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Foundations III-GI > Esophagus & Stomach > Flashcards

Esophagus & Stomach Flashcards

1
Q

Anatomy of the esophagus?

A

stratified squamous epithelium

Upper 1/3 skeletal muscle
Middle 1/3 skeletal and smooth muscle
Lower 1/3 smooth muscle

2 spincters:
-upper (UES): controls food entry into esophagus

-lower (LES): prevents reflux of gastric contents

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2
Q

Etiology of esophagitis?

A

usually infectious

  • Fungal: candida
  • Viral: CMV, HSV
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3
Q

Presentation of esophagitis?

A

Odynophagia or dysphagia

Fever, lymphadenopathy as signs of immunodeficiency

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4
Q

Demographics of esophagitis?

A

immunocompromised

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5
Q

Dx of esophagitis?

A

endoscopy:
- CMV: 1-several large lesions
- HSV: multiple, small well circumscribed “volcano like”
- Candida – linear yellow-white plaques, diffuse, adherent

definitive: cytology or culture from endoscopy brushings

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6
Q

Tx for esophagitis?

A

Fluconazole or ketoconazole for Candida

Acyclovir for HSV

CMV: +/- IV ganciclovir or foscarnet

tx underlying immunodeficiency

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7
Q

Etiology of corrosive esophagitis?

A

ingestion of caustic agents

Household cleaners, bleach

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8
Q

Presentation of corrosive esophagitis?

A

ulceration, necrosis and perforation in patches

Extends from oropharynx to stomach

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9
Q

comps of corrosive esophagitis?

A

Healing may lead to fibrosis and stricture formation

Increased risk of squamous cell carcinoma

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10
Q

What meds can cause med induced esophagitis?

A

NSAIDS, Potassium pills, Quinidine

Antiretrovirals, Bisphosphonates, Iron, Vitamin C

Abx: Doxycycline, tetracycline, clindamycin, Bactrim

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11
Q

Presentation of med induced esophagitis?

A

Severe retrosternal chest pain

Odynophagia, dysphagia

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12
Q

med induced esophagitis may lead to…

A

Severe esophagitis with stricture

Hemorrhage

Perforation

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13
Q

What are the dif. types of esophageal dysmotility?

A 
Neurogenic dysphagia
Zenker diverticulum
Esophageal stenosis
Achalasia
Spasm
Scleroderma
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14
Q

Etiology of esophageal dysmotility?

A

neurologic factors

blockage

failure of peristalsis

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15
Q

What is the MC presenting sxs in esophageal dysmotility?

A

dysphagia

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16
Q

esophageal dysmotility seen with neurogenic prob?

A

dysphagia to liquid and solids

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17
Q

esophageal dysmotility seen with zenker’s diverticulum

A

dysphagia to undigested food & liquid

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18
Q

esophageal dysmotility seen with esophageal stenosis?

A

dysphagia to solids

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19
Q

What is schatzi’s ring?

A

mechanical disorder

Thin circumferential ring occurring at GE junction

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20
Q

Etiology of schatzki’s ring?

A

Caused by GERD, or as a congenital/developmental deformity

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21
Q

Presentation of schatzki’s ring

A

Episodic dysphagia to solids

Large food boluses may become impacted
Abrupt onset of sub-sternal discomfort

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22
Q

What are esophageal webs? presentation?

A

mechanical disorder

Mucosal fold that protrudes into lumen

Intermittent dysphagia to solids

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23
Q

Esophageal webs is assoc. with?

A

Plummer-Vinson syndrome

Symptomatic webs in iron-deficient, middle-aged women

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24
Q

esophageal dysmotility seen with achalasia

A

dysphagia to solids and liquids

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25
Q

esophageal dysmotility seen with diffuse esophageal spasm

A

+/- dysphagia assoc. with eating

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26
Q

esophageal dysmotility seen with scleroderma?

A

reflux

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27
Q

What looks like a “parrot beak” on esophagram?

A

achalasia

Dilated esophagus tapering to distal obstruction

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28
Q

Etiology of diffuse esophageal spasm?

A

frequent, intermittent, abnormal, non-propulsive esophageal contractions

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29
Q

Presentation of diffuse spasm?

A

Chest pain, dysphagia or both to liquids and solids

Precipitated by stress or drinking cold liquids

Pain may radiate to the back, chest, both arms, jaw

Can be acute, severe and mimic an MI

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30
Q

Dx of diffuse spasm?

A

exclude MI

Barium esophagram: corkscrew esophagus

Correct diagnosis often difficult to make

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31
Q

Tx for diffuse spasm?

A

Smooth muscle relaxants:
NTG : before meals and at bedtime

Isosorbide dinitrate: before meals

Nifedipine SL: before meals

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32
Q

What is scleroderma?

A

fibrosis of skin and viscera

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33
Q

What is CREST syndrome?

A 
Calcinosis
Raynaud’s phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasias

assoc. with scleroderma

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34
Q

Dx of dysphagia in general?

A

Barium swallow (esophagogram): structural and motor problems

Endoscopy (EGD):
directly see abnormalities and biopsy

Esophageal manometry:
Assess strength and coordination of peristalsis,
Assesses pressures of LES

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35
Q

Tx of neurogenic dysphagia?

A

treat underlying cause; can lead to aspiration pneumonia

strictures: dilate or resect

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36
Q

Tx of diverticula, achalasis, stenosis?

A

Endoscopic dilation (bougienage), resection if needed

Surgery - myotomy

Medical therapy has not been shown to be effective (CCB, nitrates, botox)

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37
Q

Clinical work up for dysmotility?

A

1ST: barium esophagram/UGI swallow/barium swallow for initial investigation

THEN endoscopy (EGD) allows treatment

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38
Q

Etiology of mallory-weiss tear?

A

Linear tear in mucosa of esophagus

Usually at GE junction

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39
Q

Patho involved in mallory weiss tear?

A

Usually occurs with forceful vomiting/retching

Causes hematemesis (typically painless)

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40
Q

RF for mallory-weiss tear?

A

Alcohol use

hyperemesis gravidarum

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41
Q

Dx of mallory weiss tear?

A

endoscopy (EGD)

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42
Q

Tx of mallory weiss tear?

A

May resolve on own

inject epi during endoscopy to stop bleeding

Thermal coagulation

Surg if arterial bleed is severe

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43
Q

What are esophageal varices?

A

Dilated veins of esophagus, usually distal

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44
Q

Etiology of esophageal varices?

A

Portal hypertension:

Usually from cirrhosis of liver
Due to alcohol abuse or chronic viral hepatitis

other: budd-chiari syndrome

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45
Q

RF for esophageal varices?

A

NSAIDS can exacerbate

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46
Q

Presentation fo esophageal varices?

A

Painless upper GI bleed

“brisk” bleeding

Bright red blood or coffee ground emesis (hematemesis)

Can also have melena, hematochezia

hypovolemia if large bleed

usually axs until they bleed, when they do (life threatening)

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47
Q

dx of esophageal varices?

A

Endoscopy

48
Q

tx of esophageal varices?

A

HD support:

  • High volume fluid replacement
  • Endoscopic Vasopressors/vasoconstrictors (octreotide drip)

Emergent EGD:
-Band ligation, sclerotherapy

49
Q

Prevention of esophageal varices?

A

In patients with cirrhosis:
B-blockers (propranolol)
No alcohol
Endoscopic band ligation

50
Q

Physiology of swallowing

A

rapid <1 sec

bolus reaches LES in 6 secs

LES relaxes 2 secs after swallowing

51
Q

Problem with LES tension may cause..

A

heart burn

52
Q

Problem with UES relaxation may cause..

A

dysphagia

53
Q

Problem with esophageal peristaltic waves may cause…

A

odynophagia

54
Q

What is Zenker’s diverticulum?

A

pouch in posterior hypopharynx just above UES

55
Q

What are some normal physiological barriers to reflux and damage?

A

LES tone

Resistance of esophageal mucosa to acid (salivary pH, esophageal epithelium, and bicarbonate secretions)

Normal gastric motility (peristalsis)

56
Q

Etiology of GERD?

A

Reflux of stomach contents into esophagus

Due to abnormality of LES

Sxs produced from prolonged exposure to gastric acid

57
Q

What meds can cause GERDs

A

antibiotics (TCN)

biphosphonates

iron

NSAIDS

anticholinergics

CCBs

narcotics

benzodiazepines

(irritate or decrease LES tone)

58
Q

presentation of GERD?

A

Heartburn MC

Worse after meals

Worse when lying down, bending over

Some relief with antacids

Regurgitation

Dysphagia

other sxs: hoarseness, halitosis, cough, hiccupping, sore throat, laryngitis, nausea, atypical chest pain

59
Q

What can indicate more severe GERD?

A

night time sxs

60
Q

Alarm sxs for GERD?

A

Anemia

Loss of weight

Anorexia

Recent onset of progressive
symptoms

Melena or hematemesis

Swallowing difficulties (Dysphagia / Odynophagia)

61
Q

Dx of GERD?

A

often clinical

Uncomplicated patient: heartburn + regurg of acid + relief with antacids (cimetidine, ranitidine, famotidine)

Trial of PPI x 4-8 weeks

Endoscopy to confirm & assess epithelial damage

62
Q

More testing for GERD for pt with more severe disease or surg planning?

A

Barium swallow

Esophageal manometry

Ambulatory 24-hour pH monitoring
*Gold standard objective test for surgical planning

63
Q

Tx of GERD includes…

A

lifestyle modifications

PPIs

Surg (if refractory)

64
Q

Lifestyle modifications for tx of GERD?

A

Smoking cessation

Avoid eating at bedtime

Raise head of bed

Avoid large meals

Avoid alcohol

Avoid foods that cause irritation

65
Q

What are some PPIs? When should they be taken?

A

Omeprazole (Prilosec)

Rabeprozole (Aciphex)

Lansoprazole (Prevacid)

take prior to eating

66
Q

complications of GERD?

A

Aspiration pneumonia

Acid laryngitis

Trigger asthma

Stricture formation

Barrett esophagus and adenocarcinoma

67
Q

What is Barrett esophagus?

A

Chronic damage to lower esophagus

Replacement of squamous epithelium with metaplastic columnar epithelium

Results in low or high grade dysplasia

68
Q

Barrett esophagus is assoc. with…

A

adenocarcinoma

69
Q

Tx of barrett esophagus?

A

normalization of acid, decrease cell proliferation in BE

  • radio-frequency endoscopic ablation
  • surveillance endoscopy
70
Q

What is a leiomyoma?

A

Most frequent benign tumor of esophagus

Arise in the submucosa of distal esophagus

71
Q

Presentation of leiomyoma?

A

usually asxs

may cause dysphagia

72
Q

Dx of leiomyoma? tx?

A

Discovered incidentally

Small (2-5 cm), solitary, round, firm mass

Cannot distinguish benign from malignant neoplasm unless surgically removed

tx: surg excision

73
Q

Characteristics of esophageal SCC?

A

Mid-portion of esophagus

Smokers

ETOH use

SE Asians, African Americans

74
Q

Characteristics of esophageal adenocarcinoma?

A

Distal 1/3 of esophagus

MC type in US

Smokers

Chronic reflux

Obesity

Caucasians, males
Barret esophagus

75
Q

Risk factors for esophageal CA?

A

smoking

chronic alcohol use

caustic agents

HPV

76
Q

Presentation of esophageal CA?

A

Progressive dysphagia with solid foods

Weight loss

Heartburn

Vomiting

Regurgitation, aspiration (aspiration pneumonia)

Hoarseness

77
Q

Dx of esophageal CA?

A

Barium esophagogram: best initial test
“apple-core” lesions

Endoscopy with biopsy – to make diagnosis

78
Q

What is used to determine staging of esophageal CA?

A

CT chest, abdomen

Endoscopic US with guided FNA biopsy of lymph nodes

PET-CT

+/- Bronchoscopy

79
Q

tx of esophageal CA?

A

Surgery

Radiation, chemotherapy can be used

poor px

mets tends to be to stomach, colon

80
Q

Proximal parts of the stomach? Distal?

A

fundus & body

antrum and pylorus

81
Q

Role of mucous cells?

A

secrete bicarb

coats & lubricates gastric surface

82
Q

Role of endocrine cells of the stomach?

A

secretes gastrin

important in control of acid secretion and gastric motility

83
Q

Role of chief cells?

A

synthesize and secrete pepsinogen

84
Q

What do parietal cells secrete?

A

hydrochloric acid

85
Q

What is gastritis? etiology?

A

Inflammation of stomach

H. Pylori!!

autoimmune disorders

NSAIDs

stress

alcohol

86
Q

Presentation of gastritis?

A

Dyspepsia

Indigestion, nausea, heartburn, upper abd fullness, early satiety, bloating, belching

Abdominal pain

87
Q

Dx of gastritis?

A

Endoscopy with biopsy (confirm h. pylori)

urea breath test

stool antigen testing (h pylori)

serology for H. pylori

88
Q

Tx for gastritis?

A

remove causitive factor

tx underlying cause
-NSAID: PPI if persistent

-H. pylori: tx for 14 days, then recheck

89
Q

What is H. pylori gastritis assoc with?

A

PUD

gastric adenocarcinoma

low grade B cell gastric lymphoma

90
Q

What is Peptic ulcer disease?

A

Any ulcer of the upper GI system (gastric, duodenal)

Associated with gastric cancer

91
Q

Etiology of peptic ulcer disease?

A

break in mucosa from injury, NSAIDa, stress, alcohol

H. pylori infx (MCC)

92
Q

Presentation of PUD?

A

Abdominal pain

Burning or gnawing, may radiate to the back

Gastric ulcer: worse after eating

duodenal ulcer: improves after eating

dyspepsia

93
Q

Dx of peptic ulcer disease?

A

endoscopy
-sample of bx, cultures or urease testing

barium swallow

H pylori testing

94
Q

Tx of PUD?

A

Avoid triggers:
Smoking, NSAIDs, alcohol

Therapy for H. pylori x 2-4 weeks
Same regimens as H. pylori gastritis

Gastric ulcers: PPI x 12 weeks

Duodenal ulcers: PPI x 4-8 weeks

95
Q

PUD prophylactic tx for pts with hx of ulcers and other comorbidities?

A

Misoprostol (Cytotec)
Helps prevent ulcers when using an NSAID

Sucralfate (Carafate)
Take 1 hour before meals

PPI

96
Q

Complications of PUD?

A

Obstruction – due to scarring

GI bleed

Ulcer perforation

Penetration / fistulization

97
Q

What is gastroparesis?

A

Delayed gastric emptying/altered motility

Associated with many diseases

98
Q

Etiology of gastroparesis?

A

DM

idiopathic

disease of smooth muscle

neurologic dysfunc

99
Q

Presentation of gastroparesis?

A

Nausea

Excessive fullness after meals – early satiety

Bloating, weight loss, abdominal pain

100
Q

Dx of gastroparesis?

A

Endoscopy

Scintigraphic gastric emptying study

101
Q

Tx of gastroparesis?

A

Diet modification: smaller meals, avoid carbonation

Prokinetic meds: cisapride, metoclopramide (Reglan)

102
Q

What is a hiatal hernia?

A

protrusion of stomach through diaphragm via the esophageal hiatus

increases with age

103
Q

Presentation of hiatal hernia?

A

asxs

GERD

chest discomfort

104
Q

Dx of hiatal hernia?

A

barium esophagogram

endoscopy

105
Q

Tx of hiatal hernia?

A

acid reduction

surg repair

106
Q

What is a gastrinoma?

A

Gastrin secreting tumor causes hypergastrinemia which causes PUD (duodenum)

Called Zollinger-Ellison syndrome (ZES)

Most are in duodenum

107
Q

1/3 of ____are part of MEN I

A

gastrinomas

108
Q

presentation of gastrinomas?

A

abd pain, diarrhea, GI bleed

109
Q

Dx of gastrinomas?

A

Fasting serum gastrin level > 150 pg/mL

Secretin test to confirm ZES
Gastrin levels will rise by > 200

Endoscopy/CT/MRI

110
Q

Tx of gastrinoma?

A

PPI

Surgery to remove tumor

Screen for MEN1

111
Q

Risk factors for gastric adenocarcinomas?

A

Smoking

H. pylori infection

genetic factors

112
Q

Clinical presentation for gastric adenocarcinoma?

A

abd mass

dyspepsia, wt loss, anemia, GI bleed

113
Q

Signs of metastatic spread of gastric adenocarcinoma?

A

Virchow node: left supraclavicular lymphadenopathy

Sister Mary Joseph nodule: umbilical nodule

114
Q

Dx of gastric adenocarcinoma?

A

Endoscopy – any patient > 40 years with dyspepsia who is unresponsive to therapy

CBC: Iron deficiency anemia is most common lab finding

CT – to determine extent

115
Q

Tx of gastric adenocarcinoma?

A

surg +/- chemo and radiation

116
Q

Risk of gastric lymphoma is 6x higher if…

A

+ H pylori infx

Foundations III-GI (8 decks)

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