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Fun Med Spring-AM > Gastro- Quiz 1 > Flashcards

Gastro- Quiz 1 Flashcards

1
Q

Symptomatic esophageal web + iron deficiency anemia + dysphagia

(esp. in middle age woman, with koilonychia-spoon nails, and glossitis)

A

Plummer-Vinson Syndrome

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2
Q

Surgical Tx for Achalasia

A

Heller Myotomy +/- Nissen or Toupet

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3
Q

DDx of GERD

A

Esophagitis, PUD, Cancer, biliary colic (bad gallbladder)- “great imitator”, CAD, motility disorders

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4
Q

Complications of Achalasia

A

Pts are at a higher risk for bronchitis, pneumonia, lung abscess (due to aspiration), stasis esophagitis, esophageal squamous cell carcinoma (17x’s a normal person)

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5
Q

Mediastinitis is a serious complication of what disorder?

A

perforation from instrumentation

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6
Q

Tx for PUD

A
  1. PPI - 90% effective by 8 wks
  2. Sucralfate (carafate) - only first few days, helps heal ulcer, interupts absorption of other meds

Refractory (uncommon)-

  • MC due to noncompliance
  • Refer for surgery if ruled out NSAID use or H.pylori -Vagotomy +/- antrectomy (Billroth I or II)
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7
Q

An esophageal infection with a pathogen that is common in an immunocompromised host (organ transplants, chemo, HIV/AIDS w/CD4 count < 100) -> doesn’t occur in healthy people

A

Infectious Esophagitis

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8
Q

Tx of EoE

A
  • PPI (either exclude GERD, or could help Sx of EoE- overlap thing)
  • Elimination diet: milk, wheat, egg, soy, nuts, and seafood, followed by reintroduction
  • swallowed glucocorticoids
  • severe cases = systemic glucocorticoids

-Surgical dilation? -> higher risk of perforation due to stiffness of esophagus

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9
Q

4 types of hiatal hernias

A

1: sliding- GEJ and cardia extend through hiatus
2: paraesophageal- cardia & fungus extend through hiatus, GEJ stays fixed
3: combo of 1 & 2
4: other viscera extend through hiatus

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10
Q

Factors that exacerbate GERD:

A
  • Abdominal obesity
  • pregnancy
  • gastric hypersecretory states
  • delayed gastric emptying
  • disruption of esophageal peristalsis
  • gluttany
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11
Q

A break in the mucosal surface greater than 5 mm and a depth penetrating the submucosa

A

Ulcer

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12
Q

Sx of B ring

A

usually asymptomatic

present in 10-15% of population

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13
Q

Sx of esophageal disorders

A 
heartburn
dysphagia
odynophagia
chest pain
regurgitation
globus sensation
water brash
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14
Q

Common symptoms of esophageal disease;

A 
heartburn
regurgitation
chest pain
dysphagia
odynophagia
globus sensation
water brash
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15
Q

Tx for corrosive esophagitis

A

supportive, pain meds, IV fluids

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16
Q

Sx of Radiation esophagitis

A

dysphagia and odynophagia that can last weeks to months following therapy. Esophageal mucosa can look red, swollen and friable

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17
Q

Tx of GERD

A

Lifestyle changes & acid inhibitors for 8-12 wks

-avoid refluxogenic foods:
Fatty foods
ETOH
Spearmint/peppermint
Tomato-based foods
Coffee/tea

Omeprazole 30 min prior to first meal of the day for 8-12 wks (No proven differences in efficacy between the subtypes of meds in this class -prazole)
+/- H2 blockers (-tidine)

Long term use of PPI only for Sx return after discontinuance, erosive disease, and/or Barrett’s esophagus

Nissen (for intractable GERD, reqiures pH probe & normal esophageal function)
Toupet (abnormal esophageal function)

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18
Q

Least common complication of PUD

A

Gastric Outlet Obstruction

Look for new onset early satiety, nausea, vomiting, increase in postprandial abdominal pain, and weight loss

2 causes:

  • Ulcer-related inflammation and edema in the peripyloric region; resolves with ulcer healing
  • A fixed, mechanical obstruction secondary to scar formation in the peripyloric area; requires endoscopic balloon dilatation or surgical intervention
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19
Q

Sx of Esophageal cancer

A

Progressive dysphagia, weight loss, heartburn, hoarseness

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20
Q

MC complication of PUD

A

Bleeding- 15%, >60 yo, and 20% have no warning

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21
Q

Tx of perforation

A

NG suction, IV Abx, prompt surgical drainage & repair.

conservative Tx- NPO, IV Abx

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22
Q

What is the work up with suspected Achalasia

A

Barium swallow
+/- manometry
Endoscopy if pseudoachalasia is suspected

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23
Q

Characteristics of Duodenal Ulcers (DU)

A

Discomfort is 90 min-3 hours after eating, is relieved by antacid or eating, and may be awakened at night by Sx*

MC with H.pylori infection

With penetration perforation, this type usually goes to the pancreas

MC in 30-55 yo
5x more common

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24
Q

How do you get rid of Achalasia?

A

No known prevention or reversibility.

Therapy: reduce pressure, improve movement

Rx

Surgery/ Dilation

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25
Q

B ring with a lumen < 13 mm

A

Schatzki’s ring

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26
Q

Dx of perforation

A

CT- to check for air in mediastinum

Contrast swallow w/ gastrografin followed by thin barium

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27
Q

How does esophageal chest pain differ from cardiac chest pain?

A

It is non-exertional, doesn’t improve with rest, meal-related, improved with antacids and can be accompanied by heartburn, dysphagia, and regurgitation.

If difficult to determine origin, do an EKG

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28
Q

Work up/Dx of esophageal atresia

A

Inability to pass tube >10-15 cm

Flouroscopy

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29
Q

Disorder characterized by healthy esophageal epithelium is replaced by metaplastic columnar and goblet cells (stomach cells) from prolonged exposure to gastric aced of GERD

A

Barrett’s Esophagus

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30
Q

Ingestion of alkali or acid, typically accidental but can be suicide attempt

A

Corrosive esophagitis

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31
Q

Cause of hiatal hernias

A

wear and tear, obesity, pregnancy, or genetic predisposition

Risk increase with age

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32
Q

Hypertensive LES

A

Hypermotility

Minor abnormality of similar Sx to Achalasia, but this is diagnosis when not enough to Dx Achalasia

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33
Q

How do you Dx Schatzki’s ring?

A

Barium swallow

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34
Q

“steakhouse syndrome” (solid food dysphagia)

A

Schatzki’s ring

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35
Q

What disorder is characterized by dysphagia, esophageal food impactions, atypical chest pain (due to spasms), heartburn non responsive to PPIs, and a Hx of atopy in adults?

And…chest and abdominal pain, N/V, and food aversion in children?

A

Eosinophilic esophagitis (EoE)

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36
Q

Sx of perforation

A

pleuritic retrosternal chest pain

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37
Q

Full thickness rupture at the GEJ due to forceful vomiting or retching. Could also be from iatrogenic perforation during endoscopy

A

Boerhaave’s Syndrome

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38
Q

Tx of Booerhaave’s Syndrome

A

If small/stable - IV fluids, NPO, Abx, H2 blockers

If large/severe- surgery

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39
Q

This rare disorder is characterized by hypermotility, and abnormal esophageal contractions in the presence of normal swallowing. It has an ill-defined pathology, but is sometimes seen post-op

A

Diffuse Esophageal Spasm (DES)

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40
Q

Sx: odynophagia, dysphagia, hematemesis, dypsnea

A

Corrosive esophagitis

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41
Q

Barrett’s esophagus risk factors:

A

middle age white male with chronic GERD

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42
Q

Sx of Gastritis

A

often asymptomatic in chronic

Acute= anorexia, epigastric discomfort, n/v

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43
Q

Patient’s with Barrett’s Esophagus need regular screening for what?

A

Cytologic and endoscopic screenings for carcinoma. Can progress to adenocarcinoma

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44
Q

Thin, membranous narrowing at the squamocolumnar mucosal junction

A

B ring

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45
Q

MC meds associated with pill esophagitis

A

bisphosphanates, NSAIDs, ferrous sulfate, doxycycline, tetracycline, quinidine, phenytoin, potassium chloride,

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46
Q

Proximal and distal esophagus to not communicate and therefore cannot swallow or handle secretions in an infant

A

Esophageal Atresia

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47
Q

Esophageal Foreign Bodies/Food Impaction

A
  • complete obstruction of esophagus
  • could be associated with stricture, carcinoma, rings, EoE, or carelessness

Sx: foaming at the mouth, chest pain

Tx: spontaneous resolution or w/ endoscope
(sometimes try glucagon

Should evaluate for possible causes

48
Q

A herniation of mucosa and submucosa through esophageal muscle. Associated with achalasia or distal esophageal stricture.

A

Epiphrenic

-False diverticula

49
Q

MC tests for esophageal disorders

A

upper endoscopy and barium radiography

50
Q

This rare disorder is characterized by Hypomotility- basically a lazy esophagus that isn’t contracting due to a degeneration of ganglion cells in the esophageal myenteric plexus. The esophagus becomes dilated with a “sigmoid deformity” and the LES becomes hypertrophied. Thought to be an autoimmune disorder triggered by Herpes Simplex 1 + genetic susceptibility

A

Achalasia

51
Q

Factors that increase risk of developing DU or GU

A

NSAIDs, H. pylori, smoking, alcohol, stress, NG tubes, genetics, ischemia, medications, chemo, steroids, crack cocaine

52
Q

3 types of Infectious Esophagitis

A

Candida albicans

Herpetic Esophagitis - HSV 1 or 2, varicella herpes zoster

Cytomegalovirus- w/ HIV/AIDS, organ transplant pt

53
Q

Where does a perforation from instrumentation during endoscopy usually occur?

A

Hypopharynx, GEJ, or at site of stricture

54
Q

What disorder is secondary to eosinophilic infiltration, has an overlap with GERD, is immunologically induced by antigen sensitivity- often with dietary factors and food sensitivity?

A

Eosinophilic esophagitis (EoE)

55
Q

Dx of Corrosive esophagitis

A

Early endoscopy to assess and grade the injury and look for possible complications

56
Q

A thin, eccentric, smooth extension of normal esophageal tissue consisting of mucosa and submucosa typically in the proximal esophagus

A

Esophageal web

57
Q

How to Dx Booerhaave’s Syndrome

A

Chest CT/CXR + contrast swallow w/ gastrografin

58
Q

Normal Esophageal Motility has primary and secondary peristaltic contractions. As well as tertiary non peristaltic contractions. What is the difference?

A

Primary contraction waves begin high in the pharynx and progress down the entire esophagus once swallowing is initiated.

Secondary contraction of the circular esophageal muscle that begins without swallowing.
Usually in response to distention (something getting stuck)

Tertiary contraction occur simultaneously at different levels of the esophagus (or entire length). Isolated event can be normal, repetitive events are disease process. May be spontaneous or in relation to swallowing.

59
Q

Perforation is the 2nd MC complication of PUD. What are the 2 types?

A

Free Perforation- contents spill into abdominal cavity

Penetration perforation- ulcer tunnels to other organ
DU MC to pancreas
GU MC to L hepatic lobe

60
Q

Diagnosis of EoE is by symptoms plus endoscopy. What can be seen on endoscopy?

A

edema, multiple esophageal rings, longitudinal furrows, exudate/punctate

Also may see eosinophils on CBC

61
Q

Diagnosing H.pylori Gastritis

A

No hard and fast guidelines to test for H.pylori, although most EGD’s will bx and test for it.

Non-invasive testing:

  • Quant Serologic Elisa test (blood, 80% accuracy, only measures antigens)
  • Fecal antigen or urea breath test (sensitivity and specificity over 95%,
62
Q

Sx of DES

A

chest pain, dysphagia

63
Q

Sx of persistent drooling & aspiration, with regurgitation of food in an infant

A

Esophageal Atresia

64
Q

Work up for GERD

A

Manometry, ph testing

65
Q

complications of Radiation esophagitis

A

submucosal fibrosis, degenerative tissue changes, and stricture can occur years later

66
Q

Nutcracker (Jackhammer) Esophagus

A

Hypermotility, excessive esophageal contractions > 2 SD above normal

Sx: chest pain, dysphagia

Dx: manometry-> increased pressure during peristalsis

Tx: reduce esophageal pressure with CCBs, nitrates, botox, Sildenafil

67
Q

The 2 types of work ups for PUD are:

A

1) Endoscopy
- most sensitive and specific
- have photo documentation
- good when suspicions are high

2) Textbook= barium swallow
- if ulcer identified, then endoscopy
- some small lesions will not show up on barium swallow

68
Q

Hallmark Sx of GERD

A

Heartburn & regurgitation (can treat empirically based on these Sx)

Can also experience chronic cough at night, hoarseness, recurrent laryngitis, asthma exacerbations, dental erosions, aspiration

If also experiencing dysphagia or chest pain, must rule out other causes

69
Q

Complications of GERD

A

at risk for esophagitis, stricture, Barrett’s, bleeding, adenocarcinoma (metaplasia -> dysplasia -> adenocarcinoma)

*Endoscopic screening q 3-5 years

70
Q

3 parts of Mucosal Defense System:

A
  • Mucous gel layer -composed of 95% water and 5% mucin (serves as barrier protection)
  • Surface epithelial cells (mucus production, pH regulation, and produce protective heat shock proteins that prevent protein denaturation)
  • Subepithelial elements that provide cell protection and regeneration (they produce a host of protective factors and can migrate to repair areas where the pre-epithelial layers have been breached)

plus significant microvasculature that helps with defense and healing

71
Q

Risk factor for adenocarcinoma of the esophagus

A

Barrett’s esophagus

72
Q

Lower esophageal cancer is more likely to be what type of cancer?

A

adenocarcinoma

73
Q

DDx of EoE

A

GERD, drug hypersensitivity, connective tissue disorder, hyper-eosinophilic syndrome, infection

74
Q

Disorders of the esophagus manifest by impaired _____ or _______.

A

function or pain

75
Q

Causes of esophageal web

A

congenital or due to inflammation (ex. with EoE)

76
Q

An inflammation of the stomach, most commonly by H.pylori, that is often an incidental finding

A

Gastritis

At risk for gastric carcinoma

77
Q

Testing for esophageal disorders includes:

A 
upper endoscopy (EGD)
Barium radiography
esophageal manometry
endoscopic US
Ambulatory Reflux testing
78
Q

Age of onset for Achalasia

A

ages 25-60

79
Q

Who should be tested to check for Gastritis?

A

pts with PUD, Hx of PUD, or gastric cancer

80
Q

Tx of Radiation esophagitis

A

supportive/ pain control

Dilation for chronic strictures

81
Q

3 dominant mechanisms of GERD:

A
  • Frequent transient LES relaxation (90%)
  • LES hypotension
  • Anatomic distortion of GEJ
82
Q

Tx of Barrett’s Esophagus

A

PPI, GERD related diet plan: avoid fatty foods, chocolate, peppermint, alcohol, coffee, tomatoes, acidic foods

83
Q

Pernicious Anemia Gastritis

A

Severe lack of IF due to gastric atrophy

  • may be a genetic link
  • often a comorbid autoimmune disease

Sx: gastric output of HCl acid, pepsin, IF severely reduced

More common in men, 60 yo, although blacks and latinos are often younger

Normal life expectancy for women. Men slightly reduced due to higher incidence of gastric cancer

84
Q

Upper esophageal cancer is more likely to be what type of cancer?

A

Squamous cell carcinoma

85
Q

This disorder is characterized by symptoms that include solid & liquid dysphagia, regurgitation of food and secretions often seen as foaming at the mouth, chest pain from esophageal spasm, heartburn and weight loss (esp later in the disease).

A

Achalasia

86
Q

Sx of hiatal hernias

A

Most asymptomatic, but are likely to cause GERD

large ones cause:
heartburn
regurg.
acid reflux
dysphagia
chest/ab pain
SOB
87
Q

MC congenital esophageal disorder

A

Esophageal Atresia and tracheoesophageal fistulas

88
Q

Menetrier’s Disease (Hypertrophic gastropathy)

A

Large, tortuous mucosal folds in body and fungus. Often due to CMV in kids, but unknown in adults. Too much TGF-a?

Sx: epigastric pain, n/v, anorexia, peripheral edema, wt loss, GI bleeding

Dx: barium swallow, endoscopy w/ bx

Tx: anticholinergics, PG, prednisone, somatostatin analogues, H2 blockers, EGF inhibitory antibody- Cetuximab (last resort = gastrectomy)

DDx: ZES, malignancy, infx, gastritis

89
Q

A herniation of mucosa and submucosa through esophageal muscle, with weakness at cricopharyngeus muscle that causes herniation or out-pouching

A

Zenker’s (or hypopharyngeal)

-False diverticula

90
Q

Details to inquire about when assessing esophageal disorders include:

A 
Weight gain or loss
Gastrointestinal bleeding
Dietary habits including the timing of meals
Smoking
Alcohol consumption
History of vomiting
History of eating disorders
91
Q

This complicates Tx of thoracic cancers (breast and lung) with risk proportional to radiation dosing

A

Radiation esophagitis

92
Q

Sx of PUD

A

epigastric pain that is burning, gnawing, dull, like a bad hunger pain (characteristic of both GU and DU)

May be asymptomatic until complications occur

93
Q

Tx of esophageal web

A

Dilation

94
Q

Complications from corrosive esophagitis

A

may lead to esophageal perforation, bleeding, stricture, and death.

Also associated with severe stricture formation and can require repeated dilation

95
Q

Only true esophageal diverticula

A

Midesophageal- due to traction from adjacent inflammation (usually TB)

96
Q

Tx of DES

A

Anxiolytics

+/- nitrates, CCB, vasodilators, botox

Surgery- long myotome or esophagectomy (rare- only in serious cases)

97
Q

Characteristics of Gastric Ulcers (GU)

A

Discomfort with eating, nausea & wt loss

Usually NSAID use induced, because they block COX1 which decreases PG

With penetration perforation, this type usually goes to the L hepatic lobe

MC in 55-70 yo

98
Q

Disorders of the esophagus are manifested by

A

impaired function or pain.

99
Q

Triple therapy for Tx of Gastritis includes:

A

Omeprazole + clarithromycin + amoxicillin for 10 days

although there are 8 approved treatment combinations

eradication confirmation testing is done (fecal or breath)

100
Q

When would you order an esophageal manometry?

A

To measure function of lower esophageal sphincter and muscles of esophagus.

Order for pts with dysphagia, odynophagia, intractable heartburn, non-cardiac chest pain

101
Q

Tx of hiatal hernias

A

Antacids
PPIs
H2 blockers
lifestyle changes (food choices- avoid trigger foods, small meals, avoid laying down after eating, maintain healthy wt, stop smoking, elevate head of bed)

Surgery for persistent

102
Q

Pts with Gastritis are at an elevated risk of developing…

A

Low grade B-cell lymphoma

Gastric MALT lymphoma

103
Q

Tx of esophageal atresia

A

surgery

Good prognosis

104
Q

SX of esophageal diverticula

A

usually asymptomatic until large enough to retain food, then coughing and regurgitation

105
Q

Hallmark of Infectious Esophagitis

A

Odynophagia (no matter the infectious agent)

Can also have dysphagia, chest pain, hemorrhage

106
Q

Tx for Infectious Esophagitis

A

Candida - fluconazole 14-21 days (if can’t swallow - IV echinocandin caspofungin 7-21 days)

Herpetic - Acyclovir PO or IV, if immunocompromised then increase days

CMV - ganciclovir 3-6 weeks, or foscarnet

May need maintenance therapy

107
Q

DDx of Achalasia

A

DES, Chagas, pseudoachalasia

108
Q

What is visualized on a barium swallow with Achalasia

A

Sigmoid esophagus, dilation, tapering, air/fluid levels

109
Q

Tx for Schatzki’s ring

A

Dilation

110
Q

In PUD, an ulcer appears in either of 2 areas:

A

stomach (GU) or duodenum (DU)

111
Q

DDx of PUD

A

Functional dyspepsia, GERD, cancer, vascular disease, pancreatic disease, gallbladder disease, Crohn’s disease, post-op changes

112
Q

Rx for Achalasia

A

nitrates, CCB, botox, phosphodiesterase inhibitors

113
Q

Dilation of the submucosal esophageal glands. Associated with candida & proximal esophageal strictures. Pitting seen.

A

Intramural Esophageal Pseudodiverticula

-False diverticula

114
Q

How do you diagnose DES?

A

Must rule out other causes of dysphagia

Manometry -> spastic esophageal activity in distal esophagus

“corkscrew” esophagus on Barium swallow (can also be seen in Achalasia)

115
Q

Symptoms seen on Physical exam of PUD

A
  • Epigastric tenderness (poor predictive value)
  • Abdominal tenderness may fall right of midline 20% of the time

Watch for signs of bleeding or perforation:
Tachycardia
Orthostatic bp changes
Guarding, rigidity, rebound tenderness

Fun Med Spring-AM (2 decks)

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