GIT Flashcards
a. Gastric contents (acid) refluxes up into esophagus/mouth
b. Comp: Esophagitis, Esophageal stricture, Barrett’s esophagu
GERD
c. Hx: Heartburn, acid regurgitation, belching, excessive salivation (water brash), odynophagia (late in GERD)
i. DH: calcium channel blockers
ii. SH: smoking, alcohol
GERD
d. PE: Obese, pregnant, tender epigastrium
e. Red flags: >40 years old, dys/odynophagia, bleeding, weight loss
i. No symptom improvement with simple treatment (PPIs)
GERD
Endoscopy
i. Longitudinal mucosal breaks in severe esophagitis
ii. Usually distal 8-10 cm of esophagus
GERD
a. Complication caused by GERD
b. Boundary between columnar gastric epithelium extends proximally
i. Replacing normal esophageal squamous epithelium; metaplasia
c. 40x increased risk of esophageal cancer – adenocarcinoma
Barrett’s esophagus
a. Causes: GERD, drugs, infection
b. Drugs: pill induced – prolonged mucosal contact leads to inflammation NSAIDS, vitamin C, bisphosphonates
esophagitis
a. Spasm of esophageal muscles
diffuse esophageal spasm
c. Sudden onset of pain, thinks they have MI
d. Corkscrew appearance on barium swallow
diffuse esophageal spasm
Hx:
i. Intermittent dysphagia, solids and liquids (from the start)
ii. chest pain – especially after hot/cold/fizzy drinks
iii. Can be severe and sound like acute coronary syndrome
diffuse esophageal spasm
a. Failure of lower esophageal sphincter (LES) to relax to allow bolus to pass into stomach
i. Secondary to degeneration of nerves in myenteric plexus
b. Hx: dysphagia, regurgitation, weight loss
c. Bird beak appearance
achalasia
CREST syndrome
i. Calcinosis, Raynaud’s, esophageal dysmotility, sclerodactyly, telangiectasia
ii. Vascular injury causes stricture formation
a. CREST syndrome
b. Hx: reflux, dysphagia – food getting stuck (stricture), other crest symptoms
c. Investigations = anticentromere antibodies
systemic sclerosis
a. Pharyngeal outpouching – chronic impaired relaxation of cricopharyngeal muscle; increased pressure while swallowing
b. Hx: dysphagia, regurgitation, gurgling with liquids, halitosis, couch
zenkers
a. Thin extension of normal esophageal mucosa and submucosa – very thin narrowing
b. Hx: dysphagia with solids, symptomatic anemia
Esophageal web
a. Circumferential narrowing in lower esophagus
i. Normal mucosa, submucosa, +/- muscle layer
b. Hx: dysphagia with solids
Esophageal ring
a. Over 50
b. SCCA or adenocarcinoma
d. Apple core on barium
Esophageal cancer
c. Hx: age, dysphagia, weight loss, retrosternal chest pain, melaena
i. Barrett’s esophagus, GERD, achalasia, obesity = adenocarcinoma
ii. Smoking and alcohol = SCCA
Esophageal cancer
a. Esophageal tear at gastro esophageal junction – resulting from excessive vomiting
b. Leads to hematemesis/ melaena
c. Hx: red blood in vomit, exceeded by excessive vomiting
Malory weiss
a. Esophageal rupture secondary to vomiting
i. Transmural perforation
ii. Usually left posterolateral wall, lower 1/3
iii. Air and esophageal contents in chest
boerhaave syndrome
b. Hx: Sudden onset severe pain – upper abdo/lower chest, excessive vomiting (often alcohol related), pain increased with swallowing, pleuritic chest pain
boerhaave syndrome
Investigations
i. CXR: pleural effusion, pneumothorax, pneumomediastinum
ii. Barium swallow
boerhaave syndrome
a. Engorged esophageal veins
i. Secondary to cirrhosis and portal HTN
b. Hx: acute massive hemorrhage – hematemesis
c. Exam: unstable, shocked, massive upper GI bleeding
esophageal varices
a. Duodenal x4 MC than gastric
b. Defect in mucosa extending through musclaris
c. Causes: H pylori 90% - duodenal; NSAIDS 35% - gastric
peptic ulcer
Hx:
i. Dyspepsia, epigastric pain (relieved by drinking milk), worse at night, weight loss
ii. DH: NSAIDs
iii. SH: smoking
peptic ulcer
