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intro & Esophageal disorders Flashcards

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1
Q

Abd pain is a ____ not a _____

A

symptom, not a Dx

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2
Q

not all abd pain is of ____ origin

A

GI

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3
Q

Abdominal pain, if there area no alarm signs, what can you do?

A

its ok to watch and wait

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4
Q

4 common features in GI disorders

A

dysphagia (difficulty swallowing)
odynophagia (pain with swallowing)
regurgitation
heartburn-pyrosis (reflux)

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5
Q

older pt with new swallowing/heartburn complaint.. think?

A

RED FLAG

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6
Q

what SHOULD be gold standard test for esophageal disorders?

A

EGD (aka upper endoscopy)

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7
Q

who do you refer to for pharynx/swallowing problems?

A

ENT and/or speech pathology

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8
Q

are the sphincters of the esophagus true sphincters?

A

NO

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9
Q

physiological reflux is common, ____ and ____. what is usually the presenting symptom? what does the pathology include?

A

physiological reflux is common, short lived, and asymptomatic.
heartburn is usually the presenting symptoms to pathologic reflux.
-pathology includes symptoms (including nocturnal)

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10
Q

what percent of healthy people experience heartburn at least once a month? what percent develop mucosal damage?

A

44%

50%

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11
Q

GERD red flags/ alarm symptoms (5)

A

anemia, chest pain (not burning) , dysphagia, hematemesis, weight loss
*any chronic symptoms of GERD are bad

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12
Q

how can GERD cause asthma exacerbation?

A

microaspiration

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13
Q

cause of GERD

A

too much acid or poor LES (lower esophageal sphincter) function
-both show the same symptoms

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14
Q

GERD Dx: pursue a Dx eval if…

A

symptoms are chronic, refractory or if there are alarm symptoms

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15
Q

4 types of GERD Dx tests (2 major 2 minor)

A

major: endoscopy and ambulatory pH monitoring
minor: esophageal manometry (LES pressure)
and barium swallow

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16
Q

technical gold standard Dx test for GERD (and what is the one more commonly used?)

A

technically: pH ambulatory monitoring
real: EGD

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17
Q

what is pH ambulatory monitoring and who is it good for?

A

Useful in Pts who have not benefited from a trial of anti-secretory meds or have refractory problems, or has a normal endoscopy and cont’d symptoms.

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18
Q

results from both EGD nor pH monitoring …

A

do NOT correlate well with severity of symptoms

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19
Q

early/mild esophagitis vs erosive/severe

A

early: reddened
severe: has gone into submucosa

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20
Q

Goals for GERD txt

A

prevent reflux, lower acid secretion, prevent complications of esophagitis

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21
Q

txt for GERD

A 
lifestyle modifications (diet, elevate bed with blocks)
neutralize acid with meds (antacid, PPI, H2 blocker)
surgery (fundoplication)
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22
Q

what is a Nissen fundoplication?

A

fold fundus of stomach and wrap around esophagus to prevent reflux (increase pressure)

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23
Q

antacids ____ but do not _____ acids.

A

neutralize but do not suppress

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24
Q

what are the antacids? antacids should be taken when?

A

Mg++, Al++, Ca++ salts

immediately after meals (when you have symptoms)

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25
two drugs to help reflux, second-line to antacids.
H2 blockers | PPI (preferred)
26
what do H2 blockers do for GERD?
block production of acid by gastric parietal cells
27
when are PPIs taken?
before you eat (this is when the enzyme works best)
28
one downside to PPIs?
inc risk for infection cause its taking away the acid that normally neutralizes bacteria that comes with food.
29
___ have good healing action for ulcers (GERD)
PPIs
30
which GERD medication has diagnostic value? how is this applicable?
PPIs take PPI (trial for a month) and symptoms go away... and stay gone w/ discontinuance : mild problem and come back w/ discontinuance : maybe something worse (peptic ulcer disease, stomach cancer, etc)
31
how do you take PPIs? efficacy between PPIs? usual starting dose?
step-up and step-down approach, taken before meals, no difference in efficacy among the PPIs OTC omeprazole 20 mg qd is usual starting dose.
32
for severe disease, give PPIs ...
BID for 2-4 weeks then qd 8-12 weeks most will relapse at discontinuance w/out lifestyle modification
33
GERD complications: 4
esophageal stricture, esophageal ulceration, hemorrhage, barrett esophagus
34
what is barretts esophagus?
longterm acid exposure predisposes for adenocarcinoma - metaplastic columnar epithelial cells replace squamous epithelium - not a Cancer but neoplastic changes that inc. the risk for cancer
35
barretts esophagus presents in __% of people with longterm GERD
10
36
when to use endoscopy for barrett's?
to ID barett: screening after 5 years w/longstanding reflux periodic re-assessment
37
txt for barrett's
resection of that part of the esophagus (b/c does not get better with acid suppression, neoplastic change has already occurred)
38
what is a haital hernia? symptomatic?
protrusion of portion of the stomach through the haitus of the diaphragm into the thoracic cavity - usually asymptomatic
39
if you have ___ and ____, GERD symptoms are usually worse
hiatal hernia and reflux
40
what is achalasia?
esophageal motality disorder, absence of peristalsis in lower 1/2 of esophagus (LES failure) - leads to progressive dysphagia, regurg, spasm - weight loss and halitosis (b/c food gets trapped)
41
best for Dx of achalasia?
barium swallow- dilated tapering to "birds beak" appearance of esophagus
42
txt for achalasia?
balloon dilation of LES Ca++ channel blockers or botox (block hyper-reactive smooth muscle reaction) myotomy (cuts in muscle)
43
smooth muscle spastic disorder: what is it? what does it feel like? symptoms are progressive or intermittent?
diffuse esophageal spasm feels like "non-cardiac chest pain" dysphagia w/ non-coordinated contractions sympt: intermittent
44
txt for smooth muscle spastic disorder
nitroglycerine (same as for angina) | also Ca++ blocker and anti-depressants
45
what is scleroderma?
subQ tissue becomes progressively calcified and stiffened. - peristalsis wave defect - reduced LES pressure
46
what % of patients with scleroderma have GI issues?
90%
47
txt for scleroderma?
depends on symptoms (txt with reflux or motility medications)
48
pill-induced esophagitis: what is it and what pills usually cause it?
caused by delayed transit time in esophagus ASA, NSAIDS, Ferrus Sulfate, Tetracyclines*** (alendronate/fosamax)
49
caustic esophagitis
strong alkali and acids (drano, lye, bleach) * alkali injury generally worse than acid - can lead to death, strictures, etc.
50
txt for caustic esophagitis
IV H2 blockers NG tube (don't try to neutralize, just flush out)
51
eosinophilic esophagitis: what is it and how does it present?
allergy in esophagus | - almost always present with dysphagia/regurg/food impaction with GERD-like complaints
52
who gets eosinophilic esophagitis?
men>women, often presents in children, STRONG FH, with atopy (eczema, asthma, allergies)
53
txt: eosinophilia esoph. on Bx responds to ___ better than _____. But how will we txt?
steroids better than PPIs | but... txt with PPIs then topical ICS if poor response (swallow the spray!)
54
only test of cure for eosinophilia esoph. is what?
re-biopsy, so we often just txt symptoms
55
infectious esophagitis, commonly seen in what people? common pathogens?
immunosuppressed patients | Herpes, Candida, CMV
56
symptoms for infectious esoph.
dysphagia and odynophagia (very painful)
57
txt for infectous esoph.
txt underlying condition, appropriate anti-infectives
58
esophageal rings: what are they? etiology? Sx? Txt?
thin, diaphragm-like membranes - mucosal and (mostly) muscular - etiology: varied (reflux, hernia, etc) - Sx: intermittent dysphagia - txt: dilation and txt underlying cuase
59
esophageal webs are more ___ while rings are more ____
webs: mucosal rings: muscular
60
what is a schatzki ring? what does it cause?
``` mucosal ring oropharyngeal dysphagia (disfunctional swallowing) ```
61
esophageal diverticula (aka ____)
Zenker's : caused by motility d/o of upper esophagus; relaxation/contraction problems, causes high pressures that result in diverticuli (pouches/herniation in muscular wall of pharynx)
62
symptoms of esophageal diverticula? txt?
regurg and really FOUL breath | txt: excision
63
risk factors for esophageal cancer
men, smokers, alcohol.
64
___ year abstinence of smoking and alcohol reduce risk for esophageal cancer by ___ %
10 year | 10 %
65
risk factors for AC esophageal cancer
barretts and GERD | increased BMI
66
esophageal cancer is uncommon but...
lethal!
67
esophageal cancer: presentation & Dx
late with no symptoms of early disease | Dx: endoscopy, CT to evaluate metastasis/nodal involvement, PET scan
68
txt for esophageal cancer
early detection and prevention, major surgery for resection, maybe radiation/chemo, brachytherapy (palliative radiation), stenting for dysphagia
69
esophageal varicies
dilation of esophago-gastric venous plexus (from elevated portal HTN)
70
mallory-weiss syndrome
Mucosal lacerations at the gastro-esophageal junction or gastric cardia Hematemesis associated with persistent retching and vomiting, often following an alcoholic binge Distension of the nondistensible lower esophagus causes tears
71
mallor weiss syndrome: tear: Majority of patients ______ _______ with only minor blood loss, but ~__% may have more serious sequelae Monitor for ...
heal spontaneously | 10%shock, need for transfusion

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