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Maddy - GI II Exam I - some pharm > Clin - Dysphagia, Odynophagia, Atypical CP > Flashcards

Clin - Dysphagia, Odynophagia, Atypical CP Flashcards

1
Q

panacinar emphysema is associated with

A

alpha 1 antitrypsin deficiency

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2
Q

positive anti-Scl-70

A

diffuse scleroderma

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3
Q

corrugated ringed appearance of esophagus on EGD

A

eosinophilic esophagitis

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4
Q

risk of developing B cell non-Hodkin lymphoma

A

sjogren’s

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5
Q

what imaging is used to diagnose zenker diverticulum

A

barium esophagography

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6
Q

what imaging is used to diagnose achalasia

A

esophageal monometry

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7
Q

when to use esophageal pH monitoring

A

GERD patients with atypical sx

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8
Q

immune related bowel dz with ASCA antibodies

A

Crohn’s

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9
Q

herniation of mucosa in killian’s triangle

A

zenker’s diverticulum

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10
Q

uncoordinated esophageal contractions

A

diffuse esophageal spasm

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11
Q

rheumatologic dz with topoisomerase I antibodies

A

diffuse scleroderma

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12
Q

widened mediastinum on plain x-ray

A

aortic dissection

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13
Q

corkscrew appearance of esophagus on x-ray

A

diffuse esophageal spasm

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14
Q

iron deficiency anemia

A

plummer vinson syndrome

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15
Q

fecal occult blood test would be useful in looking for

A

colon cancer

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16
Q

iatrogenic causes of esophageal perforation

A
  • nasogastric tube placement

- endoscopy

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17
Q

CXR with air in mediastinum and/or subcutaneous emphysema indicates what

A

esophageal perforation

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18
Q

tx for esophageal perforation

A
  • NPO (nothing by mouth)
  • parenteral antibiotics
  • surgery
  • endoscopic stenting
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19
Q

“gnawing, dull, aching, hunger-like” epigastric pain

A

PUD

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20
Q

diagnostic tests for PUD

A
  1. EGD w/ biopsy
  2. x-ray, CT, MRI
  3. CBC (anemia)
  4. Fecal and breath tests for H. pylori
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21
Q

purpose of EGD w/ biopsy in testing for PUD

A

excludes malignancy and can be used as treatment intervention of active bleeding

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22
Q

complications of ulcer located on posterior wall of duodenum or stomach

A

it may perforate into contiguous structures such as pancreas, liver, or biliary tree
- can cause pancreatitis

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23
Q

compare lower esophageal sphincter b/w nutcracker esophagus and diffuse esophageal spasm

A

nutcracker: relaxes normally, but has elevated pressure at baseline

DES: normal

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24
Q

compare diagnosis/tx b/w nutcracker esophagus and diffuse esophageal spasm

A

nutcracker: manometry, video fluoroscopy

DES: manometry, EDG, barium swallow

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25
"rosary bead esophagus"
diffuse esophageal spasm
26
compare sx b/w nutcracker esophagus and diffuse esophageal spasm
both have intermittent (NOT progressive) dysphagia to solids and liquids and atypical chest pain
27
describe dysphagia in GERD
intermittent, NOT progressive
28
alarm features w/ GERD that require further evaluation
1. weight loss 2. persistent vomiting 3. constant/severe pain 4. palpable mass/adenopathy 5. hematemesis 6. melena 7. anemia
29
hernia as a result of increased abd pressure from obesity, pregnancy, etc
sliding hiatal hernia
30
herniation into mediastinum and includes a visceral structure other than the gastric cardia, most commonly the colon
paraesophageal hernia
31
"upside down stomach"
paraesophageal hernia
32
dx and tx for hiatal hernias
barium x-ray if symptoms --> surgical repair, otherwise nothing
33
inability to swallow liquids including their own saliva
foreign bodies and food impaction
34
globus pharygneus
sensation of lump lodged in throat with swallowing unaffected
35
describe dysphagia with esophageal webs
intermittent nOT progressive
36
where do schatzki rings and esophageal webs occur in the esophagus
rings: distal webs: mid to proximal
37
diagnostic study for esophageal webs
``` barium swallow (esophagogram) - EDG can be done but is less sensitive ```
38
tx esophageal webs
dilatation (bougie dilator) or small endoscopic electrosurgical incision - long term PPI if heartburn or needing repeat dilation
39
sx of plummer vinson syndrome
1. angular chelitis (around mouth) 2. glossitis 3. symptomatic esophageal webs 4. koilonychia (spoon nails) 5. iron deficiency anemia
40
describe dysphagia in zenker's diverticulum
gradual/insidious onset (years)
41
structural abnormality of zenker's diverticulum
1. herniation b/w cricopharyngeus m. and inferior pharyngeal constrictor m. 2. loss of elasticity of UES
42
dx test for zenker's diverticulum
video esophagography or barium swallow
43
tx for zenker's diverticulum
surgery - upper myotomy or surgical diverticulectomy
44
dx test for sjogren's
lip biopsy, serology
45
tx for sjogren's
supportive
46
compare antibodies b/w diffuse scleroderma and limited scleroderma
diffuse: topoisomerase I antibodies (scl-70) limited: anti-centromere antibodies
47
compare regions affected b/w diffuse scleroderma and limited scleroderma
diffuse: diffuse involvement including proximal extremities and trunk limited: fingers, toes, face, distal extremities
48
compare prognoses b/w diffuse scleroderma and limited scleroderma
diffuse: worse prognosis than limited
49
CREST syndrome is associated with what scleroderma
limited
50
what is CREST syndrome
``` C: calcinosis cutis R: raynaud's E: esophageal dysmotility S: sclerodactyly T: telangectasia ```
51
describe dysphagia in scleroderma pts
progressive
52
hallmark of scleroderma
atrophy of esophageal smooth muscle
53
dx test for scleroderma
serology
54
tx for scleroderma
control sx and slow progression to improve quality of life and prolong survival
55
describe dysphagia with esophageal stricture
progressive, first with solids then with solids and liquids
56
describe how heartburn changes as esophageal stricture progresses
reflux and heartburn lessens/improves because the stricture acts as a barrier to reflux
57
diagnostic test for esophageal stricture
1. barium swallow | 2. endoscopy (EGD) w/ biopsy
58
tx for esophageal stricture
1. dilation at the time of endoscopy 2. long term therapy on PPI 3. maybe steroids injected into stricture
59
diagnostic test for barretts esophagus
screening EGD w/ biopsy (case by case basis, depends on pt)
60
management/suveillance of barretts esophagus
surveillance endoscopy every 3-5 years, monitoring for adenocarcinoma
61
recommended tx in barretts esophagus pts w/ high grade dysplasia or intramucosal adenocarcinoma
endoscopic ablation
62
diagnostic test for esophageal squamous cell cancer
EGD w/ biopsy
63
tx esophageal squamous cell cancer
surgery (esophagectomy)
64
diagnostic test for esophageal adenocarcinoma
EGD w/ biopsy
65
tx esophageal adenocarcinoma
endoscopic therapy (ablation)
66
describe how barretts esophagus becomes adenocarcinoma
barrett metaplasia --> dysplasia --> adenocarcinoma
67
describe the dysphagia in esophageal ring
intermittent, NOT progressive
68
what esophageal structural dz is associated with hiatal hernia
esophageal ring
69
"steakhouse syndrome"
a large poorly chewed food bolus getting stuck in esophagus | - associated w/ esophageal rings
70
diagnostic test for esophageal ring
barium swallow (esophagogram)
71
tx for esophageal ring
dilatation (bougie dilator) or small endoscopic electrosurgical incision - long term PPI if heartburn or needing repeat dilation
72
describe the dysphagia in achalasia
progressive
73
diagnostic test for achalasia
1. barium esophagogram (bird's beak sign) 2. EGD 3. esophageal manometry 4. CXR
74
what does esophageal manometry show in an achalasia patient
- complete absence of normal peristalsis and incomplete lower esophageal sphincter relaxation w/ swallowing - -> confirms diagnosis
75
sx of pill-induced esophagitis
- severe retrosternal CP | - odynophagia and dysphagia
76
diagnostic test for pill-induced esophagitis
endoscopy
77
tx for pill-induced esophagitis
healing occurs rapidly when offending agent is eliminated
78
preventative measures for pill-induced esophagitis
take pills with 4oz water and remain upright for 30 mins after ingestion
79
what history findings are associated w/ eosinophilic esophagitis
history of food bolus impaction
80
diagnostic test for eosinophilic esophagitis
EGD
81
"feline esophagus"
eosinophilic esophagitis
82
compare sx of eosinophilic esophagitis b/w adults and children
adults: dysphagia, pyrosis, poor med response, regurgitation children: vomiting, difficulty feeding, dysphagia, failure to thrive
83
cause of caustic esophageal injury
accidental or deliberate ingestion of liquid or crystalline alkali (drain cleaners) or acid
84
sx of caustic esophageal injury
severe burning, varying degrees of chest pain, gagging, dysphagia, drooling
85
diagnostic test for caustic esophageal injury
laryngoscopy, chest and abd x-rays
86
complications of caustic esophageal injury
1. pneumonitis 2. perforation 3. esophageal stricture 4. increased risk of esophageal squamous carcinoma
87
tx for caustic esophageal injury
1. ICU hospitalization 2. nasogastric lavage 3. oral antidotes

Maddy - GI II Exam I - some pharm (23 decks)

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