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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
What are the symptoms for BOTH Nutcracker Esophagus and Diffuse Esophageal Spasms?
Atypical chest pain Dysphagia Intermittent symptoms
26
What are the symptoms for BOTH Nutcracker Esophagus and Diffuse Esophageal Spasms?
Atypical chest pain Dysphagia Intermittent symptoms
27
Tests and treatment for Nutcracker Esophagus and Diffuse Esophageal Spasms?
Tests - Manometry and Barium Swallow X-ray(for DES) | Treatment - Nitrates and calcium antagonists
28
A corkscrew esophagus/rosary bead esophagus on a barium swallow x-ray could indicate?
Diffuse Esophageal Spasms
29
Patient symptoms with Eosinophilic Esophagitis?
Male > Female | = Vague retrosternal pain, dysphagia and regurgitation of food
30
2 common PMH items with Eosinophilic Esophagitis?
- Allergies or Atopic Conditions --> (+) inflammation | - History of food bolus impaction
31
2 common PMH items with Eosinophilic Esophagitis?
- Allergies or Atopic Conditions --> (+) inflammation | - History of food bolus impaction
32
What will the CBC and EGD show with Eosinophilic Esophagitis?
CBC - eosinophilia | EGD - multiple circular rings with corrugated appearance and edema
33
3 treatment options for Eosinophilic Esophagitis?
1. Swallow inhaled (topical) glucocorticoids 2. Refer to allergist 3. Esophageal dilation to relieve dysphagia
34
With Eosinophilic Esophagitis, an Esophageal Dilation can be performed to relieve the dysphagia. What does that put the patient at risk for?
Esophageal perforation
35
What can cause Esophageal Impaction (food bolus/foreign body)?
Eosinophilic esophagitis
36
What are the symptoms of an Esophageal Impaction?
Hypersalivation, drooling, frothing and foaming at the mouth, chest pain
37
Symptoms and treatment for an Esophageal Impaction?
Hypersalivation, drooling, frothing and foaming at the mouth, chest pain - Emergent EGD
38
3 types of Esophagitis that can present with Atypical chest pain AND Odynophagia?
Pill induced Infectious Caustic
39
Odynophagia
Painful swallowing
40
What pills may cause Pill-Induced Esophagitis?
NSAIDS, Antibiotics Potassium Chloride Bisphosphonates for Osteoporosis
41
What will make Pill-Induced Esophagitis more likely?
If the pills are swallowed without water or while supine
42
What will make Pill-Induced Esophagitis more likely?
If the pills are swallowed without water or while supine
43
Symptoms of Pill-Induced Esophagitis?
Retrosternal chest pain, odynophagia, dysphagia - Hours after taking pill and may persist for several days - - Elderly usually have little pain
44
Treatment for Pill-Induced Esophagitis?
STOP medication and switch to a different form | = will heal rapidly
45
What are the 4 most common pathogens for Infectious Esophagitis?
Candida Albicans Herpes Simplex CMV HIV
46
What are the 4 most common pathogens for Infectious Esophagitis?
Candida Albicans Herpes Simplex CMV HIV
47
Risk factors for Infectious Esophagitis?
Immunosuppressed, uncontrolled diabetes, corticosteroids, antibiotics, radiation therapy - normal hosts with Herpes Simplex
48
Symptoms of Infectious Esophagitis?
Atypical chest pain, odynophagia, dysphagia
49
What will the EGD show if Candida is causing the infectious esophagitis?
Yellow-white plaques adherent to mucosa
50
What will the EGD show if Herpes simplex is causing the infectious esophagitis?
Multiple DEEP ulcerations
51
What will the EGD show if CMV is causing the infectious esophagitis?
Large, SHALLOW, superficial ulcerations
52
What causes Caustic Esophagitis?
Ingestion of liquid/crystalline alkali or acid
53
Ingestion of liquid/crystalline alkali or acid may cause?
Caustic Esophagitis
54
Symptoms of Caustic Esophagitis?
Odynophagia, chest pain, severe burning with oral burns/lesions
55
What should you do for Caustic Esophagitis?
Stabilize the patient - Laryngoscopy - EGD within 12-24 hours
56
What should you NOT do for Caustic Esophagitis?
Nasogastric lavage and oral antidotes | = Risk re-exposure of esophagus to agent and cause more injuries
57
What should you NOT do for Caustic Esophagitis?
Nasogastric lavage and oral antidoes | = Risk re-exposure of esophagus to agent and cause more injuries
58
What are possible complications of Caustic Esophagitis?
Perforation, fistulas, esophageal strictures
59
What are 3 types of esophagitis that present with atypical chest pain and odynophagia (painful swallowing)?
Pill-induced Infectious Caustic
60
What are 3 life threatening causes of GI atypical chest pain?
PUD Iatrogenic Esophageal Perforation Boerhaave Syndrome

GI - 2 (61 decks)

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