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PATH 3 > Lecture 9 - Pathologies of Digestive System: Esophageal Diseases > Flashcards

Lecture 9 - Pathologies of Digestive System: Esophageal Diseases Flashcards

1
Q

what 4 structures does the upper GI tract include?

A

mouth
esophagus
stomach/gaster
duodenum

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2
Q

what are 4 functions of upper GI tract?

A

mastication
deglutition
ingestion
digestion

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3
Q

what 2 structures does the lower GI tract include?

A

small and larger intestine

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4
Q

what does the small intestine do?

A

digestion and absorption of nutritients

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5
Q

what does the large intestine do?

A

absorb water and electrolytes
produce vitamins
store waste products of digestion until elimination

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6
Q

what are the 6 accessory structures of the GI tract?

A 
teeth
tongue
salivary glands
liver
gall bladder
pancreas
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7
Q

what are the 6 basic processes involved in digestion?

A 
ingestion
secretion
mix/propulsion
digestion
absorption
defecation
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8
Q

what system is called the “second brain”?

A

enteric NS

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9
Q

what are the two plexus of the enteric NS?

A

submucosal plexus

myenteric plexus

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10
Q

what systems provide neural innervation to the GI tract?

A

enteric and autonomic NS

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11
Q

what % of immune cells of the body are in the gut?

A

70-80%

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12
Q

what part of the brain possess the reflex area of vomiting?

A

medulla oblongata

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13
Q

what are 4 drugs that may cause nausea?

A

morphine
codeine
anesthetics
chemo drugs

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14
Q

what are 3 overarching SSx of GI disease?

A

nausea/vomiting
diarrhea
constipation

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15
Q

the hypothalamus relates so what sign of diarrhea?

A

fever (due to dehydration=higher blood temp)

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16
Q

how does diarrhea result in acidosis?

A

depletion of bicarbonate

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17
Q

what demographic is constipation more prevalent in?

A

women and 65+

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18
Q

what are two functional causes of chronic constipation?

A

psychogenic and neurogenic disorders

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19
Q

what are hemorrhoids?

A

varicose veins of anus and rectum

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20
Q

what are anal fissures?

A

cracks in the skin around the anus

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21
Q

what is ileus?

A

painful obstruction of ileum or other part of intestines

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22
Q

what does the relaxation of upper esophageal sphincter result in?

A

permits entry of bolus from laryngopharynx into esophagus

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23
Q

esophageal peristalsis results in?

A

bolus pushed down into stomach

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24
Q

relaxation of lower esophageal sphincter results in?

A

bolus enters stomach

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25
Q

secretion of mucus into esophagus results in?

A

lubricates esophagus for smooth passage of bolus

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26
Q

what are the 5 most important disease of the esophagus?

A

hiatal (diaphragmatic) hernia
GERD (esophagitis)
neoplasms
esophageal varices (circulatory disturbances)
congenital conditions (tracheoesophageal fistula)

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27
Q

what are 3 typical symptoms of esophageal disease?

A 
dysphagia (difficulty swallowing)
esophageal pain (substernal/retrosternal burning -heart burn)
aspiration/regurgitation of food (re-entry to oral cavity)
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28
Q

what is a hiatal (diaphragmatic) hernia?

A

when the enlarges lower esophageal sphincter allows the stomach to pass through the diaphragm into thoracic cavity.

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29
Q

what results in a congenital hiatal hernia?

A

failed full development of diaphragm

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30
Q

what are 4 causes of an acquired hiatal hernia?

A

penetrating wound
blunt trauma from MVA
surgical trauma
sub phrenic abscess

31
Q

what is the difference between sliding hiatal and rolling (para-esophageal) hernia?

A

sliding are affected by swallowing - with each swallow the stomach is pulled up and at the end it drops back into abdomen; rolling hernias remain in chest at all times and are not affected by swallowing

32
Q

what is more common between sliding hiatal and rolling (para-esophageal) hernia?

A

sliding (90%)

33
Q

what are two conditions that may aggravate reflux esophagitis?

A

tight clothing

laying down flat

34
Q

what are 3 main symptoms of reflux esophagitis?

A

heart burn 30-60 min after meal
substernal pain (especially if large hernia)
dysphagia

35
Q

what 2 external contributions may weaken the lower esophageal sphincter?

A

smoking and caffeine (pregnancy reduces tone of LES)

36
Q

what is the most common cause of reflux esophagitis?

A

hiatal hernia

37
Q

what is the opposite of a hiatal hernia?

A

achalasia (spasm/ increased tone of LES)

38
Q

T or F: achalasia is an idiopathic condition?

A

True

39
Q

What are 3 characteristics of achalasia?

A

spasm of LES
dilation of esophagus prox to spasm
dysphagia
(anxiety/emotional tension aggravates attacks)

40
Q

what are 4 most common causes of GERD, leading to esophagitis?

A

gastric juice reflux (peptic esophagitis)
infections in immuno-suppressed or debilitated person (herpes, cytomegalovirus, systemic candida albicans)
chemical agents
physical trauma (radiation/intubation)

41
Q

what other condition is GERD often associated with?

A

sliding hiatal hernia

42
Q

what is the incidence of GERD?

A

15% of population have daily symptoms

43
Q

what are 5 primary symptoms of GERD in young adults?

A 
heart burn (30-60 min after meal)
reflux
belching
dysphagia/ painful swallowing
burning pain moving up and down
44
Q

what are 5 of the atypical symptoms of GERD seen in older adults (70+)

A 
dysphagia
vomiting
respiratory difficulties
weight loss/anorexia
anemia
45
Q

what are 2 types of neoplams affecting the esophagus?

A
  1. squamous cell carcinoma (90%)

2. adenocarcinoma (sign. rise in the West)

46
Q

what is a precursor of adenocarcinoma?

A

barrett’s esophagus

47
Q

what happens to the cells of the lower esophagus with Barrett esophagus?

A

metaplasia- normal epithelial cells of the lower esophagus are replaced with columnar cells (typically seen in intestine)

48
Q

T or F: esophageal cancers are common?

A

false

49
Q

how does H.pylori eradication in GERD relate to esophageal adenocarcinoma?

A

may play a role in increasing incidence of this cancer (h.pylori has a protective effect against esophageal cancer)

50
Q

what does h.pylori predispose someone to?

A

peptic ulcers as gastric neoplasms

51
Q

what 6 esophageal/related disease increases the risk of esophageal cancer?

A 
hiatal hernia
GERD (adenocarcinoma)
Barrett's esophagus
diverticula 
scarring strictures
head and neck cancers
52
Q

what racial group is more affected by carcinoma of the esophagus?

A

black 3x’s

53
Q

what is the ratio of male to females affected by carcinomas of the esophagus?

A

4: 1 - states
1: 1 - china and south africa

54
Q

T or F: esophageal carcinoma’s are locally invasive?

A

true - most have already spread by time of diagnosis

55
Q

what are 5 contributing factors to the etiology of esophageal cancers?

A 
chronic inadequate nutrition 
obesity (adenocarcinoma)
changes allowing for food or fluid in the esophagus for a long time (metaplasia and ulcerations)
alcohol and tobacco irritation 
nitrosamines (carcinogenic)
56
Q

what are nitrosamines?

A

chemical compounds used in the manufacturing of cosmetics, pesticides, tobacco products and most rubber products

57
Q

what are common clinical manifestations of esophageal cancers?

A 
dysphagia with out without pain - predominant symptoms
pressure pain between scapula
heart burn  after laying down
anorexia/weight loss
hoarseness
58
Q

what is the prognosis of esophageal cancers?

A

~ 95% of patients die within 2 years of the diagnosis (rapid metastases = lowest cure possibility)

59
Q

what are esophageal varices?

A

dilated veins in the lower third of the esophagus beneath the mucosa

60
Q

what causes esophageal varices?

A

portal vein HTN secondary to liver cirrhosis

61
Q

what size of dilation to the veins can lead to rupture and bleeding?

A

greater than 5 mm in diameter

62
Q

in relation to esophageal varices, how does varicose vein bleeding present?

A

painless but massive hematemesis with OR without melena (hypovolemia = shock)

63
Q

define ‘ melena’

A

dark, sticky stool with digested blood

64
Q

the clinical picture of esophageal varices is consistent with what disease?

A

chronic liver disease

65
Q

what % of bleeding episodes due to esophageal varices cease without intervention?

A

50% (others may need endoscopic interventions)

66
Q

define ‘sclerotherapy’

A

injecting solution directly into vein to cause vein to scar and collapse forcing blood to reroute to healthier veins

67
Q

what is Mallory-Weiss syndrome?

A

bleeding due to the laceration of the mucosa of the lower end of the esophagus (and junction of stomach)

68
Q

what is the most common cause of Mallory-Weiss syndrome?

A

severe anti-peristalsis and vomiting from alcohol-abuse, bulimia or viral syndrome

69
Q

what is the treatment method for Mallory- Weiss syndrome?

A

endoscopic ligation (closing off a blood vessel)

70
Q

what are 5 conditions related to Mallory-Weiss syndrome outside of the primary cause?

A 
pregnancy
migraine
hiatal hernia
gastric ulcer
sudden raise in trans abdominal pressure
71
Q

what is tracheoesophageal fistula?

A

occurs when the esophagus fails to develop as a continuous passage and makes an abnormal communication with the trachea - congenital or acquired

72
Q

what is one of the most common esophageal anomalies and congenital defects?

A

TEF (tracheoesophageal fistula) (1/4000 live births with equal gender distribution)

73
Q

define ‘fistula’

A

an abnormal connection between 2 body parts

74
Q

what are 3 clinical signs of congenital TEF following feeding?

A

coughing
choking
cyanosis
(newborn can have excessive drooling from oral secretions and occasionally aspiration)

PATH 3 (12 decks)

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