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Foundations III-GI > Esophagus & Stomach > Flashcards

Esophagus & Stomach Flashcards

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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
esophageal dysmotility seen with diffuse esophageal spasm
+/- dysphagia assoc. with eating
26
esophageal dysmotility seen with scleroderma?
reflux
27
What looks like a "parrot beak" on esophagram?
achalasia Dilated esophagus tapering to distal obstruction
28
Etiology of diffuse esophageal spasm?
frequent, intermittent, abnormal, non-propulsive esophageal contractions
29
Presentation of diffuse spasm?
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
30
Dx of diffuse spasm?
exclude MI Barium esophagram: corkscrew esophagus Correct diagnosis often difficult to make
31
Tx for diffuse spasm?
Smooth muscle relaxants: NTG : before meals and at bedtime Isosorbide dinitrate: before meals Nifedipine SL: before meals
32
What is scleroderma?
fibrosis of skin and viscera
33
What is CREST syndrome?
``` Calcinosis Raynaud’s phenomenon Esophageal dysmotility Sclerodactyly Telangiectasias ``` assoc. with scleroderma
34
Dx of dysphagia in general?
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
35
Tx of neurogenic dysphagia?
treat underlying cause; can lead to aspiration pneumonia strictures: dilate or resect
36
Tx of diverticula, achalasis, stenosis?
Endoscopic dilation (bougienage), resection if needed Surgery - myotomy Medical therapy has not been shown to be effective (CCB, nitrates, botox)
37
Clinical work up for dysmotility?
1ST: barium esophagram/UGI swallow/barium swallow for initial investigation THEN endoscopy (EGD) allows treatment
38
Etiology of mallory-weiss tear?
Linear tear in mucosa of esophagus Usually at GE junction
39
Patho involved in mallory weiss tear?
Usually occurs with forceful vomiting/retching Causes hematemesis (typically painless)
40
RF for mallory-weiss tear?
Alcohol use hyperemesis gravidarum
41
Dx of mallory weiss tear?
endoscopy (EGD)
42
Tx of mallory weiss tear?
May resolve on own inject epi during endoscopy to stop bleeding Thermal coagulation Surg if arterial bleed is severe
43
What are esophageal varices?
Dilated veins of esophagus, usually distal
44
Etiology of esophageal varices?
Portal hypertension: Usually from cirrhosis of liver Due to alcohol abuse or chronic viral hepatitis other: budd-chiari syndrome
45
RF for esophageal varices?
NSAIDS can exacerbate
46
Presentation fo esophageal varices?
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)
47
dx of esophageal varices?
Endoscopy
48
tx of esophageal varices?
HD support: - High volume fluid replacement - Endoscopic Vasopressors/vasoconstrictors (octreotide drip) Emergent EGD: -Band ligation, sclerotherapy
49
Prevention of esophageal varices?
In patients with cirrhosis: B-blockers (propranolol) No alcohol Endoscopic band ligation
50
Physiology of swallowing
rapid <1 sec bolus reaches LES in 6 secs LES relaxes 2 secs after swallowing
51
Problem with LES tension may cause..
heart burn
52
Problem with UES relaxation may cause..
dysphagia
53
Problem with esophageal peristaltic waves may cause...
odynophagia
54
What is Zenker's diverticulum?
pouch in posterior hypopharynx just above UES
55
What are some normal physiological barriers to reflux and damage?
LES tone Resistance of esophageal mucosa to acid (salivary pH, esophageal epithelium, and bicarbonate secretions) Normal gastric motility (peristalsis)
56
Etiology of GERD?
Reflux of stomach contents into esophagus Due to abnormality of LES Sxs produced from prolonged exposure to gastric acid
57
What meds can cause GERDs
antibiotics (TCN) biphosphonates iron NSAIDS anticholinergics CCBs narcotics benzodiazepines (irritate or decrease LES tone)
58
presentation of GERD?
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
What can indicate more severe GERD?
night time sxs
60
Alarm sxs for GERD?
Anemia Loss of weight Anorexia Recent onset of progressive symptoms Melena or hematemesis Swallowing difficulties (Dysphagia / Odynophagia)
61
Dx of GERD?
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
More testing for GERD for pt with more severe disease or surg planning?
Barium swallow Esophageal manometry Ambulatory 24-hour pH monitoring *Gold standard objective test for surgical planning
63
Tx of GERD includes...
lifestyle modifications PPIs Surg (if refractory)
64
Lifestyle modifications for tx of GERD?
Smoking cessation Avoid eating at bedtime Raise head of bed Avoid large meals Avoid alcohol Avoid foods that cause irritation
65
What are some PPIs? When should they be taken?
Omeprazole (Prilosec) Rabeprozole (Aciphex) Lansoprazole (Prevacid) take prior to eating
66
complications of GERD?
Aspiration pneumonia Acid laryngitis Trigger asthma Stricture formation Barrett esophagus and adenocarcinoma
67
What is Barrett esophagus?
Chronic damage to lower esophagus Replacement of squamous epithelium with metaplastic columnar epithelium Results in low or high grade dysplasia
68
Barrett esophagus is assoc. with...
adenocarcinoma
69
Tx of barrett esophagus?
normalization of acid, decrease cell proliferation in BE - radio-frequency endoscopic ablation - surveillance endoscopy
70
What is a leiomyoma?
Most frequent benign tumor of esophagus Arise in the submucosa of distal esophagus
71
Presentation of leiomyoma?
usually asxs may cause dysphagia
72
Dx of leiomyoma? tx?
Discovered incidentally Small (2-5 cm), solitary, round, firm mass Cannot distinguish benign from malignant neoplasm unless surgically removed tx: surg excision
73
Characteristics of esophageal SCC?
Mid-portion of esophagus Smokers ETOH use SE Asians, African Americans
74
Characteristics of esophageal adenocarcinoma?
Distal 1/3 of esophagus MC type in US Smokers Chronic reflux Obesity Caucasians, males Barret esophagus
75
Risk factors for esophageal CA?
smoking chronic alcohol use caustic agents HPV
76
Presentation of esophageal CA?
Progressive dysphagia with solid foods Weight loss Heartburn Vomiting Regurgitation, aspiration (aspiration pneumonia) Hoarseness
77
Dx of esophageal CA?
Barium esophagogram: best initial test “apple-core” lesions Endoscopy with biopsy – to make diagnosis
78
What is used to determine staging of esophageal CA?
CT chest, abdomen Endoscopic US with guided FNA biopsy of lymph nodes PET-CT +/- Bronchoscopy
79
tx of esophageal CA?
Surgery Radiation, chemotherapy can be used poor px mets tends to be to stomach, colon
80
Proximal parts of the stomach? Distal?
fundus & body antrum and pylorus
81
Role of mucous cells?
secrete bicarb coats & lubricates gastric surface
82
Role of endocrine cells of the stomach?
secretes gastrin important in control of acid secretion and gastric motility
83
Role of chief cells?
synthesize and secrete pepsinogen
84
What do parietal cells secrete?
hydrochloric acid
85
What is gastritis? etiology?
Inflammation of stomach H. Pylori!! autoimmune disorders NSAIDs stress alcohol
86
Presentation of gastritis?
Dyspepsia Indigestion, nausea, heartburn, upper abd fullness, early satiety, bloating, belching Abdominal pain
87
Dx of gastritis?
Endoscopy with biopsy (confirm h. pylori) urea breath test stool antigen testing (h pylori) serology for H. pylori
88
Tx for gastritis?
remove causitive factor tx underlying cause -NSAID: PPI if persistent -H. pylori: tx for 14 days, then recheck
89
What is H. pylori gastritis assoc with?
PUD gastric adenocarcinoma low grade B cell gastric lymphoma
90
What is Peptic ulcer disease?
Any ulcer of the upper GI system (gastric, duodenal) Associated with gastric cancer
91
Etiology of peptic ulcer disease?
break in mucosa from injury, NSAIDa, stress, alcohol H. pylori infx (MCC)
92
Presentation of PUD?
Abdominal pain Burning or gnawing, may radiate to the back Gastric ulcer: worse after eating duodenal ulcer: improves after eating dyspepsia
93
Dx of peptic ulcer disease?
endoscopy -sample of bx, cultures or urease testing barium swallow H pylori testing
94
Tx of PUD?
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
PUD prophylactic tx for pts with hx of ulcers and other comorbidities?
Misoprostol (Cytotec) Helps prevent ulcers when using an NSAID Sucralfate (Carafate) Take 1 hour before meals PPI
96
Complications of PUD?
Obstruction – due to scarring GI bleed Ulcer perforation Penetration / fistulization
97
What is gastroparesis?
Delayed gastric emptying/altered motility Associated with many diseases
98
Etiology of gastroparesis?
DM idiopathic disease of smooth muscle neurologic dysfunc
99
Presentation of gastroparesis?
Nausea Excessive fullness after meals – early satiety Bloating, weight loss, abdominal pain
100
Dx of gastroparesis?
Endoscopy Scintigraphic gastric emptying study
101
Tx of gastroparesis?
Diet modification: smaller meals, avoid carbonation Prokinetic meds: cisapride, metoclopramide (Reglan)
102
What is a hiatal hernia?
protrusion of stomach through diaphragm via the esophageal hiatus increases with age
103
Presentation of hiatal hernia?
asxs GERD chest discomfort
104
Dx of hiatal hernia?
barium esophagogram endoscopy
105
Tx of hiatal hernia?
acid reduction surg repair
106
What is a gastrinoma?
Gastrin secreting tumor causes hypergastrinemia which causes PUD (duodenum) Called Zollinger-Ellison syndrome (ZES) Most are in duodenum
107
1/3 of ____are part of MEN I
gastrinomas
108
presentation of gastrinomas?
abd pain, diarrhea, GI bleed
109
Dx of gastrinomas?
Fasting serum gastrin level > 150 pg/mL Secretin test to confirm ZES Gastrin levels will rise by > 200 Endoscopy/CT/MRI
110
Tx of gastrinoma?
PPI Surgery to remove tumor Screen for MEN1
111
Risk factors for gastric adenocarcinomas?
Smoking H. pylori infection genetic factors
112
Clinical presentation for gastric adenocarcinoma?
abd mass dyspepsia, wt loss, anemia, GI bleed
113
Signs of metastatic spread of gastric adenocarcinoma?
Virchow node: left supraclavicular lymphadenopathy Sister Mary Joseph nodule: umbilical nodule
114
Dx of gastric adenocarcinoma?
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
Tx of gastric adenocarcinoma?
surg +/- chemo and radiation
116
Risk of gastric lymphoma is 6x higher if...
+ H pylori infx

Foundations III-GI (8 decks)

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