari syndrome may cause thrombosis of the portal vein, leading to...
Esophageal varices

Clin Med- GI (8 decks)

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