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Gastroenterology > Midterm > Flashcards

Midterm Flashcards

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

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

erosive esophagitis

A

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

23
Q

nonerosive reflux disease

A

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

24
Q

Mild intermittent symptom GERD treatment

A
  • 1 to 2 times per week
  • life style modifications
  • H2 receptor antagonists (-tidine)
25
Q

severe symptom GERD treatment

A
  • more than 2 times per week or erosive

- PPI first line (-prazole)

26
Q

PPI therapy

A
  • 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
Q

PPI ADE

A
  • infection (C. diff)
  • malabsorption
  • osteoporosis
  • plavix interaction due to shared hepatic pathway
28
Q

GERD surgical treatment

A
  • fundoplication
  • patients with extraesophageal manifestations
  • unwilling to take lifelong medical therapy
  • large hiatal hernia
  • refractory symptoms on high dose PPI
29
Q

barrett’s esophagus

A
  • metaplastic columnar epithelium
  • asymptomatic
  • PPI reduce risk of cancer (esophageal adenocarcinoma)
30
Q

peptic stricture

A
  • decreased reflux due to acting as a barrier
  • most at gastroesophageal junction
  • treat with dilation and PPI to reduce recurrence
31
Q

infective esophagitis

A
  • common in immunocompromised patients

- candida, CMV, herpes simplex

32
Q

infective esophagitis presentation

A
  • odynophagia
  • dysphagia
  • chest pain (less common)
33
Q

infectious esophagitis

A
  • presumptive based on symptoms of immunocompromised patient

- confirm by EGD

34
Q

infectious esophagitis treatment

A
  • empiric if candida suspected

- otherwise at specific pathogen

35
Q

candida esophagitis

A
  • linear yellow white plaques
  • uncontrolled DM
  • glucocorticoid therapy
  • antibiotic use
  • radiation therapy
36
Q

CMV esophagitis

A
  • linear ulcers
  • fever
  • odynophagia
37
Q

herpetic esophagitis

A
  • well circumscribed circular ulcers

- with or without fever

38
Q

candida infectious esophagitis treatment

A
  • oropharyngeal: nystatin

- esophageal: fluconazole

39
Q

CMV infectious esophageal treatment

A
  • gancyclovir IV

- then switch to valganciclovir PO

40
Q

herpetic infectious esophagitis treatment

A
  • acyclovir

- course depends on immune system status

41
Q

eosinophilic esophagitis

A
  • 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
Q

eosinophilic esophagitis treatment

A
  • food elimination
  • topical corticosteroids
  • esophageal dilation
  • PPI
43
Q

induced esophagitis

A
  • esophageal injury from pills with prolonged mucosal contact
  • chest pain, odynophagia, dysphagia
  • ulcers on EGD
  • discontinue offending medication
44
Q

barrett esophagus risk factors

A
  • 50 or older
  • male
  • white
  • chronic GERD
  • hiatal hernia
  • elevated BMI or intra abdominal body fat
  • diet low in fruit/vegetable
45
Q

achalasia

A
  • idiopathic motility disorder with loss of peristalsis of distal end
  • barium swallow “birds beak”
  • treat with dilation
46
Q

esophageal adenocarcinoma

A
  • more common in whites
  • complication of barretts
  • associated with obesity
47
Q

esophageal squamous cell carcinoma

A
  • blacks, asians

- smoking and alcohol use

48
Q

caustic esophageal injury

A
  • 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
Q

mallory-weiss syndrome

A
  • esophageal tears associated with frequent vomiting
  • alcoholism
  • treat with blood transfusions
50
Q

esophageal webs/rings

A
  • 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
Q

zenker diverticulum

A

-at pharyngoesophageal junction

Gastroenterology (1 decks)

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