what patients do you seen esophageal varices
cirrhosis and portal HTN
what is the symptom if an esophageal varice ruptures?
what does odynophagia mean
pain on swallowing
“disordered esophageal motility with inability to relax LES”
how does achalasia appear on barium swallow
bird beak sign
what causes achalasia?
damaged ganglion cells in myenteric plexus
where is the myenteric plexus?
in between the inner circular and outer longitudinal layer (layers in the muscularis propria)
what is a common cause of alchalasia in latin america?
chagas disease that damages the myenteric plexus
besides the bird beak sign, what are some other clinical features of alchalasia
dysphagia for solids & liquids
high LES Pressure on esophgeal manometry
with alchalasia there is increased risk for..
esophageal squamous cell carcinoma
what causes GERD?
decreased LES tone
what are some risk factors for GERD
alcohol, tobacco, obesity, fat rich diet, caffeine, hiatal hernia
what is the most common type of hiatal hernia
sliding hiatal hernia
what is a sliding hiatal hernia?
part of the stomach (cardia) goes up into the esophagus
how does a sliding hiatal hernia appear on barium swallow? why?
hour glass appearance of stomach
because the LES is still in tact (so bulge of stomach-LES-stomach)
what is a para-esophageal hernia? what causes it?
stomach herniates up next to the esophagus due to defect in diaphragmatic connective tissue membrane
what hernia will you hear bowel sounds in lower lung fields?
tell me what the metaplasia of the esophagus epithelium is (what it was and what it becomes)
from non keratinizing squamous epithelium to non ciliated columnar cells with goblet cells
what are some clinical presentations of GERD
asthma and cough
damage to teeth enamel
ulceration with stricture
what is the most common type of esophageal cancer in the US (and the western world)
what is the most common type of esophageal carcinoma in the world?
squamous cell carcinoma
where does adenocarcinoma usually arise int he esoophagus
where in the esophagus does squamous cell carcinoma usually arise?
upper or middle 1/3
what are some risk factors for squamous cell carcinoma?
anything that irritates the mucosa alcohol & tobacco very hot tea achalasia celiac sprue chronic esophagitis esophageal web esophageal injury
an esophageal carcinoma of the upper 1/3 likes to spread to which lymph nodes?
an esophageal carcinoma of the middle 1/3 likes to spread to which lymph nodes?
mediastinal or tracheobronchial nodes
an esophageal carcinoma of the lower 1/3 likes to spread to which lymph nodes?
celiac and gastric nodes
what is gastrochisis
“splitting of the stomach”
abdominal wall is actually split
what is omphalocele? what causes it?
persistent herniation of bowel into umbilical cord. due to failure of herniated intestines to return to body cavity during development
how is gastrochisis different from omphalocele?
in omphalocele the abdominal contents are enclosed in a bubble whereas in gastrochisis the contents are exposed
when does a baby with pyloric stenosis present?
they are born normal and it takes 2 weeks to develop because it is a congenital hypertrophy of the pyloric stomach muscle
is the vomiting in pyloric stenosis billous or non billious?
non billious because the content that is being vomited has yet to reach the intestines
what disease do you feel an “olive like mass” in the abdomen?
what is acute gastritis
burning of the stomach by acid
what are the defenses against acid in the mucosa?
foviolar cells produce mucus
bicarb secreted to neutralize acids
normal blood supply to provide nutrients to protection layer and to “take away” the acid
whats a curling ulcer? what is it a risk factor for
a severe burn on a person–>hypovolemia–>less blood flow to mucosa of GI–>less nutrients and unable to sweep away acids–>acute gastritis
why can NSAIDs lead to acute gastritis
prostaglandins are needed for creating the protective barrier by decreasing acid production, stimulating the ability of cells to produce mucus & bicarb and by increasing blood flor to the mucosal barrier
why is alcohol a risk for acute gastritis
will directly damage the mucosal cells
what is a cushing ulcer? what can it lead to
increased intracranial pressure–>increased vagal stimulation–>increased Ach–>binds parietal cells and increases acid production
what are 3 things that trigger acid secretion from parietal cells?