Esophagus, stomach, duodenum Flashcards
(123 cards)
1
Q
What is the most common cause of esophagitis
A
GERD
2
Q
What is esophagitis
A
inflammation or injury to esophageal mucosa
3
Q
What is the most common cause of infection of the esophagus
A
Fungus
4
Q
What is Eosiniphilic esophagitis (EoE)
A
Chronic immune antigen-related esophageal disease
5
Q
What is the common presentation of esophagitis
A
retrosternal chest pain
heart burn
odynophagia / dysphagia
6
Q
What can help differentiate the subtypes of esophagitis
A
endoscopy and bx
7
Q
What is CMV esophagitis
A
several large, shallow, superficial ulcerations
8
Q
What is HSV esophagitis
A
multiple small, deep ulcerations
9
Q
What does EoE esophagitis look like
A
white exudates/papules, red furrows, corrugated concentric rings and strictures
10
Q
What medication must be avoided with esophagitis
A
NSAIDs
11
Q
What are some complications of esophagitis
A
bleeding
stricture
barretts esophagus
perforation
laryngitis
aspiration pneumonia
12
Q
What is gastritis
A
Inflammation of gastric mucosa caused by infection, drugs, stress, atrophic gastritis
13
Q
How do you diagnose gastritis
A
endoscopy
14
Q
How do you differentiate between erosive and non-erosive gastritis
A
based of the severity of mucosal injury
15
Q
What causes gastric atrophy
A
result of long standing gastritis
(loss of intrinsic factors)
16
Q
What is the clinical presentation of non-erosive gastritis
A
mostly asx but may c/o with dyspepsia
17
Q
What is the treatment of non-erosive gastritis
A
Eradication of H.pylori
18
Q
What is the most common pathogen that causes gastritis
A
H.Pylori
19
Q
What is the most common/gold standard to diagnose H.pylori
A
Urea breath test
20
Q
What is the treatment of H.Pylori
A
PPI plus 2 antibiotics
21
Q
What does H.Pylori typically cause
A
Gastritis
PUD
Gastric adenosine-carcinoma
gastric lymphoma
22
Q
What does H.Pylori put you at an increased risk for
A
Stomach cancer
*class 1 carcinogen
23
Q
How does H.Pylori cause gastritis
A
Increased gastrin production which results in increased acid production predisposing to pre pyloric and duodenal ulcer
24
Q
What is the best treatment for H.Pylori
A
PPI + Metronidazole + tetracycline + Bismuth subsalicylate x 14 days
25
If ulcers are present, how long does a PPI need to be used in tx of H.Pylori
4 week minimum
26
What is erosive gastritis
damage to mucosal defenses
*usually acute with bleeding
27
What are common causes of Erosive gastritis
NSAIDs
Alcohol
Stress
28
What is the first sign of erosive gastritis
Hematemesis or melena for 2-5 days of inciting event
29
What is GERD
Incompetence of LES allowing reflux of gastric contents into the esophagus = burning pain
30
What is the typical sx of GERD
heartburn 30-60min postprandial
31
What increases the risk for GERD
Weight gain
fatty food
caffeinated/carbonated drinks
alcohol
tobacco smoking
drugs/meds
32
Which drugs will worsen GERD
Anticholinergics
antihistamines
TCSa
CCBs
progesterone
nitrates
33
What are the components of Gerd
Impaired LES function
hiatal hernia
irritant effects of reflux (pH>4)
abnormal esophageal clearance
34
What conditions can weaken LES
hiatal hernia
pregnancy
35
What condition affect transit from stomach to the small intestine
diabetes
PUD
connective tissue disorders
36
What is the common clinical presentation of GERD
heartburn
regurgitation
dysphagia
37
What is heartburn
retrosternal burning discomfort located in the epigastric area.
May radiate upwards and typically occur postprandial
38
If GERD does not respond to empiric treatment or has longstanding symptoms, how do you work them up
Endoscopy with cytology and/or bx is test of choice
39
What are some complications of GERD
Barretts esophagus
esophagitis
chronic aspiration
peptic strictures
esophageal ulcers
40
What is the number one treatment for GERD
lifestyle modification
41
What are things to avoid with GERD
Eating within 3 hours of bedtime
strong stimulants for acid secrete
Certain meds
specific foods
smoking
42
What are some drug therapy that can be done for GERD
Antacids
H2 blockers
PPIs
43
What are some antireflux procedures that can be done for GERD
Laparoscopic fundoplication
bariatric surgery
esophageal strictures
44
what is the only complication of GERD with malignant potential
barretts esophagus
45
Who is Barretts esophagus typically seen in
middle age white males
46
what cellular changes are seen with Barretts esophagus
conversion of normal esophageal squamous epithelium into metaplastic columnar epithelium
47
What is the clinical presentation for Barretts esophagus
chronic history of GERD with no other specific exam finding
48
What are the screening guidelines for Barretts esophagus in men
>5 years of chronic GERD with 2 additional risk factors
>50yo, hx smoking, white ethnicity, central obesity, +fh BE
49
What will be seen on endoscopy with Barretts esophagus
columnas metaplasia (salmon pink tongues of mucosal tissues)
50
What will be seen on bx from Barretts esophagus
goblet cells
51
What is used for routine surveillance of Barretts esophagus
hi-def white light endoscopy
52
When is an esophagectomy done for Barretts esophagus
is intramucosal cancer is present
53
What type of cancer can Barretts cause
adenocarcinoma
54
What is another name for a gastrinoma
Zollinger-Ellison syndrome (Z-E)
55
Where are gastrinomas found
in the pancreas of duodenal wall
56
How do you diagnose a gastrinoma
Measure serum gastrin levels
57
What is a gastrinoma
Type of pancreatic endocrine tumor arising from islets cells and gastrin producing cells in the duodenum
58
What syndrome is highly associated with Z-E syndrome
MEN
59
What is the initial treatment of gastrinomas
PPI
60
What serum gastrin level is indicative of a gastrinoma
>1000pg/mL
&
gastric acid secretion >5mEq/hr
61
What PE findings may be seen with esophageal motility disorders
prolonged swallowing time
62
What are common symptoms of esophageal motility disorder
dysphagia
chest pain/pressure
heartburn
63
What types of evaluations can be done for esophageal motility disorders
upper endoscopy
barium swallow
esophageal manometry
acid-reflux tests
64
What are some common causes of esophageal motility disorder
secondary neurogenic
Diffuse esophageal spasm
achalasia
65
What is diffuse esophageal spasm (DES)
Spectrum of motility disorders characterized by non-propulsive contractions, hyper dynamic contractions, or elevated LES pressure
66
How can you treat DES
nitrates
CCB
botulinum toxin
surgical myotomy
antireflux therapy
67
What are some symptoms of DES
Substernal chest pain
pain that wakes from sleep
temp extremes aggravate
severe pain w/o dysphagia
68
What test will provide most specific descriptions of spasms in DES
Esophageal manometry
69
What is achalasia
Neurogenic esophageal disorder characterized by impaired esophageal peristalsis and lack of LES relaxation during swallowing
70
What are the symptoms of achalasia
slowly progressive dysphage and regurge of undigested food
71
What is the cause of achalasia
loss of ganglion cells in myenteric plexus of the esophagus = denervation of esophageal muscle
72
What is the primary symptom of achalasia
dysphagia of both solids and liquids
73
What is the preferred dx tests for achalasia
esophageal manometry
74
What would be seen on a barium swallow with achalasia
very dilated esophagus with a narrowed - beaklike stricture at LES
75
What needs to be ruled out in the dx of achalasia
Systemic sclerosis
GE junction cancer
76
What is the treatment for achalasia
No therapy will restore peristalsis
balloon dilation of LES and surgical/endoscopic myotome
77
What is an esophageal diverticula
Outpouching of mucosa through the muscular layer of the esophagus
78
How do you diagnose esophageal diverticula
barium swallow
79
What is the most common esophageal diverticula
Zenkers
80
What is zenkers diverticula
Posterior out pouching of mucosa & submucosa thru cricopharyngeal muscle
81
What are the different types of esophageal diverticula
Zenkers
mid-esophageal
api-phrenic
82
What are characteristic symptoms of zenkers diverticula
pouching fills with food and will empty when leaning forward
83
What is the treatment of senders diverticula
none unless very large or symptomatic... then resection will be done
84
What are some intrinsic esophageal obstructions
esophageal tumors
esophageal rings
esophageal webs
strictures from GERD
85
What are some extrinsic esophageal obstructions
enlarged left atrium
aortic aneurysm
suubsternal thyroid
cervical bony exostosis
thoracic tumor
86
What is the treatment for a complete obstruction
emergen endoscopy to clear blockage
87
What is a Schatzki ring
lower esophageal ring
88
What is a presentation for schatzki ring
intermittent dysphagia for solids
*worse with meat and dry bread
89
When does a schatzki ring typically present
<25
90
How do you diagnose a schatzki ring
Endoscopy or barium swallow
91
What is the treatment for lower esophageal rings
Wide lume = chew food thoroughly
Narrow lumen = dilation by endoscopy
92
What is Plummer-vinson syndrome
esophageal web
93
What is an esophageal web
thin mucosal membrane that grows across the lumen
94
What causes esophageal webs
untreated, severe iron deficiency anemia
95
What is mallory-Weiss syndrome
Non-penetrating mucosal laceration of the distal esophagus and proximal stomach caused by vomiting, retching, or hiccuping
96
How is mallory-weiss syndrome diagnosed
*typically clinical
can have a diagnostic/therapeutic endoscopy done
97
If intervention is needed, what procedures can be done for mallory-weiss
Clip placement
injection of ethanol / epi
electrocautery
98
What are esophageal varices
Dilated veins in the distal esophagus or proximal stomach caused by elevated pressure in portal venous system
99
How do you treat esophageal varices
Endoscopy
100
What is the treatment for esophageal varices
Endoscopic banding
IV octreotide
*may need TIPS
101
What can cause esophageal varices
When portal pressure > IVC pressure
102
Where are the most dangerous collaterals from portal HTN
Distal esophagus and gastric fundus
103
When can variceal rupture occur
pressure gradient >12mmHg
104
How do those with esophageal varices typically present
sudden, painless, upper GI bleeding (often massive)
105
What does mortality depend of with esophageal varices
The severity of the liver disease
106
What are the first things that are done for treatment of ruptures esophageal varices
Airway management
Transfusion
prophylactic abx (ceftriaxone)
107
What is the primary treatment of esophageal varices
endoscopic banding
108
What is a concurrent treatment for esophageal varices
IV octreotide
109
What is PUD
Erosion of GI mucosa (usually stomach) penetrating muscularis mucosa
110
What generally causes PUD
H Pylori vs NSAIDs
111
What are the symptoms for PUD
burning epigastric pain that is often relieved by food
112
What are the symptoms of a duodenal ulcer
pain is absent when awakening and appears mid-morning
relieved with food and then will reoccur 2-3 hours after meal
113
If a patient is woken up at night in pain, what type of ulcer do they probably have
duodenal
114
How do you diagnose PUD
endoscopy
115
What is the most common concern with PUD
hemorrhage
116
What are the common complications of PUD
hemorrhage
perforation
recurrence
117
If PUD causes a perforation, where is it most commonly
anterior wall of the duodenum
118
What are the ssx of a free preformation with PUD
sudden, intense, continuous epigastric pain that spread rapidly
prominent in ROQ that refers to 1 or both shoulders
119
What will be seen in CT/XR with a perforation in PUD
free air under diaphragm or peritoneal cavity
120
What can cause a gastric outlet obstruction
scarring, spasms, or inflammation
121
What are the ssx of a gastric outlet obstruction
recurrent, large volume vomiting, usually at the end of the day
122
What is the duodenal ulcer surgery of choice
parietal cell vagotomy
123
What are some surgical complications from PUD
Anemia (Fe)
Dumping syndrome
mechanical problems
