Ch. 14 slide 35-66 Flashcards
what is esophagitis? MC cause? % of U.S. adults?
esophageal inflammation; reflux esophagitis (GERD); 25-40% of adults
what is Chemical esophagitis?
acute, self-limited; tobacco, alcohol, pill-induced etc.
what is infectious esophagitis?
MC secondary to Ulcer; HSV, CMV, fungal; severe mucosal necrosis
Mallory-Weiss tear?
MC cause of esophageal laceration; inadequate LES relaxation
Hematemesis occurs in 80% of upper G.I bleeds from a Mallory-Weiss tear
false; 50%
what is a hiatal hernia?
widening of esophageal hiatus
types of hiatal hernia?
Axial (sliding)- bell shaped, MC 95%
Non-axial (rolling)- separate portion of stomach protrudes, prone to strangulation or obstruction
hiatal hernias occur in 90% of all adults and only 20% of those are asymptomatic
false; 20% of all adults get one; 90% are asymptomatic
hiatal hernia symptoms?
esophagitis; possible perforation; MC among non-axial type
DDx: angina pectoris; GERD
what is barrett esophagus?
esophageal metaplasia- stratified squamous and columnar epi with goblet cells; distal esophagus; preneoplastic lesion
who is at risk for Barrett esophagus?
males 4x; Caucasians 30-100x, obese; 40-60 yrs. old; family hx.
complications of Barrett esophagus?
esophageal carcinoma (30-100x); ulcerations, strictures; METAPLASIA- red, velvety mucosa, the bands extend superiorly
types of esophageal tumors
leiomyoma; adenocarcinoma (50% of US esophageal cancer); squamous cell carcinoma (MC worldwide, 90% of esophageal cancer)
Esophageal adenocarcinoma
developed nations; MC in late stages- obstruction, vomiting, cachexia, fatigue
Early invasion of lymphatic’s has POOR prognosis <25%
esophageal adenocarcinoma doesn’t have a diffuse infiltration, its in the upper 1/3 of esophagus, & is not associated with TP53.
false; distal 1/3, Does have diffuse infiltration with flat or raised patches; commonly has TP53 mutation early on.
who is at risk for esophageal squamous cell carcinoma
> 45 male (4x), Af. Am. (6x), alcohol, tobacco, HPV (3x); rural, underdeveloped, poverty
esoph. squam. cell carc. has a poor prognosis if mets to lymphatics
true; <10% 5 year survival
features of esoph. squam. cell carc.
may cause strictures/rigidity, hemorrhage, or fistula; dysphagia, odynophagia, cahexia
where does esoph. sqam. cell carc. occur?
middle 1/3 of esophagus
what is gastritis? risks? types?
inflammation of gastric mucosa;
risks: alcohol, nsaid’s, age, chemo; commonly asymptomatic
types: acute & chronic
acute gastritis
acute inset: transient inflam. neutrophils
-acute erosive hemorrhagic gastritis is possible
acute peptic ulceration
severe stress; NSAID’s; coffee ground hematemesis; heal within days/weeks
chronic gastritis
less severe, more prolonged; assoc. with peptic ulcers
complications of chronic gastritis
peptic ulcer disease gastric adenocarcinoma (5x)
10-20% of chronic gastritis have h. pylori infxn.
false; 70-90%
effects of chronic gastritis
inc. acid prod.; epi metaplasia
MC ~60 yrs. old
pernicious anemia- Ab’s to parietal cells
Peptic ulcer disease (PUD)
develops in highly acidic areas: Prox. duodenum (4x); gastric antrum
Has solitary “punched out “ lesion
PUD causes
NSAID; heli. pylori; older age, alcohol, smoking, corticosteroids
Does PUD have epigastric pain?
yes; MC at night 1-3 hours after eating, relieved by alkaline substances
treat PUD?
antibiotics, PPI’s, H2 receptor antagonist
if perforation/hemorrhage= medical emergency
duodenal PUD
relieved by food; pain returns 1-3 hours after eating
gastric PUD
less predictable- empty stomach or after eating
shared charac. of duodenal & gastric PUD
relieved by alkaline; worse at night; inconsistent pain patterns
what are gastric polyps? MC type?
mass projecting from mucosa; inflammatory & hyperplastic polyp MC (75%)
what makes up more than 90% of gastric cancers?
gastric adenocarcinomas
where is gastric adenocarc. MC? risks?
japan (20x); h. pylori, EBC
symptoms of gastric adenocarc.
MC develop late; gastritis, nausea, anorexia, weight loss, altered bowels, anemia, hemorrhage
