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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
Q

“rosary bead esophagus”

A

diffuse esophageal spasm

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26
Q

compare sx b/w nutcracker esophagus and diffuse esophageal spasm

A

both have intermittent (NOT progressive) dysphagia to solids and liquids and atypical chest pain

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27
Q

describe dysphagia in GERD

A

intermittent, NOT progressive

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28
Q

alarm features w/ GERD that require further evaluation

A
  1. weight loss
  2. persistent vomiting
  3. constant/severe pain
  4. palpable mass/adenopathy
  5. hematemesis
  6. melena
  7. anemia
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29
Q

hernia as a result of increased abd pressure from obesity, pregnancy, etc

A

sliding hiatal hernia

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30
Q

herniation into mediastinum and includes a visceral structure other than the gastric cardia, most commonly the colon

A

paraesophageal hernia

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31
Q

“upside down stomach”

A

paraesophageal hernia

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32
Q

dx and tx for hiatal hernias

A

barium x-ray

if symptoms –> surgical repair, otherwise nothing

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33
Q

inability to swallow liquids including their own saliva

A

foreign bodies and food impaction

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34
Q

globus pharygneus

A

sensation of lump lodged in throat with swallowing unaffected

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35
Q

describe dysphagia with esophageal webs

A

intermittent nOT progressive

36
Q

where do schatzki rings and esophageal webs occur in the esophagus

A

rings: distal
webs: mid to proximal

37
Q

diagnostic study for esophageal webs

A 
barium swallow (esophagogram)
- EDG can be done but is less sensitive
38
Q

tx esophageal webs

A

dilatation (bougie dilator) or small endoscopic electrosurgical incision
- long term PPI if heartburn or needing repeat dilation

39
Q

sx of plummer vinson syndrome

A
  1. angular chelitis (around mouth)
  2. glossitis
  3. symptomatic esophageal webs
  4. koilonychia (spoon nails)
  5. iron deficiency anemia
40
Q

describe dysphagia in zenker’s diverticulum

A

gradual/insidious onset (years)

41
Q

structural abnormality of zenker’s diverticulum

A
  1. herniation b/w cricopharyngeus m. and inferior pharyngeal constrictor m.
  2. loss of elasticity of UES
42
Q

dx test for zenker’s diverticulum

A

video esophagography or barium swallow

43
Q

tx for zenker’s diverticulum

A

surgery - upper myotomy or surgical diverticulectomy

44
Q

dx test for sjogren’s

A

lip biopsy, serology

45
Q

tx for sjogren’s

A

supportive

46
Q

compare antibodies b/w diffuse scleroderma and limited scleroderma

A

diffuse: topoisomerase I antibodies (scl-70)
limited: anti-centromere antibodies

47
Q

compare regions affected b/w diffuse scleroderma and limited scleroderma

A

diffuse: diffuse involvement including proximal extremities and trunk
limited: fingers, toes, face, distal extremities

48
Q

compare prognoses b/w diffuse scleroderma and limited scleroderma

A

diffuse: worse prognosis than limited

49
Q

CREST syndrome is associated with what scleroderma

A

limited

50
Q

what is CREST syndrome

A 
C: calcinosis cutis
R: raynaud's
E: esophageal dysmotility
S: sclerodactyly
T: telangectasia
51
Q

describe dysphagia in scleroderma pts

A

progressive

52
Q

hallmark of scleroderma

A

atrophy of esophageal smooth muscle

53
Q

dx test for scleroderma

A

serology

54
Q

tx for scleroderma

A

control sx and slow progression to improve quality of life and prolong survival

55
Q

describe dysphagia with esophageal stricture

A

progressive, first with solids then with solids and liquids

56
Q

describe how heartburn changes as esophageal stricture progresses

A

reflux and heartburn lessens/improves because the stricture acts as a barrier to reflux

57
Q

diagnostic test for esophageal stricture

A
  1. barium swallow

2. endoscopy (EGD) w/ biopsy

58
Q

tx for esophageal stricture

A
  1. dilation at the time of endoscopy
  2. long term therapy on PPI
  3. maybe steroids injected into stricture
59
Q

diagnostic test for barretts esophagus

A

screening EGD w/ biopsy (case by case basis, depends on pt)

60
Q

management/suveillance of barretts esophagus

A

surveillance endoscopy every 3-5 years, monitoring for adenocarcinoma

61
Q

recommended tx in barretts esophagus pts w/ high grade dysplasia or intramucosal adenocarcinoma

A

endoscopic ablation

62
Q

diagnostic test for esophageal squamous cell cancer

A

EGD w/ biopsy

63
Q

tx esophageal squamous cell cancer

A

surgery (esophagectomy)

64
Q

diagnostic test for esophageal adenocarcinoma

A

EGD w/ biopsy

65
Q

tx esophageal adenocarcinoma

A

endoscopic therapy (ablation)

66
Q

describe how barretts esophagus becomes adenocarcinoma

A

barrett metaplasia –> dysplasia –> adenocarcinoma

67
Q

describe the dysphagia in esophageal ring

A

intermittent, NOT progressive

68
Q

what esophageal structural dz is associated with hiatal hernia

A

esophageal ring

69
Q

“steakhouse syndrome”

A

a large poorly chewed food bolus getting stuck in esophagus

- associated w/ esophageal rings

70
Q

diagnostic test for esophageal ring

A

barium swallow (esophagogram)

71
Q

tx for esophageal ring

A

dilatation (bougie dilator) or small endoscopic electrosurgical incision
- long term PPI if heartburn or needing repeat dilation

72
Q

describe the dysphagia in achalasia

A

progressive

73
Q

diagnostic test for achalasia

A
  1. barium esophagogram (bird’s beak sign)
  2. EGD
  3. esophageal manometry
  4. CXR
74
Q

what does esophageal manometry show in an achalasia patient

A
  • complete absence of normal peristalsis and incomplete lower esophageal sphincter relaxation w/ swallowing
  • -> confirms diagnosis
75
Q

sx of pill-induced esophagitis

A
  • severe retrosternal CP

- odynophagia and dysphagia

76
Q

diagnostic test for pill-induced esophagitis

A

endoscopy

77
Q

tx for pill-induced esophagitis

A

healing occurs rapidly when offending agent is eliminated

78
Q

preventative measures for pill-induced esophagitis

A

take pills with 4oz water and remain upright for 30 mins after ingestion

79
Q

what history findings are associated w/ eosinophilic esophagitis

A

history of food bolus impaction

80
Q

diagnostic test for eosinophilic esophagitis

A

EGD

81
Q

“feline esophagus”

A

eosinophilic esophagitis

82
Q

compare sx of eosinophilic esophagitis b/w adults and children

A

adults: dysphagia, pyrosis, poor med response, regurgitation
children: vomiting, difficulty feeding, dysphagia, failure to thrive

83
Q

cause of caustic esophageal injury

A

accidental or deliberate ingestion of liquid or crystalline alkali (drain cleaners) or acid

84
Q

sx of caustic esophageal injury

A

severe burning, varying degrees of chest pain, gagging, dysphagia, drooling

85
Q

diagnostic test for caustic esophageal injury

A

laryngoscopy, chest and abd x-rays

86
Q

complications of caustic esophageal injury

A
  1. pneumonitis
  2. perforation
  3. esophageal stricture
  4. increased risk of esophageal squamous carcinoma
87
Q

tx for caustic esophageal injury

A
  1. ICU hospitalization
  2. nasogastric lavage
  3. oral antidotes

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

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