Flashcards in Final Exam -- Cocaine Use Disorder and GI Disease I (Esophagus) Deck (67):
How long does it take for inhaled cocaine to reach the brain? How long is its effect?
Reaches brain in 3-5 minutes, lasts 60-90 minutes
How long does it take for injected cocaine (dissolved in water) to reach the brain? How long is its effect?
Reaches brain in 15-30 seconds, lasts 20-60 minutes
How long does it take for inhaled cocaine vapor to reach the brain? How long is its effect?
Reaches brain instantaneously, lasts 5-10 minutes
Injected cocaine can cause what kind of retinopathy?
True or false: the upper 2/3 of the esophagus has skeletal muscle while the lower 1/3 has smooth muscle.
False; the upper 1/3 of the esophagus has skeletal muscle while the lower 2/3 has smooth muscle.
Comparing the upper esophageal sphincter (UES) and the lower esophaegeal sphincter (LES), which is under voluntary control and which is not under voluntary control?
UES is under voluntary control; LES is not under voluntary control.
Which type of dysphagia arises from the oropharynx, larynx, and/or UES?
Oropharyngeal dysphagia causes difficulty in initiating a swallow, and ___________ (solids/liquids) are more problematic.
What are the symptoms of oropharyngeal dysphagia?
Inability to form a bolus, difficulty initiating a swallow, coughing/choking, aspiration/regurgitations, food sticking at the level of throat. Liquids are more problematic.
There are neurologic, iatrogenic, structural, muscular, infectious, and metabolic causes of oropharyngeal dysphagia. What neurologic causes are possible?
Cardiovascular accident, Parkinson's, ALS
There are neurologic, iatrogenic, structural, muscular, infectious, and metabolic causes of oropharyngeal dysphagia. What iatrogenic causes are possible?
There are neurologic, iatrogenic, structural, muscular, infectious, and metabolic causes of oropharyngeal dysphagia. What structural causes are possible?
Neoplasia, Zenker's diverticulum, cricopharyngeal bar
What is the name of the study in which you swallow barium and the camera can construct a video of how the swallowed foods move into the stomach?
Videofluoroscopic swallowing study (VFSS**) or modified barium swallow
Which type of dysphagia arises from the esophagus or LES?
Esophageal dysphagia has issues with solids or liquids?
What are the symptoms of esophageal dysphagia?
Coughing/choking at night (unrelated to swallowing), symptoms of GERD, associated chest pain and regurgitation, feeling that swallowed bolus is "stuck" on the way down. Dsyphagia occurs with solids and liquids.
What are the causes of esophageal dysphagia?
Abnormality of peristalsis and/or deglutitive inhibition or abnormality of LES (achalasia, scleroderma, chronic GERD).
What would a chest X-ray show on a patient with esophageal dysphagia?
Widened esophagus, and bird beak sign toward the end of the esophagus.
Manometry is used to evaluate esophageal dysphagia. What does it measure?
Measures the strength, duration, and sequential nature of esophageal contraction.
In terms of diet and eating habits for a person with dysphagia, which of the following recommendations is incorrect?
Eat in an upright position
Eat small bites
Don't talk while eating
Check inside of cheek for pocketed food after eating
Turn head up when swallowing
Remain in upright position for 30-45 minutes after eating.
Turning head up when swallowing is incorrect; it is recommended that the patient turn their head down when swallowing.
The National Dysphagia Diet consists of three levels, numbered 1-3, depending on the severity of the swallowing difficulty. Which level refers to a mild difficulty, in which the patient can still eat most foods but needs them cut into small, bite-sized pieces first?
The National Dysphagia Diet consists of three levels, numbered 1-3, depending on the severity of the swallowing difficulty. Which level refers to a mild to moderate difficulty, in which the patient's foods must have a consistency similar to minced meat?
The National Dysphagia Diet consists of three levels, numbered 1-3, depending on the severity of the swallowing difficulty. Which level refers to a moderate to severe difficulty, in which the patient's foods must have a pudding/puree-like consistency?
What is the term for pain on swallowing?
What is the term for inability to swallow?
Achalasia consists of non-peristaltic esophageal contractions and __________ (increased/impaired) relaxation of the LES.
______________ consists of non-peristaltic esophageal contractions and impaired relaxation of the LES.
True or false: achalasia is associated with the degeneration of postganglionic inhibitory neurons.
True or false: achalasia is mostly idiopathic, though 2-5% of cases are familial with autosomal dominant mode of inheritance.
False; most cases are indeed idiopathic; but in the 2-5%, the mode of inheritance is autosomal recessive.
What sign might be seen on a chest x-ray of a patient with achalasia?
What types of pharmaceutical agents can be used to try and treat achalasia?
Sublingual nitroglycerin, calcium channel blockers, phosphodiesterase inhibitors, and anticholinergics.
_________________ is a way to treat achalasia that involved placing a baloon at the LES to stretch the area.
_________________ is a treatment for achalasia that involves cutting the muscles of the LES.
Which GI condition leads to atrophy of esophageal smooth muscle and loss of LES tone?
What are the symptoms of scleroderma?
Dysphagia, dry mouth, calcific skin deposits, tight skin, severe GERD, and chest pain.
In how many patients with scleroderma is the esophagus involved?
In which gender and age range are scleroderma more common?
Women; 30-50 years
What sort of lab tests could you run on a patient with scleroderma?
ANA, anti-scl-70, anticentromere antibodies
Manometry on a patient with scleroderma esophagus would show ___________ (hypotensive/hypertensive) LES and ____________ (poor/strong) peristaltic contraction.
True or false: there is no specific treatment for scleroderma esophagus, besides getting the patient on pronton pump inhibitors to help with the GERD.
True. You can also use endoscopy to monitor for esophageal cancer.
Which upper GI order is the most common in the Western World, consisting of 75% of esophageal diseases?
Gastroesophageal reflux disease (GERD)
The primary anti-reflux barrier for the esophagus is the LES. What two main patterns of dysfunction can cause GERD?
Hypotensive LES; transient LES relaxation (can be predisposed by hiatal hernia)
Some predisposing factor for GERD include hiatal hernia, certain foods and medications, direct mucosal damage, and certain lifestyle habits. Which foods tend to predispose to GERD?
Caffeine, chocolate, peppermint, alcohol, and tomato-based products.
Some predisposing factor for GERD include hiatal hernia, certain foods and medications, direct mucosal damage, and certain lifestyle habits. Which medications tend to predispose to GERD?
Diazepam, estrogens, progesterone, anticholinergics, and TCAs
Some predisposing factor for GERD include hiatal hernia, certain foods and medications, direct mucosal damage, and certain lifestyle habits. What are a few things that can damage the mucosa?
Aspirin, iron salts, TCAs, quinidine, potassium chloride tablets
Some predisposing factor for GERD include hiatal hernia, certain foods and medications, direct mucosal damage, and certain lifestyle habits. What lifestyle habits can predispose to GERD?
Weight gain, obesity, smoking, and eating prior to reclining.
What are the typical symptoms of GERD?
Heartburn, regurgitation, and dysphagia
What are the atypical symptoms of GERD?
Hoarseness, chronic laryngitis and sore throat, globus sensation, otitis media, dental erosion, non-cardiac chest pain, aspiration pneumonia, and asthma
Ambulatory pH monitoring, barium swllow, esophageal manometry, and endoscopy are all tests that can be used to evaluate GERD. Which test is the most diagnostic test, with a sensitivity and specificity of 92%?
Ambulatory pH monitoring.
Ambulatory pH monitoring, barium swllow, esophageal manometry, and endoscopy are all tests that can be used to evaluate GERD. Which test is used for the detection of complications from GERD?
Briefly describe ambulatory pH monitoring.
An acid-sensitive catheter is placed in the esophagus for a prolonged period of time to measure the pattern of pH changes. Diet and exercise are unrestricted, and the patient should have stopped acid-suppressing medications 3-14 days prior to the study.
What sorts of lifestyle changes can a patient with GERD make to ease the symptoms?
Weight loss, elevate bed slightly, avoid reclining within 2-3 hours of eating, eat small meals, stop smoking, and avoid foods and drinks that trigger the GERD.
What medications can be given to treat GERD?
Antacids, H2 blocking agents, and proton pump inhibitors.
_____________ is a surgical treatment for GERD that involves wrapping the stomach around the lower esophagus to strengthen the LES. In what percentage of patients does this surgery lead to symptom resolution?
Laproscopic fundoplication; symptom resolution in more than 90%.
In 12% of patients with reflux documented by pH monitoring, what complication is found?
In Barret's esophagus, ____________ (squamous/columnar) epithelium is replaced by __________ (squamous/columnar) epithelium.
Squamous epithelium is replaced by columnar epithelium.
What does the typical patient with Barret's syndrome look like, in terms of gender, race, and age?
Middle-aged Caucasian male
True or false: the symptoms of Barret's esophagus are the same as GERD.
True or false: Barret's esophagus is a cancerous condition.
False; it is a precancerous condition. 1/200 Barret's esophagus patients develop cancer per year.
What are the risk factors for Barret's esophagus?
High BMI, male, age, tobacco smoking, heavy alcohol use, poor diet with low fruits and vegetables, and poor compliance with proton pump inhibitors.
What is the treatment for Barret's esophagus that does NOT involve high-grade dysplasia?
The same as GERD: proton pump inhibitors and/or laproscopic fundoplication. The patient may also need a biopsy done with some frequency depending on the level of metaplasia/dysplasia.
What are the treatment options for Barret's esophagus that DOES involve high-grade dysplasia?
Endoscopic mucosal resection (EMR)*, photodynamic therapy (PDT)*, radiofrequency ablation, focal thermal ablation, and cryoablation.
True or false: Barret's esophagus that invovles high-grade dysplasia has an 80% risk of cancer development.
False; it's a 30% risk of cancer development.*
One of the esophageal conditions discussed in class has a higher prevalence in men. Which condition is it?
One of the esophageal conditions discussed in class has a higher prevalence in women. Which condition is it?
Scleroderma esophagus. (Scleroderma is more common in women, and since the esophagus is involved in 75-85% of patients with scleroderma, I assume scleroderma esophagus is also skewed toward women.)
A patient has ALS and is exhibiting difficulty swallowing. What type of dysphagia are they most likely to have, oropharyngeal or esophageal?