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Clin Med 2 > GI Esophageal + Gastric Disease > Flashcards

GI Esophageal + Gastric Disease Flashcards

1
Q

Dyshagia

A

sensation of impaired passage of food or liquids from mouth to stomach

oropharyngeal
esophageal

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2
Q

Odynophagia

A

painful swallowing

Typically represents a severe inflammatory process

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3
Q

Oropharyngeal dysphagia

A

difficulty transferring food from mouth to the upper esophagus sphincter

typically mucosal disruption

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4
Q

Esophageal dysphagia

A

difficulty with the passage of ingested material form the hypopharynx to the stomach

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5
Q

Causes of Oropharyngeal dysphagia

A

Neurologic: CVAs (brainstem), Parkinsons
Anatomic: neoplasma, Zenker’s Diverticulum

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6
Q

Causes of Esophageal dysphagia

A

Neurologic: diffuse esophageal spasm, Achalasia
Autoimmune disorder: Scleroderma
Obstructive lesions: strictures, rings/webs, carcinoma

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7
Q

What are common esophageal symptoms

A

Chest pain
Dysphagia
Odynophagia

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8
Q

Zenker’s Diverticula

A

diverticulum in the esophagus that can retain food and cause a ton of problems

needs surgery

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9
Q

What age group presents with Zenker’s diverticula?

A

> 50 years old

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10
Q

What is the treatment for Zenker’s Diverticula

A

surgery

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11
Q

Achalasia

A

nerves in the esophagus get damaged, making it difficult for food and liquid to pass into the stomach
leads to dilated esophagus

cause is unknown

insidious onset

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12
Q

Achalasia triad

A

increased LES resting pressure
inability of the LES to relax
absence of peristalsis in body of the esophagus

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13
Q

What is the treatment for achalasia?

A

medications: nitrates, CCB
BoTox injection
Endoscopic pneumatic dilation
surgical intervention

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14
Q

Schatzki’s ring

A

ring of mucosal issue in the distal esophagus which can cause narrowing and dysphagia

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15
Q

Eosinophilic Esophagitis

A

allergic inflammatory condition
eosinophilic infiltration of mucosa

typically presents with dysphagia and food impaction

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16
Q

Epi of eosinophilic esophagitis

A

child and adults

M > F

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17
Q

What is the treatment for eosinophilic esophagitis?

A

dietary modification
topical (inhaled) and oral steroids
dilation with stricture

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18
Q

Who is more likely to get esophageal infections?

A

immunocompromised

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19
Q

What is the most common symptom for esophageal infections

A

odynophagia

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20
Q

What is the most common infection of the esophagus?

A

candidiasis

herpes and CMV can also infect

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21
Q

Risk factors for medication -induced esophagitis?

A 
don't drink enough fluids with drugs 
supine after taking medications
pre-existing swallowing disorders
decreased salivation 
anatomic abnormalities
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22
Q

What drugs are most common for causing drug induced esophagitis?

A 
doxycycline
iron
potassium
vitamin C
aspirin
NSAIDs
alendronate
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23
Q

Common abnormalities seen with GERD?

A

LES incompetence
hiatal hernia
increased intra-abdominal pressure

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24
Q

Common clinical presentations of GERD?

A 
substernal discomfort 
throat discomfort 
hoarseness
coughing
wheezing
gingivitis
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25
Q

How do you dx GERD?

A

typical sxs without alarm signs require no specific investigations (unless concern of cardiac disease)

studies:

  • barium study
  • pH monitoring
  • endoscopy
  • esophageal manometry
  • radionuclide scanning
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26
Q

What are the common sxs of esophageal spasm?

A

chest pain

dysphagia

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27
Q

What are the alarm sxs of GERD?

A

dysphasia
odynophagia
weight loss
anemia

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28
Q

Barrett’s Epithelium

A 
10% of pts with GERD have this 
asymptomatic 
M > F
RISK OF GETTING CA
Risk of adenocarcinoma is 40X greater than the general population
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29
Q

Who gets an endoscopy in regards to GERD?

A
  • pts with 5 year hx of uncontrolled GERD
  • pts >45 years with new dx of GERD
  • alarm sxs

WHY?
concerned about them having Barrett’s epithelium and thus a 40X great risk of adenocarcinoma

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30
Q

What are the 2 types of esophageal cancer and who gets them?

A

SCC (EtOH, smoking)

Adenocarcinoma (comes from Barrett’s)

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31
Q

What is the treatment for esophageal cancer?

A

Surgery is the only option

5 year survival is 5-10%

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32
Q

Which meds are really important to ask about when evaluating for PUD?

A

NSAIDs
steroids
anticoags/antiplatelets

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33
Q

What is the gold standard for dx PUD?

A

endoscopy

EGD - esophagogastroduodenoscopy

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34
Q

What are risk factors for PUD?

A 
ASA/NSAIDs
H. pylori infection 
acid hypersecretory state 
anticoagulation 
chronic disease that might disrupt the mucosal blood flow (CV, cirrhosis, etc) 
hospitalization, ventilation
35
Q

What are the sxs of PUD?

A 
Epigastric pain (MC --seen in 80 - 90% of pts) 
N/V
Anorexia
Melena
Hematemesis 
Weight loss
36
Q

Where are PUD most common?

A

5x more common in the duodenum

if in the stomach, benign ulcers are located most commonly in the antrum

37
Q

____% of regular NSAID users will get PUD?

A

10-20%

50% have gastric erosions

38
Q

Not everyone taking NSAIDs gets ulcers, what are the risk factors of taking NSAIDs progressing to ulcers?

A 
hx of GI complications 
older age 
anitcoag use
steroid use 
higher dosage
39
Q

H. Pylori

A

gram NEGATIVE rod

Infects GI tract —-leads to immune response and inflammation —-produces urease which reacts with urea to form ammonia —-ammonia is what directly breaks down intestinal mucosa

40
Q

What are the risk factors for H. Pylori?

A

Low socioeconomic status
elderly and childhood
minority groups
immigrant populations

41
Q

How can you test for H. Pylori?

A

Urea breath test
stool antigen
gastric biopsy
serology (hardly ever used)

42
Q

What is the treatment for H. Pylori?

A

Triple therapy
2 ABX for 2 weeks (Clarithromycin and Amoxicillin)
PPI

be sure to check stool after treatment for eradication

43
Q

How effective are PPIs wit ulcers?

A

90% of duodenal ulcers heal after 4 weeks

90% of gastric ulcers heal after 8 weeks

44
Q

H2 blockers

A

used in PUD
block histamine –which is used in acid production

rapid onset (<1hour) 
take longer to heal compared to PPIs

not used as commonly these days

45
Q

Zollinger-Ellison Syndrome

A

makes up 0.1-1% of all pts with duodenal ulcers

46
Q

What are the sxs of gastritis and duodenitis?

A 
anorexia
epigastric pain 
GI bleeding
nausea
vomiting
47
Q

What do you see on endoscopy for gastritis?

A

subepithelial hemorrhages
petechiae
erosions

48
Q

What causes erosive gastritis?

A 
medications (NSAIDs) 
EtOH
stress
portal HTN (liver dz or cirrhosis) 
Ischemia 
Caustic ingestion 
Radiation
49
Q

What causes non-erosive gastritis?

A

H. Pylori
Pernicious anemia
esopinophilic gastritis

50
Q

What causes specific gastritis?

A

infections (necrotizing)
Menetrier disease
Granulomatous (Crohns, sarcoid)

51
Q

Gastroparesis

A

motility of the stomach is either abnormal or absent

stomach is unable to contract normally, and therefore cannot crush food nor propel food into the small intestine

52
Q

What are sxs of gastroparesis?

A 
bloating 
N/V
early satiety 
epigastric pain 
regurg of undigested food 
weight loss
53
Q

Bezoar

A

undigested food in the stomach that has to be removed

in pts with gastroparesis

54
Q

How do you dx gastroparesis?

A

EGD (upper endoscopy)

gastric emptying test

55
Q

Who gets gastroparesis?

A 
DM 
infections 
endocrine disorders 
Meds (benzos, CCB, narcotics) 
Easting disorders
56
Q

What is the treatment for gastroparesis?

A

diet (small, frequent meals)
avoid high fiber (stays in the stomach longer)
feeding tube
anti-emetics

Metoclopramide (reglan) BBW –crosses BBB

Domperidone (not available in the US)

Erythromycin (acts on motilin)

surgery

57
Q

Can you tell the difference between cardiac disease and esophageal disease?

A

No!
They mimic one another

Squeezing chest pain 
Localized or radiate 
May be triggered by cold or hot substances (this is the only one that might be the difference between the two) 
Not always triggered by swallowing 
Can awaken you from sleep
58
Q

A pt comes in complaining of a lump on his neck that only appears after he eats, making it difficult to swallow, however if he presses on the lump he can swallow easier. He comes to you today because he woke up this morning with last nights dinner on his pillow. What do you think this guys has?

A

Zenker’s diverticula

False diverticula of the esophagus that can be large enough it retains food and compresses the actually esophagus

  • fullness or gurgling in the neck
  • coughing, aspiration
  • regurgitation of retained food
  • obstructive sxs by compression
59
Q

On X-ray with contrast you see clear bilateral notches on the esophagus, what do you suspect?

A

Schatzki’s ring

60
Q

How does an esophageal infection from herpes differ than CMV on scope?

A

Herpes typically coalesce and cause ulcerations

CMV is classic small solitary ulcer

61
Q

Are you more likely to see odynophagia or dysphagia with medication inducted esophagitis?

A

Odynophagia

62
Q

Esophageal spasm

A

(Aka nutcracker esophagus?)

Altered peristalsis that prevents the food from moving effectively down into the stomach

Presents with chest pain and dysphagia

Must distinguish from cardiac disease

63
Q

Who gets GERD?

A

Males and females

60% of adults >65 y/o have monthly sxs

64
Q

What is GERD?

A

Reflux of gastric contents into the esophagus —-primary offending agent is acid

65
Q

What are complications of GERD?

A 
Bleeding 
Stricture 
Ulceration 
Barret’s epithelium 
Adenocarcinoma
66
Q

What is the primary role of endoscopy with GERD?

A

Determine:

  • presence of tissue injury
  • presence of barrett’s epithelium
  • etiology of dysphagia
  • evidence of bleeding
67
Q

Bravo Capsule

A

A dx test of pH monitoring for GERD

Placed 5cm above the LES

68
Q

What dietary modifications should a pt with GERD be on?

A

Small volume meals
Low fat diet
Avoidance of precipitating factors

Avoid recumbency after eating

Avoid medications which decrease LES pressure

69
Q

What types of medications are available for pts with GERD?

A 
Antacids (neutralization) 
Acid suppression 
-H2 receptor antagonists
-PPI
Prokinetic agents 
-metachlopromide (reglan)
70
Q

What surgery options are there for pts with GERD?

A

Anti-reflux surgery reserved for recalcitrant sxs and complications

  • <5% require surgical intervention
  • 2-8% morbidity, <1% mortality

Open v s laparoscopic procedures

71
Q

Esophageal SCC affects which part of the esophagus?

A

Top 1/3

72
Q

Adenocarcinoma of the esophagus affects which part of the esophagus?

A

Lower 1/3

73
Q

What is the most common cause of acute upper hemorrhage?

A

PUD

74
Q

What is the most common sx seen with PUD?

A

Epigastric pain

75
Q

What is the most common cause of gastroduodenal injury in the US?

A

NSAIDS

Can affect any portion of the GI tract at any dose

76
Q

What medications do you give prior to endoscopy?

A

IV PPI
Why? To suppress acid, facilitate clot formation and stabilization

Duration: at least until EGD, and then based on findings

77
Q

How do you control acute ulcer bleeding?

A

Pt gets admitted to hospital
Given PPI IV prior to endoscopy (EGD)

Early endoscopy (within 24hr) is the most effective way to control acute ulcer bleeding

Endoscopic hemostasis starts with injection of saline or epi or ethanol

If that fails move to cautery methods and if that fails move to mechanical therapy such as clips or banding

78
Q

What is coaptive coagulation?

A

Direct pressure and thermal therapy

Used with injection therapy for PUD endoscopy treatment of a bleeding ulcer

79
Q

When do we move to surgical therapy for PUD?

A

If our attempts to stop bleeding endoscopically have failed

We don’t typically get to this phase

80
Q

What is the post-endoscopy management for pts who had bleeding ulcers?

A

PPI IV x 72 hours

81
Q

How do PPIs work?

A

Bind the acid-secreting enzyme H+ K+ ATPase or “proton pump” permanently inactivating it
Inhibits >90% of 24 hour acid secretion

82
Q

For pts who are normally on baby aspirin for CV disease but have presented with bleeding ulcer, what do you do?

A

Stop the aspirin until bleeding is resolved, then restart them on aspirin

83
Q

What is the treatment for Zollinger-Ellison Syndrome?

A

High dose PPI

Removal of tumor

Clin Med 2 (13 decks)

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