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GI - 2 > Atypical Chest pain and Odynophagia > Flashcards

Atypical Chest pain and Odynophagia Flashcards

1
Q

What are 3 NON-GI life threatening causes of atypical chest pain?

A

MI
PE
Aortic Dissection

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2
Q

What are 3 GI life threatening causes of atypical chest pain?

A

PUD
Iatrogenic Esophageal Perforation
Boerhaave Syndrome

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3
Q

What may cause Iatrogenic Esophageal Perforation?

A

Trauma due to tube placement/endoscopy

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4
Q

What may cause spontaneous Esophageal Perforation?

A

Forceful vomiting, alcohol use

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5
Q

What is Boerhaave’s Syndrome?

A

Transmural rupture at the gastroesophageal junction

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6
Q

Patient signs/symptoms with Iatrogenic Esophageal Perforation

A

Chest pain, dyspnea, patients in distress

  • Subcutaneous emphysema/pneumomediastinum on CXR/Chest CT
  • Hamman’s Sign
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7
Q

What is Hamman’s sign and what is it seen with?

A
  • Seen with Iatrogenic Esophageal Perforation
    = With Auscultation - crunching/rasping sound over the precordium, synchronous with muffled heart sounds during systole
    – patient in left lateral decubitus position
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8
Q

Subcutaneous Emphysema/Pneumomediastinum on CXR/Chest CT with Hamman’s Sign may indicate?

A

Iatrogenic Esophageal Perforation

  • Life threatening
  • Hamman’s sign = With Auscultation - crunching/rasping sound over the precordium, synchronous with muffled heart sounds during systole
    • patient in left lateral decubitus position
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9
Q

What may cause/make worse Peptic Ulcer Disease (PUD)?

A

Defensive factors overwhelmed by gastric acid, pepsin

    • H. Pylori, NSAIDS
    • Made worse by coffee, alcohol and stress
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10
Q

With PUD the ulcers extend through the?

A

Muscularis mucosa

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11
Q

Patient signs/symptoms with PUD?

A

Intervals of gnawing, hunger-like epigastric pain or Atypical chest pain

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12
Q

What test should be ordered with PUD?

A

EGD with biopsy - therapeutic and diagnostic

– X-ray/MRI/CT if suspecting obstruction or perforation

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13
Q

If a nasogastric lavage is (-) for blood, does that exclude an active DU bleed?

A

NO

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14
Q

2 tests to detect H. Pylori and confirm it is eradicated?

A

Fecal Antigen Test

Urea Breath Test

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15
Q

What test for H. Pylori can NOT confirm its eradication due to a (+) result years after infection?

A

IgA antibodies

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16
Q

What is the BEST, yet most invasive test for detecting H. Pylori?

A

EGD with Gastric Biopsy

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17
Q

When detecting H. Pylori, what tests should you do first?

A

NON-invasive first

– Fecal Antigen test, Urea breath test, IgA antibody test

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18
Q

Treatment for PUD?

A

Acid suppression with proton pump (-) and eradicate H. Pylori

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19
Q

What are a few alarming features of GERD?

A

Constant and severe pain

Dysphagia or Odynophagia

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20
Q

With GERD if there are signs of a GI bleed you need?

A

Further evaluation

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21
Q

What is Nutcracker Esophagus?

A

Swallowing contractions are too powerful

= Lower esophageal sphincter has an INCREASED baseline pressure

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22
Q

Swallowing contractions are too powerful, which causes the lower esophageal sphincter to have an increased baseline pressure

A

Nutcracker Esophagus

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23
Q

What are Diffuse Esophageal Spasms?

A

Uncoordinated esophageal contractions - spastic contractions of circular muscle
– imbalance between (+) and (-) post-ganglionic pathways

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24
Q

Uncoordinated esophageal contractions

A

Diffuse Esophageal Spasms

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25
Q

What are the symptoms for BOTH Nutcracker Esophagus and Diffuse Esophageal Spasms?

A

Atypical chest pain
Dysphagia
Intermittent symptoms

26
Q

What are the symptoms for BOTH Nutcracker Esophagus and Diffuse Esophageal Spasms?

A

Atypical chest pain
Dysphagia
Intermittent symptoms

27
Q

Tests and treatment for Nutcracker Esophagus and Diffuse Esophageal Spasms?

A

Tests - Manometry and Barium Swallow X-ray(for DES)

Treatment - Nitrates and calcium antagonists

28
Q

A corkscrew esophagus/rosary bead esophagus on a barium swallow x-ray could indicate?

A

Diffuse Esophageal Spasms

29
Q

Patient symptoms with Eosinophilic Esophagitis?

A

Male > Female

= Vague retrosternal pain, dysphagia and regurgitation of food

30
Q

2 common PMH items with Eosinophilic Esophagitis?

A
  • Allergies or Atopic Conditions –> (+) inflammation

- History of food bolus impaction

31
Q

2 common PMH items with Eosinophilic Esophagitis?

A
  • Allergies or Atopic Conditions –> (+) inflammation

- History of food bolus impaction

32
Q

What will the CBC and EGD show with Eosinophilic Esophagitis?

A

CBC - eosinophilia

EGD - multiple circular rings with corrugated appearance and edema

33
Q

3 treatment options for Eosinophilic Esophagitis?

A
  1. Swallow inhaled (topical) glucocorticoids
  2. Refer to allergist
  3. Esophageal dilation to relieve dysphagia
34
Q

With Eosinophilic Esophagitis, an Esophageal Dilation can be performed to relieve the dysphagia. What does that put the patient at risk for?

A

Esophageal perforation

35
Q

What can cause Esophageal Impaction (food bolus/foreign body)?

A

Eosinophilic esophagitis

36
Q

What are the symptoms of an Esophageal Impaction?

A

Hypersalivation, drooling, frothing and foaming at the mouth, chest pain

37
Q

Symptoms and treatment for an Esophageal Impaction?

A

Hypersalivation, drooling, frothing and foaming at the mouth, chest pain
- Emergent EGD

38
Q

3 types of Esophagitis that can present with Atypical chest pain AND Odynophagia?

A

Pill induced
Infectious
Caustic

39
Q

Odynophagia

A

Painful swallowing

40
Q

What pills may cause Pill-Induced Esophagitis?

A

NSAIDS, Antibiotics
Potassium Chloride
Bisphosphonates for Osteoporosis

41
Q

What will make Pill-Induced Esophagitis more likely?

A

If the pills are swallowed without water or while supine

42
Q

What will make Pill-Induced Esophagitis more likely?

A

If the pills are swallowed without water or while supine

43
Q

Symptoms of Pill-Induced Esophagitis?

A

Retrosternal chest pain, odynophagia, dysphagia

  • Hours after taking pill and may persist for several days
    • Elderly usually have little pain
44
Q

Treatment for Pill-Induced Esophagitis?

A

STOP medication and switch to a different form

= will heal rapidly

45
Q

What are the 4 most common pathogens for Infectious Esophagitis?

A

Candida Albicans
Herpes Simplex
CMV
HIV

46
Q

What are the 4 most common pathogens for Infectious Esophagitis?

A

Candida Albicans
Herpes Simplex
CMV
HIV

47
Q

Risk factors for Infectious Esophagitis?

A

Immunosuppressed, uncontrolled diabetes, corticosteroids, antibiotics, radiation therapy
- normal hosts with Herpes Simplex

48
Q

Symptoms of Infectious Esophagitis?

A

Atypical chest pain, odynophagia, dysphagia

49
Q

What will the EGD show if Candida is causing the infectious esophagitis?

A

Yellow-white plaques adherent to mucosa

50
Q

What will the EGD show if Herpes simplex is causing the infectious esophagitis?

A

Multiple DEEP ulcerations

51
Q

What will the EGD show if CMV is causing the infectious esophagitis?

A

Large, SHALLOW, superficial ulcerations

52
Q

What causes Caustic Esophagitis?

A

Ingestion of liquid/crystalline alkali or acid

53
Q

Ingestion of liquid/crystalline alkali or acid may cause?

A

Caustic Esophagitis

54
Q

Symptoms of Caustic Esophagitis?

A

Odynophagia, chest pain, severe burning with oral burns/lesions

55
Q

What should you do for Caustic Esophagitis?

A

Stabilize the patient

  • Laryngoscopy
  • EGD within 12-24 hours
56
Q

What should you NOT do for Caustic Esophagitis?

A

Nasogastric lavage and oral antidotes

= Risk re-exposure of esophagus to agent and cause more injuries

57
Q

What should you NOT do for Caustic Esophagitis?

A

Nasogastric lavage and oral antidoes

= Risk re-exposure of esophagus to agent and cause more injuries

58
Q

What are possible complications of Caustic Esophagitis?

A

Perforation, fistulas, esophageal strictures

59
Q

What are 3 types of esophagitis that present with atypical chest pain and odynophagia (painful swallowing)?

A

Pill-induced
Infectious
Caustic

60
Q

What are 3 life threatening causes of GI atypical chest pain?

A

PUD
Iatrogenic Esophageal Perforation
Boerhaave Syndrome

GI - 2 (61 decks)

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