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Gastroenterology > Midterm > Flashcards

Midterm Flashcards

(51 cards)

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1
Q

parotid glands

A
  • serous cells

- hypotonic aqueous fluid with electrolytes and enzymes to start digestion

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2
Q

submandibular and sublingual glands

A
  • serous and mucus cells

- produce aqueous fluid and mucus

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3
Q

stages of swallowing

A
  1. voluntary
  2. pharyngeal
  3. esophageal
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4
Q

voluntary stage

A

food is squeezed posteriorly into pharynx by tongue

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5
Q

pharyngeal phase

A

as food enters pharynx it stimulates swallowing receptor areas to initiate contractions

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6
Q

esophageal phase

A

moves food from pharynx to stomach

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7
Q

esophageal primary peristalsis

A

continuation of the peristaltic wave that begins in the pharynx and continues to the stomach

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8
Q

esophageal secondary peristalsis

A

results from distention of the esophagus

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9
Q

barium esophagography

A
  • detect esophageal narrowing
  • evaluate esophageal motility disorders
  • does not require sedation
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10
Q

EGD

A
  • evaluate persistent heartburn, odynophagia, and structural abnormalities
  • direct visualization, biopsy, dilation
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11
Q

conditions that skip barium swallow for EGD

A
  • don’t respond to 4-8 week PPI trial
  • alarm symptoms
  • structural abnormalities
  • > 50 with Barrett’s or esophageal adenocarcinoma
  • severe erosive esophagitis on previous EGD
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12
Q

esophageal manometry

A
  • measures intraesophageal pressure

- establish dysphagia etiology without mechanical obstruction

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13
Q

esophageal pH impedance testing

A
  • measures acidity of reflux and electrical conduction of peristalsis
  • useful for atypical reflux and persistent symptoms
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14
Q

dysphagia

A

difficulty swallowing

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15
Q

oropharyngeal dysphagia

A
  • difficulty initiating swallowing
  • drooling, can’t chew, cough during meals, sense of food catching in neck
  • neurological disorder
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16
Q

esophageal dysphagia

A
  • difficulty with solid foods that predictable
  • can point to where food gets stuck
  • mechanical lesions
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17
Q

odynophagia

A
  • pain with swallowing
  • limits oral intake
  • severe erosive disease
  • immunocompromised patients
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18
Q

GERD contributing factors

A
  • transient relaxation of lower esophageal sphincter

- hypotensive lower esophageal sphincter

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19
Q

hiatal hernia

A
  • asymptomatic
  • higher amounts of acid reflux and delayed clearance leads to severe esophagitis
  • found in over 90% patient with Barrett’s esophagus
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20
Q

GERD alarm signs

A
  • dysphagia
  • odynophagia
  • weight loss
  • GI bleeding
  • anemia
  • family history
  • advanced age
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21
Q

GERD atypical symptoms

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A
  • new onset asthma
  • cough
  • laryngitis
  • sore throat
  • noncardiac chest pain
22
Q

erosive esophagitis

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A

endoscopically visible breaks in the distal esophageal mucosa with or without GERD symptoms

23
Q

nonerosive reflux disease

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A

-presence of troublesome symptoms of GERD without visible esophageal mucosal injury

24
Q

Mild intermittent symptom GERD treatment

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A
  • 1 to 2 times per week
  • life style modifications
  • H2 receptor antagonists (-tidine)
25
severe symptom GERD treatment
- more than 2 times per week or erosive | - PPI first line (-prazole)
26
PPI therapy
- step up or step down therapy - take 30 minutes before eating with a week or longer before benefit - those who fail high dose H2RA therapy - discontinued after symptoms relief for 8 weeks with taper
27
PPI ADE
- infection (C. diff) - malabsorption - osteoporosis - plavix interaction due to shared hepatic pathway
28
GERD surgical treatment
- fundoplication - patients with extraesophageal manifestations - unwilling to take lifelong medical therapy - large hiatal hernia - refractory symptoms on high dose PPI
29
barrett's esophagus
- metaplastic columnar epithelium - asymptomatic - PPI reduce risk of cancer (esophageal adenocarcinoma)
30
peptic stricture
- decreased reflux due to acting as a barrier - most at gastroesophageal junction - treat with dilation and PPI to reduce recurrence
31
infective esophagitis
- common in immunocompromised patients | - candida, CMV, herpes simplex
32
infective esophagitis presentation
- odynophagia - dysphagia - chest pain (less common)
33
infectious esophagitis
- presumptive based on symptoms of immunocompromised patient | - confirm by EGD
34
infectious esophagitis treatment
- empiric if candida suspected | - otherwise at specific pathogen
35
candida esophagitis
- linear yellow white plaques - uncontrolled DM - glucocorticoid therapy - antibiotic use - radiation therapy
36
CMV esophagitis
- linear ulcers - fever - odynophagia
37
herpetic esophagitis
- well circumscribed circular ulcers | - with or without fever
38
candida infectious esophagitis treatment
- oropharyngeal: nystatin | - esophageal: fluconazole
39
CMV infectious esophageal treatment
- gancyclovir IV | - then switch to valganciclovir PO
40
herpetic infectious esophagitis treatment
- acyclovir | - course depends on immune system status
41
eosinophilic esophagitis
- inflammatory response to food or environment antigens - vague symptoms of dysphagia, food impaction, heartburn - majority have allergy history - multiple concentric rings on EGD (feline esophagus)
42
eosinophilic esophagitis treatment
- food elimination - topical corticosteroids - esophageal dilation - PPI
43
induced esophagitis
- esophageal injury from pills with prolonged mucosal contact - chest pain, odynophagia, dysphagia - ulcers on EGD - discontinue offending medication
44
barrett esophagus risk factors
- 50 or older - male - white - chronic GERD - hiatal hernia - elevated BMI or intra abdominal body fat - diet low in fruit/vegetable
45
achalasia
- idiopathic motility disorder with loss of peristalsis of distal end - barium swallow "birds beak" - treat with dilation
46
esophageal adenocarcinoma
- more common in whites - complication of barretts - associated with obesity
47
esophageal squamous cell carcinoma
- blacks, asians | - smoking and alcohol use
48
caustic esophageal injury
- ingestion of alkali or acidic substance - mild injury: NG feedings 24-48 hrs - severe injury: may require esophagectomy - increased risk of developing cancer - EGD surveillance 15-20 years
49
mallory-weiss syndrome
- esophageal tears associated with frequent vomiting - alcoholism - treat with blood transfusions
50
esophageal webs/rings
- webs: thin membranes of squamous mucosa in mid or upper esophagus - rings: circumferential mucosal stricture - combo of hiatal hernia and GERD - dysphagia and food impaction - barium swallow - dilation and PPI
51
zenker diverticulum
-at pharyngoesophageal junction

Gastroenterology (1 decks)

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